Our body is our first home, how we take care of our body now, we will enjoy more in our old age. And of course, reduce the risk of low back pain in older adults. Because caring about the body very late is much better than never start. Let say how much you are able to manage giving time to your body, cooking food is just to feed the body with energy, exercises are to boost your body stamina, and sleeping to relax your body.
So we are all pretty much to take care of our first home but need to be more precise in case of requiring the healthy one. Bones and disks issue in the spines can degenerate with time and create stiffness and perhaps soreness. But the low back pain is not compulsory to happen as a result of age-related if only we take care of our lifestyle.
Types of Lower Back Pain
There are many ways to categorize low back pain – two common types include:
By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.
There are many additional sources of pain, including claudication pain (from stenosis) myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates from another part of the body and presents in the lower back (such as kidney stones, or ulcerative colitis).
It is also possible for low back pain to develop with no definitive cause. When this happens, the primary focus is on treating the symptoms (rather than the cause of the symptoms) and the patient’s overall health.
For subacute and chronic lower back pain causes, a thorough diagnosis is important to lay the foundation for appropriate treatment and rehabilitation. Lower back pain treatment reduces the likelihood of recurrent back pain flare-ups and helps prevent the development of chronic lower back pain.
Symptoms of The Low Back Pain In Older Adults
We all might experience back pain at some point in our lives but there are due to the wrong lifestyle we followed such as Smoking, being overweight, and poor eating habits, or due to some health conditions like cancer or spinal diseases. But the main cause for low back pain is nothing but AGING.
Usually, the pain takes its time during morning and evening when a person feels the highest stiffness. Disturbs sleep due to the pain. Feel more of a pain when the injured area in the spine is pressed. Along with the feeling of aching and periodic pain while a person increases the body activity. Feeling the loss of flexibility and stiffness in the back.
Low back pain can happen for every age group but while a person across the age of 60 they are more prone to it which is due to the degeneration of the joints in the lumbar spine. Older adults are usually suffering low back pain because of Osteoarthritis and Spinal Stenosis.
While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine.
Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis. Symptoms of lower back pain and stiffness that is the most pronounced in the morning and in the evening Includes any combination of the below symptoms:
- Pain that interrupts sleep
- Pain that is most pronounced first thing in the morning and again toward the end of the day
- Localized tenderness when the affected area of the spine is pressed
- Aching, steady, or intermittent pain in the lower back that is aggravated by extended activity
- Stiffness or loss of flexibility in the back such as, unable to bend comfortably at the waist
Symptoms of sudden onset of lower back pain, limited flexibility, height loss
Includes any of the following:
- Sudden onset of back pain
- Standing or walking will usually make the pain worse
- Lying on one’s back makes the pain less intense
- Height loss
- Limited spinal flexibility
- Deformity and disability
Possible cause of Spinal compression fracture: As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.
The Common Reason For Facet Joint Osteoarthritis
The spine contains individual bones which are called vertebrae and they are settled one on the top of the other. Between each of the vertebra, small joints are there which helps your spine to move, along with disks with jelly-like centers that work as shock absorbers and don’t let your bones rubbing against each other.
While the process of aging, the discs between the vertebrae get rubbed and shrink and makes pain with stiffness while the bones start to rub against each other. As a result, the space between the spinal cord gets narrows by time. That is known as spinal stenosis. In this situation pressure comes on the cord and spinal nerves, creating pain.
Reduced bone mass, or osteoporosis, can even cause the vertebrae to weak to fractures. Also, The facet joints where each vertebra meets those vertebrae above and below start to degenerate, and create the other issue which is spinal arthritis.
Facet joint osteoarthritis, also known as degenerative arthritis or osteoarthritis of the spine, is a condition of degenerative that gradually increases over time. The injury happens because of the breakdown of the cartilage in the facet joints of the spine. Initially, the symptom can be intermittent, but later increase into more constant pain in the lower back, and ultimately causes sciatica as well to low back pain.
Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first, the symptoms may only be intermittent.
But can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain. Osteoarthritis (degenerative arthritis) can cause the breakdown of cartilage between the facet joints. When the joints move, the lack of cartilage causes pain as well as the loss of motion and stiffness.
The facet joints are located in the back portion (posterior) of the spine. The joints combine with the disc space to create a three-joint complex at each vertebral level. The facet joint consists of two opposing bony surfaces with cartilage between them and a capsule around it that produces fluid.
The combination of the cartilage and the fluid allows the joint to move with little friction. However, facet joint arthritis causes the cartilage to breakdown and the joint movement is associated with more friction. The patient loses motion and as they get stiffer they have more back pain.
Low Back Pain from Osteoarthritis: Typically, the low back pain is most pronounced first thing in the morning. Throughout the day, normal movement causes fluid to build up in the joint and it becomes better lubricated, which decreases the pain. Later in the day the pain typically becomes worse again as more stress is applied across the joint.
Conservative Treatments for Osteoarthritis: Conservative (nonsurgical) treatments that concentrate on maintaining motion in the back are most effective for relieving the pain. Stretching exercises for the hamstring muscles, hip joints, and the back can usually serve to prevent the pain from getting worse. For more severe pain, chiropractic manipulations can help relieve pain.
