Q: Hi, I have low back pain. My back hurts to even move or stretch. I can’t even get up. I can only stay still in one position and move my arms. I can’t move my legs or it tugs on my back muscles. It’s been sore for 3 days. I had to do a lot of lifting so I had to bend down and get up repeatedly. This happened before now but went away slowly after I slept. The pain is sharp pain in my lower back left side. When it started to feel sore, I couldn’t bend too much forward or back. I get back pain a lot so it could also be my posture too. It feels like a muscle cramp in my lower back. What do you think I have?
What do you have?
Firstly, thank you for your question. Did you know that in Canada, 4 out of 5 adults will experience at least one episode of back pain at some time in their lives, and the incidence is highest between the ages of 30-50 years old? So, you’re definitely not alone. To answer your question though, we need to take a closer look at the different parts of the low back that can generate pain and like a detective through the process of elimination see what is the most likely cause. Of course without doing a proper history and physical examination we can only base our diagnosis on the little bit of information you’ve given us. With those limitations in mind, let’s look at some relevant anatomy.
Muscle: The low back muscles (lumbar paraspinals) are generally, with some exceptions, regarded as extensor muscles. They are called that because their main action is to bring the body (extend) into an upright position against gravity. Acute muscle strain injuries can occur with heavy lifting particularly when you lift abruptly and use momentum to lift something far too heavy for you to begin with. A strain or tear can occur in this instance and typically is felt immediately with the pain intensity worsening over the next few days. When asked how it happened patients usually know the exact moment the injury occurred. The nature of the pain is more of a tight and pulling sensation.
If this is you, it is likely that both flexion and extension of the spine will hurt as the former lowers your body against gravity and the latter raises your body against gravity. In other words, those low back muscles contract and work with almost every movement we make and when strained or torn can reproduce pain. On the other hand, if you use your arms to help you stand this should be much less painful and performing a sit up should produce little to no pain at all.
The good news is that muscle strain injuries respond quickly and favourably to therapeutic exercise. This is because of the ample blood flow that is in muscle tissue. It is important to start the process of exercise early to allow the muscle fibres to heal in proper alignment. You would start with low load high repetitions and progress with more exercises as the healing progresses from inflammatory to sub-acute stages of healing.
Impinged Nerve: In this illustration we have a visual of the nerves in the low back exiting as yellow strands through an opening called the neural foramen (literally translated as “nerve opening”). When a nerve root in the low back is abruptly compressed this will commonly cause shooting pain down the buttock and into one or rare occasions both legs. Some other common symptoms are numbness and tingling in the leg and when severely compressed you will experience weakness. Typically backward bending will reproduce your shooting pain where as forward bending will relieve it. In fact, when this occurs in the older person it’s usually due to a condition called spinal stenosis and bending forward when standing and walking is the only way to be upright pain free. There are some notable exceptions to this, however, which brings me to the next possibility to explain the pain – a disc injury.
Disc: The discs in the low back are pictured here as white flat pieces sandwiched like the whites of an oreo cookie between the vertebral bodies. Disc injuries can happen at any age but have the highest probability of occurrence between the ages of 30 to 50. Possible mechanisms for a disc injury are repetitive heavy lifting, prolonged sitting, and although not a mechanism, poor posture can lead to a weakened disc and make it more vulnerable to being sprained to the extent that even a innocent bending over to pick up something from the floor can be the proverbial straw that breaks the camel’s back spraining the disc. Disc sprains are typically felt the next morning and not right away. The pain is made worse with lifting, coughing, and prolonged standing. Gentle walking and laying down with your legs elevated usually feels best. The pain can be quite intense and is more of an ache than a sharp jab, generally spread across an area, and poorly localized.
Facet Joints: The bony joints in the low back are also known as facet joints. Facet joints are situated in the posterior 1/3 of the vertebrae and serve to guide motion in the lumbar spine as well as support the back when standing upright against gravity. Like most other joints, the facet joints are lined with cartilage which start out as smooth, glisteny, slick surfaces in youth and through the process of wear and tear become roughened and riveted when we are elderly. This degenerative process is natural and is what we commonly refer to as osteorarthritis. Facet joints can be injured or sprained then you hyperextend your low back or twist very forcibly. If you take your elbow, for example, and hyperextend it you will feel that the elbow stops firmly at end range. This is because the two unyielding bones are coming together and pressing on each other and notice that this isn’t the most comfortable feeling. You can imagine that if you force it to go much further beyond this point you can cause some damage. This is no different in the spine. Undue forces on facet joints can lead to sprain injury and intense pain. Unlike a muscle strain injury, you may or may not feel like you’ve done something right away. The pain from a facet sprain injury is typically felt the next day. The pain is typically very localized to one area, usually one side more than the other, and is sharp with hyperextension of the spine. Unlike a disc injury, walking isn’t very comfortable while sitting slumped is. Laying down on your back with legs elevated is typically the most comfortable while laying on your tummy reproduces the pain. Turning in bed can be quite an ordeal as muscle spasm can accompany this type of injury even though the lumbar extensors are not necessarily injured. This spasm is due to a combination of involuntary reaction from the sharpness of the pain and an effect of splinting to prevent movement (bracing).
From the information that you’ve given us in your question and with the assumption that you do not have radiating or shooting pain in your leg(s) the most likely cause of your pain is some type of facet joint sprain in the lower back causing muscle spasm. While this in no way replaces a thorough examination, I hope this sheds some light to what could possibly be causing your pain.
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