Pain in the Lumbar Spine
Pain in the lower back or lumbar spine is by far the most common form of back pain. Although the vertebral bodies in the lumbar spine are smaller than those in the other two segments of the spine, they are required to carry the most weight on account of their position at the bottom of the trunk. The facet joints of the lumbar spine are also exposed to considerable stress when we move about in an upright position. The intervertebral discs that provide a cushioning effect between the vertebral bodies gradually lose fluid and shrink in the course of the day. While this fluid is replenished at night while we lie in bed, the degree to which it is replenished declines as we grow older and the intervertebral discs begin to shrink permanently and lose their cushioning function.
This shrinkage leads to diminished muscle tension around the spine, allowing the inward curvature of the lumbar spine to become more pronounced and effectively reducing its load-bearing capacity. Taken together or separately, these changes can lead to pain in the lower back that may radiate outward around the waist.
The lumbar spine also shares the same general area as muscles that control movements involving the lower trunk and the legs, muscles such as the hip flexors and the adductors. This is why it is often necessary to also examine the hips and legs when attempting to diagnose lower back pain.
Common Causes of Chronic Low Back Pain
After having lost fluid and elasticity, the intervertebral discs in the lumbar spine may sustain various forms of damage in the course of time, including disc herniation. When herniated, a portion of a disc may press out against one of the large nerve strands in the spine. This can cause pain at the site of the herniation and referred pain in the legs.
The term discogenic pain refers to a cause of pain that was only recently detected. Discogenic pain arises when vessels and pain fibers grow into the intervertebral disc tissue, particularly into the fiber ring of an intervertebral disc. The result is pressure-related back pain. If left untreated, this condition can lead to osteochondritis, which is a term used to describe intervertebral disc wear that elicits an inflammatory reaction in the adjacent vertebral bodies.
Osteochondritis is associated with a loss spinal stability and pain that arises in connection with movement. The spine may react by initiating the growth of bone spurs, which can then lead to increasing pain in the legs as the spurs narrow the spinal canal and crowd nerve structures. This condition, which is referred to as spinal stenosis, often represents the final stage in a long history of lower back pain.
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