Water therapy can also be helpful since the joints are unweighted in the water and do not generate as much pain when being moved.
Acetaminophen is an effective and relatively safe non-prescription medication to help alleviate the pain, and some patients find NSAIDs that including COX-2 inhibitors to be helpful.
Surgery for Osteoarthritis: The only effective surgical treatment option for osteoarthritis is a fusion to stop the motion at the painful joint, but this surgery is generally not recommended since multiple vertebral levels tend to be affected by osteoarthritis and multilevel fusions are generally not advisable.
Facet Joint Anatomy in the Lower Back
All along the back of the spine, at each level, a pair of small facet joints connect the vertebrae the bony building blocks of the spine, holding the spine together, and providing support. These joints, otherwise known as the zygapophyseal joints, are synovial, which means they allow the spine to bend and twist in different directions.
Formation of the joint. A facet joint is formed by the articulation between paired bony projections called articular processes. These processes are located at the back of each vertebra and connect adjacent vertebrae. For each disc space, there are two facet joints and a disc, which together form a tripod that creates the motion segment. The spinal nerves exit just above the upper facet at each level.
Movement within the joint. The joint surfaces of the articular processes are coated with cartilage and encapsulated by a thin, fluid-filled synovial membrane to facilitate smooth movements and prevent friction. A protective covering of the joint. The joint is surrounded by an outer capsule, which is tough, resilient, and slightly flexible, and holds about 2 ml of joint fluid for lubrication. A small amount of fat enters and leaves the capsule during spinal movements for additional lubrication.
Pain can originate from the joint surfaces of a facet or the outer capsule surrounding the facet joint.
Common Reason and Symptoms of Lumbar Spinal Stenosis
Leg pain that occurs primarily when walking and standing upright, it
includes any combination of the following:
- Unable to walk far without developing leg pain
- Lower back pain relief is achieved quickly after sitting down
- Symptoms fluctuate between severe and mild/none
- Symptoms develop gradually over time
- Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs known as sciatica
Likely causes of lower back pain are lumbar spinal stenosis or degenerative spondylolisthesis. Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.
The term stenosis is derived from Greek and refers to the process of narrowing that constricts or chokes the spinal nerves. The cause of spinal stenosis in the lumbar spine such as the lower back is commonly associated with degenerative changes, also known as spondylosis, that occur as a result of aging.
Most commonly, lumbar spinal stenosis occurs when spondylosis causes one or more of the following changes in the spine. Alterations within the facet joints, the small, stabilizing joints located between and behind vertebrae, which tend to get larger as they degenerate, compressing nearby spinal nerve roots. Dehydration of the spinal discs, resulting in the collapse of the inner soft, jelly-like material, decreasing the space available for the spinal nerves.
Thickening of the spinal ligaments inside the vertebral canal, leading to compressive forces on the spinal cord and spinal nerves. Stenosis in the lumbar spine may be diagnosed if degenerative changes have narrowed the bony openings of the spine and affected the nervous tissues, such as the spinal nerves, spinal cord, and/or the cauda equina.
Spinal stenosis in the lower back is more common in individuals over 60 years of age and typically affects the lower part of the lumbar spine—the L3 to L5 spinal levels,2 which causes symptoms to radiate into the leg. In the initial stages, these changes often produce symptoms of pain and/or cramping in the legs, especially with activity.
Over time, the pain may become more constant or severe. Additional symptoms, such as numbness and weakness may also occur. This article provides a comprehensive explanation of lumbar spinal stenosis, including the range of symptoms, causes, and nonsurgical and surgical treatment options.
Types of Lumbar Spinal Stenosis: When spinal stenosis affects the spinal nerves as they run through the foramina (bony opening on each side of the lower spine), the condition is referred to as foraminal stenosis. Narrowing of the spine that encroaches on the spinal canal is also possible and is called central canal stenosis.
Foraminal and central canal stenosis can occur at the same time, causing overlapping symptoms. When lumbar spinal stenosis occurs in conjunction with stenosis at a different level, such as in the cervical spine (neck) or thoracic spine (middle back), it is called tandem stenosis.
Depending on the location of the stenosis, various neural elements, such as the spinal nerve roots, spinal cord, and/or the cauda equina (nerves that descend from the spinal cord), may get compressed, leading to a combination of symptoms. These symptoms typically include (but are not limited to) pain, tingling, numbness, and/or weakness in the lower body, which presents as difficulty in walking.
Sciatica or lumbar radiculopathy is the sciatic nerve problem caused by compression of the nerve with numbness, tingling, weakness, or pain anywhere along the sciatic nerve.
The sciatic nerve is running from the lower back over the hips and buttocks and all the way down to the backs of the legs and feet. Which is the longest and widest nerve of the body? Usually, it is affecting one part of the body and can be severe pain or mild pain.
Sciatica is a term used to describe nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the leg.
