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Health & Exercise Forum

Back Pain: Living with Lower Back Pain. Part I of III

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May 16, 2009

Dr. Paul MackareyLiving with Lower Back Pain: This is the first in a series of 3 articles related to lower back pain: causes; diagnosis; non-surgical treatment; surgical treatment; prevention

One of the most common problems people come to my office with is lower back pain (LBP). Studies show that 80-90% of adults in the USA will experience lower back pain at one or more times in their lives. The spine consists of 24 moving vertebrae, a fused sacrum and tailbone, and shock absorbing discs between each moving segment. The spine is designed to provide support and protect the spinal cord while remaining flexible for movement and function. Spinal nerves exit the spinal cord at each segment to deliver messages from your brain to your extremities. Pressure on one of these nerves can cause pain, numbness, tingling, or weakness.

LBP can occur from many causes. Some of these include: muscle strain, disc degeneration, arthritis, scoliosis or curvature of the spine, instability from trauma or degeneration, acute trauma from a motor vehicle accident account or a fall. This column, with information from many local health care providers and The Rothman Institute will discuss many causes, tests, and treatment for lower back pain. Many workers are also at high risk for lower back pain. The Occupational Safety and Health (OSHA) and the United States Department of Labor list the following risk factors for LBP:

  • Poor Body Mechanics With Repetition:
    • Bending at the waist
    • Lifting from the floor
    • Lifting from overhead
    • Twisting at the waist
    • Twisting While Lifting
  • Lifting or Moving Objects of:
    • Excessive Weight
    • Excessive Size
    • Asymmetrical Shape
    • Awkward Position or Location
  • Prolonged Sitting (especially with poor posture):
    • Driving
    • Computer
    • Desk
  • Poor Work Station Ergonomics Without Adjustable:
    • Desk Chairs
    • Foot Rests
    • Arm Rests
    • Body Supports
    • Table/Desk/ Height or Location
    • Phone Headsets
  • Poor Grips on Handles:
    • Losing grip while lifting causing a jerk reaction to regrip
    • Slippery Footing
    • Slipping while lifting causing a quick jerk

The following information is based on information from three local spine surgeons, Dr. Pamela Costello, Dr. Allan Gillick, Dr. Philip Hlavak and the Rothman Institute of Orthopedics:

Common Causes of Lower Back Pain

The following is a list of the most common causes of mechanical and degenerative LBP. However, other medical problems such as peptic ulcers, kidney stones, and appendicitis, can cause LBP. Therefore, it is important that you see your family physician if LBP persists.

Disc Herniation or Herniated Nucleus Pulposus

The disc is comprised of two parts: a soft, jelly like inside surrounded by a harder fibrous outer layer. If the outer layer is weakened and torn by trauma or degeneration, then the jelly-like inner layer can leak or bulge onto the spinal nerve and cause pain, numbness, tingling or weakness in usually one arm or leg. This is most common in the neck (cervical) and lower back.(lumbar) region.

Spinal Stenosis

Stenosis means narrowing. Spinal stenosis is a form of arthritis in the spine in which the spinal canal, where the spinal cord travels, narrows due the boney arthritic changes. Pressure on the spinal cord can occur at any level but is more common in the neck and lower back. Symptoms include pain, numbness, tingling or weakness often in both arms and legs.

Degenerative Disc Disease

Degenerative arthritis in your spine causes the discs and vertebrae  to shrink. This is often due to the normal wear and tear of aging. Trauma or a history of disc herniation can accelerate this process. Symptoms include pain, stiffness, numbness, and tingling in the arms or legs.


One vertebrae slips in forward malalignment on another and if movement is too excessive may cause pain, numbness, tingling and weakness in the legs. Often this problem is congenital and minor and may not cause symptoms. However, a trauma or degenerative changes may aggravate the condition and cause symptoms.


An abnormal side-to-side curve develops and may cause uneven shoulders, hips, legs and twisted ribs/shoulder blades. Some cases are minor and not painful while more advanced cases may be problematic and require constant medical supervision and monitoring. It is usually a congenital problem.


An abnormal backward bending of the spine usually developing in the middle back (thoracic spine). Overtime, this problem can worsen and cause wedge shape changes in the spine. The deformity is a roundback or hunchback appearance. It is usually a congenital problem.

Spinal Instability

A spinal problem in which one vertebrae becomes unstable from trauma or degeneration. This may progress and cause deformity and loss of function. In severe cases, the instability may cause pressure on the spinal cord or nerves and lead to pain, numbness, weakness and nerve damage.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  “Diagnosis, Nonsurgical and Sugical Treatment”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.