Pain originating from the lower back may spread to other adjacent areas. The pain may spread up the back, or more commonly down to the buttocks, to the sacrum and coccyx area, and also down into the legs. Pain spreading into the legs may not necessarily be due to pinching or irritation of nerves, but may come from deeper structures in the back that tend to produce a deep dull aching type of pain spreading elsewhere. The pain may spread down as far as the feet. It often may be difficult to determine where the pain is coming from, but sometimes the pain may be reproduced by pressing on various tender spots in the lower back and pelvis area. Thus there are two types of referred pains; radicular (nerve irritation) and somatic.
- Nerve Root Pain (Radicular Pain)
Typical nerve pain is a shooting, electric shock like pain that runs down to the lower leg or foot. It is often associated with pins and needles (paraesthesiae), numbness and weakness in the lower leg. The pain comes from a chemical inflammation of the nerve and does not cause local back pain. Usually the leg pain is much more severe than the local back or buttock pain. Squashing or compressing a nerve initially is not painful at all, until inflammation sets in. The lower lumbar nerves are associated with pain around the ankles and foot. Upper lumbar nerve irritation may cause shooting pain into the groin or thigh.
- Somatic Referred Pain
This is the most common form of pain derived from spinal structures. Somatic referred pain is characteristically a deep, vague, diffuse pain, usually felt in the buttocks or hip area but may be felt further down the leg. The pain is usually worse in the back, closer to the origin of pain, and less severe in the thigh or leg. The pain may be brought on by local pressure over the painful structure in the back, but sometimes it is only brought on by prolonged sitting or standing.
This type of pain can arise from any structure that contains a nerve supply. It can come from inside the disc, the facet joint or the muscles. It does not come from pressure or pinching of spinal nerves. Thus referred pain is often difficult to localize as it comes from deep in the back. Sometimes the only way to be sure where it comes from is to perform local injections to block the pain.
Acute low back pain often derives from the soft tissues such as ligaments, muscles, tendons and nerves which don’t show on X-rays. X-rays can only show up bones or the narrowing of spaces between vertebrae. X-rays can’t show pain. Thus, in diagnosing acute low back pain, X-rays can be a waste of time and money. X-Rays are usually not needed initially, unless you have suffered an impact injury, causing a fracture of the bones. X-rays and CT scans involve radiation which can be harmful, especially to the sex organs.
Management of back pain initially involves taking an active approach. No more than 2 days bed rest is advisable as staying in bed too long results in muscles wasting and becoming weak and the spine becoming stiff and uncomfortable. Manual therapy can provide good short term relief to help you get moving and advice about the right sort of exercise can help you back on your feet. Core strengthening including Pilates can help prevent recurrences of back pain and lessen the severity of acute attacks. For persisting pain specialist advice and a multimodal approach is recommended.