It is estimated that up to 84% of adults will have low back pain at some point in their lives. 1,2 The vast majority of patients seen in primary care offices (~85 percent) will have mechanical low back pain.
Mechanical low back pain is most commonly caused by muscle spasms, spinal joint dysfunction, ligament sprains and tendon strains. The majority of acute low back pain will resolve with conservative treatment which can include manual therapy, over the counter pain medications, topical creams and prescribed oral medications. In some cases imaging is needed to evaluate for more complicated causes of low back pain.
Symptoms to watch out for are changes in bowel and bladder habits, abnormal sensations in the groin, weakness in the legs, numbness or tingling in the legs and feet, fevers, chills, sweats, malaise, headaches, unintended weight loss and more. If you have any of these symptoms you need to see a licensed physician immediately.
Dr. Kevin Mangum is a Utah sports medicine physician that specializes in non operative orthopedic conditions including low back pain. He can order blood work and appropriate medical imaging to figure out the cause of your back pain. He will discuss with you the many treatment options for your back pain and how to quickly recover.
Sciatica is a nonspecific term used to describe a variety of leg or back pain symptoms. Usually, sciatica refers to a sharp or burning pain radiating down from the buttock along the course of the sciatic nerve. Most sciatica is attributable to radiculopathy at the L5 or S1 level from a disc condition. However, referred pain is a common source of leg pain originating from the back and buttock area.3
Radiculopathy refers to symptoms or impairments related to a spinal nerve root. Some people refer to it as a pinched nerve in the back. Damage or compression to a spinal nerve root as it exits the spine may result from degenerative changes in the vertebrae, disc problems, and other causes. Over 90% of radiculopathies are caused by L5 and S1 nerve roots. Patients present with pain, sensory loss, weakness, and/or reflex changes consistent with the nerve root involved. Many patients with symptoms of acute lumbosacral radiculopathy improve gradually with supportive care and therapy. Some patients need imaging to help plan interventional procedures including epidural steroid injections and surgery.4 Dr. Kevin Mangum does fluoroscopy guided epidural pain injections for certain lumbar radiculopathies.
Spinal cord compression or cauda equina syndrome is a condition where your spinal cord is getting compressed. This is a neurological emergency and needs to be address immediately by a physician. There are many causes of cauda equina syndrome, the most common being intervertebral disc herniation. Pain is usually the first symptom of cord compression, but motor (usually weakness) and sensory findings are present in the majority of patients at diagnosis. Bowel and/or bladder dysfunction are generally late findings.5
Vertebral compression fracture is usually caused by a fall or trauma where the weight of the upper body crunches a vertebra in the back. This can also be caused by sneezing or coughing in people that have weak spinal bones. Approximately 4 percent of patients presenting in the primary care setting with low back pain will have a vertebral compression fracture.6 While some produce no symptoms, other patients present with acute onset of localized back pain which may be incapacitating. Risk factors for osteoporotic fracture include advanced age and chronic glucocorticoid use for some medical conditions. A history of an osteoporotic or traumatic fracture is a risk factor for subsequent fractures7, which can be mitigated by prescribed medications.
Lumbar spinal stenosis is most often caused by multiple conditions. Spondylosis (degenerative arthritis affecting the spine), spondylolistheses (slipping of the vertebra), and thickening of the ligamentum flavum are the most common causes, typically affecting patients older than 60. Pain when walking that is localized to the calf and leg that resolves or improves with sitting or leaning forward (“pseudoclaudication” or “neurogenic claudication”) is a common sign of lumbar spinal stenosis. Other symptoms of lumbar spinal stenosis can include back pain and sensory loss and weakness in the legs. Patients often have symptoms only when they’re active. Treatment can range from conservative options to surgery.8,9
Piriformis syndrome is a condition in which the piriformis muscle, a narrow muscle located in the buttocks, compresses or irritates the sciatic nerve causing localized pain and leg pain.10,11,12
Sacroiliac (SI) joint dysfunction and pain syndrome is a condition that describes pain in the region of the sacroiliac joint. Wear and tear arthritis, specific medical conditions, and injury to the SI joints can cause SI joint pain. Sacroiliac joint may be a referred site of pain, including from a degenerative disc at L5-S1, spinal stenosis, or osteoarthritis of the hip. Dr. Kevin Mangum does ultrasound guided SI joint injections to help diagnosis and treat SI joint pain.
Bertolotti’s syndrome is back pain that is caused by a transitional vertebra. A transitional vertebra is a common finding on radiologic studies. It is a congenital anomaly with a naturally occurring articulation or bony fusion between the transverse processes of L5 and the sacrum, and estimates of the prevalence of transitional vertebra range from 4 to 36 percent. It remains unclear whether these individuals have a higher risk of back pain than those without such an anomaly. Generally, patients with Bertolotti’s syndrome should initially be treated similarly as patients with nonspecific back pain.13
- Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976) 1987; 12:264.
- Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1860.
- Jensen, Rikke K., et al. “Diagnosis and treatment of sciatica.” bmj 367 (2019).
- Kreiner, D. Scott, et al. “An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.” The Spine Journal 14.1 (2014): 180-191.
- Todd, Nicholas V. “Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage.” British Journal of Neurosurgery 31.3 (2017): 336-339.
- Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002; 137:586.
- Crandall CJ, Larson JC, LaCroix AZ, et al. Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures. JAMA Intern Med 2021; 181:1055.
- Lurie, Jon, and Christy Tomkins-Lane. “Management of lumbar spinal stenosis.” Bmj 352 (2016).
- Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med 2015; 162:465.
- Ropper AH, Zafonte RD. Sciatica. N Engl J Med 2015; 372:1240.
- Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am 2004; 35:65.
- Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 2010; 19:2095.
- Jancuska JM, Spivak JM, Bendo JA. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti’s Syndrome. Int J Spine Surg 2015; 9:42.