Symptoms of Sciatica
What Does Sciatica Feel Like? The symptoms of sciatica are commonly felt along the path of the large sciatic nerve. Sciatica is often characterized by one or more of the following features:
- Pain. Sciatica pain is typically felt like a constant burning sensation or a shooting pain starting in the lower back or buttock and radiating down the front or back of the thigh and leg and/or feet.
- Numbness. Sciatica pain may be accompanied by numbness in the back of the leg. Sometimes, tingling and/or weakness may also be present.
- One-sided symptoms. Sciatica typically affects one leg. The condition often results in a feeling of heaviness in the affected leg.1 Rarely, both legs may be affected together.
- Posture induced symptoms. Sciatica symptoms may feel worse while sitting, trying to stand up, bending the spine forward, twisting the spine, lying down, and/or while coughing. The symptoms may be relieved by walking or applying a heat pack over the rear pelvic region.
It is important to note that any type of lower back pain or radiating leg pain is not sciatica. Sciatica is specific to pain that originates from the sciatic nerve.
Causes of Sciatica
Sciatica can occur due to so many reasons along with aging. It may also happen due to some traumatic injury that affects the lower spine. The main common reasons of the Sciatica are;
Herniated Disk: Spinal disks are acting like cushions within the vertebrae. If the hard outer portion of the disk tears, the soft stuff inside the disk leaks out, and once it starts pressing against a nearby nerve, you feel the pinch on the nerve. If this happens in the lower back, it presses against the sciatic nerve and causing sciatica.
Bulging Disk: The outer wall is weakened and bulging outward. Therefore, press against a nerve root and can create a herniated disk.
Degenerative Disk Disease: While aging happens, the spinal disks lose water, stiff, and become more likely to crack.
Bone Spur: known as Osteophytes, are bony enlargements that may develop on the vertebrae as a response to other changes of the spine. That is a common issue for people above 60 age.
Spinal Stenosis: is a narrowing of the spinal canal, the bony channel which houses the spinal cord and nerves.
Piriformis Syndrome: a complication of piriformis syndrome, in which the piriformis muscle, placed deep in the buttocks, creates spasms and makes buttock pain. The sciatic nerve goes right beneath the piriformis muscle.
Risk Factors for Sciatica
There are many things that can expose a higher risk of Sciatica which are;
- Sex, men are more prone to the Sciatica
- Height & Weight
- Health Factors
- Occupational cases, Sitting for a long in some jobs
Symptoms of Facet Joint Osteoarthritis
Initially, the low back pain is along with the leg pain that happens while walking and standing straight and it combined with either of these problems:
- Not being able to walk for a long due to the pain in the leg.
- Lower back pain reduces after sitting for a while.
- Pain has fluctuated sometimes very intense and sometimes mild pain.
- Feeling of tingling, weakness, and numbness that spreads from the low back to the buttocks and legs.
Other Symptoms of Low Back Pain
- Unexpected onset of low back pain
- Walking and standing may usually make the pain worse
- Height loss
- Stiffness of spine
- Deformity and disability
Less Common Causes of Lower Back Pain: While less common than the above-listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:
- Piriformis syndrome
- Spinal tumor
- Ankylosing spondylitis
Finally, it is important to note that one’s attitude and situation also have an effect on pain levels and duration. For example, people who are depressed, under stress, or have a compensable back injury are more likely to have their pain become chronic. Patients who are stress free and have little complicating psychological factors are more likely to improve with appropriate treatment for their conditions.
The Possible Reason That Can Cause Spinal Compression Fracture
Usually, the likelihood of compression fracture can happen due to any sudden onset of low back pain in adults above the age of 50. like, women with their post-menopausal who have osteoporosis, and women or men after long-term corticosteroid use. A person who has osteoporosis, the issue can get trigger even with a small amount of force give to the spine, such as sneeze that can cause a compression fracture.
Less Likely Causes of Low Back Pain
Other reasons that it may cause the lower back is listed down, though they are not as common as the above mentioned one but still can cause the problem.
- Piriformis Syndrome
- Spinal Tumor
- Ankylosing Spondylitis
All of these causes require room to talk about but meanwhile, this article is more or less concentrated on the causes and the common issues. As was discussed at the starting of the article, a person’s attitude and situation towards the body have the main impact on the duration and the level of pain. Likewise, those with a back injury, depressed people, and those under continuous stress are more porn to chronic pain. While patients with less complicating psychological problems and less stress are the ones who improve faster.
Physical Medicine To Relieve Low Back Pain
The Low Back Pain can be chronic or acute and according to the stage of the problems, there are different remedies given by physicians to get rid of the pain which can be medications, physical medicine, and even surgeries. Here we talk about physical medicines.
- Avoid those activities which can aggravate your pain
- Continue with your physical active therapy like stretching and passive ones like keeping ice, heat, body massage, electrical stimulation, and ultrasound.
- manipulation or Chiropractic therapy
- Yoga or Pilates, which is helpful to stretch and strengthen muscles.
Always you need to take your health seriously while noticing pain in your lower back you need to contact the physician and get the consultancy. Remember always curing in the first stage is easier than the last stage.