Low back pain is an extremely common symptom in the general population. It is said that up to 70% of the population will suffer from low back pain at some time in their lives. It is also common among athletes.
Clinical perspective
As with neck pain, it is often not possible to make a precise anatomical and pathological diagnosis. However, this does not prevent management and treatment. In the majority of cases of low back pain, the principles of management depend on careful assessment to detect any abnormality and then appropriate treatment to correct that abnormality. The anatomy of the low back is shown in Figure 18.1.
T h e re are a small number of conditions causing low back pain in which a definitive diag-nosis can be made. Fractures related to direct trauma, such as transverse process fracture or compression fracture of the vertebra, occur infrequently in the lumbar spine. Significant soft tissue injury is usually associated with these fractures. It is usually also possible to make a definitive diagnosis in those patients presenting with nerve root compression who have typical lancinating pain radiating to the leg in a narrow band, with or without accompanying back pain. Sensory symptoms or muscle weakness (or both) are also present. Reflexes are often abnormal. Nerve root compression in the athlete is usually due to herniation of disk material from the nucleus pulposus of the intervertebral disk. |
Fig 18.1. Anatomy of the low back
(a) Surface anatomy
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(b) Muscles of the lower back from behind (ADAPTED FROM THE CIBA COLLECTION OF MEDICAL ILLUSTRATIONS, REPRODUCED BY COURTESY OF CIBA-GEIGY LIMITED, BASEL, SWITZERLAND. ALL RIGHTS RESERVED.)
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Spondylolysis or stress fracture of the parsinterarticularis is seen in sports involving repeated hyperextension plus or minus rotation, such as gymnastics, fast bowling (cricket), throwing sports and tennis. A spondylolisthesis or slip-ping of one vertebra on another may occur in athletes with bilateral pars defects. Spinal canal stenosis is rare in young and middle-aged athletes but may occasionally be seen in older athletes. It is characterized by pain aggravated by walking and relieved by rest.
The above conditions constitute considerably less than 10% of patients presenting with low back pain. The rest of the patients presenting with low back pain may be grouped together as having ‘non-osseous causes of low back pain' or ‘somatic' low back pain.
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