COMMON SPORTS MEDICINE CONDITIONS

Low Back Pain (LBP)

Location

Patients may experience a sudden, sharp, persistent, or dull pain felt below the waist usually as a result of strain of the muscles that attach to, and surround, the bones of the spine (vertebrae) and the 'discs' between each bone. As this spinal cord protects the nerves that come from the brain, damage and pain in the lower back may mean nerves arising from the spinal cord are being compressed. Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting less than 3 months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain.

Symptoms

Although the pain may be immediately obvious both as to cause and effect, other symptoms can include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s). Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or muscle weakness in a leg or foot. However, long term pain in the lower back can also indicate spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumours (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).

Diagnosis

Details of your age and general health, any recent history of trauma or injury, your training regime or indications of other symptoms will guide diagnosis and treatment. Physical examination and blood tests may lead to imaging with MRI or CT scan of the suspected seat of the pain. Problems with your bladder or bowels or weight loss and feeling generally unwell may also indicate further diagnostic testing.

Treatment

For simple back pain, rest and medication with painkillers and muscle relaxants may resolve the problem. If pain persists for some weeks, physiotherapy or other physical treatment could follow, taking account of your training regime to make sure this is not aggravating the pain. Osteopathy and chiropractic treatments to manipulate the spine may provide short term pain relief and some find acupuncture helps. If tests indicate longer term causes of the pain, such as spinal stenosis, you may need to consider surgery.

Examination may show that the lower back pain is arising from the facet joints which link and stabilise the vertebrae, allowing the spine to bend and twist. To determine whether there is wear or damage to the facet joints, an anaesthetic injection may be used to diagnose the source of pain and, with a higher dose, to treat the pain to allow exercise therapy to strengthen the back muscles.

Further help:

Anatomy of the spine
www.thewellingtonspinalunit.com

Pain management
www.thewellingtonpainunit.com/treatments.asp

Rehabilitation for lower back pain
www.sportsmedicineuk.co.uk/lower_back.html