Low Back Pain: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

 

What is low back pain?

Low back pain is a prevalent musculoskeletal condition that affects adults. The prevalence of low back pain is high, accounting for approximately 84%. The pain may originate from different potential anatomic sources that may include intervertebral discs, nerve roots, abdominal cavity organs, fascial structures, bones, muscles, and joints. Chronic low back pain arises when the pain in the lower back region persists for a minimum of 12 weeks. (1) The evaluation of low back pain involves imaging with conservative management of the affected individual. Magnetic resonance imaging (MRI) can be useful for the identification of soft tissue lesions, inflammatory conditions, nerve root or cord compression, and malignancy of the spine. (2) This article describes the symptoms, causes, and risk factors of low back pain along with the discussion of the healing cycle and pain-relieving strategies. 

Symptoms of Low Back Pain

The symptoms of low back pain are as follows.

1. Decrease in the range of motion
2. Numbness or tingling sensation
3. 근육 약화
4. Stiffness of the back
5. 감각 상실
6. Pain in the lower back 

Causes and Risk Factors of Low Back Pain 

The causes and risk factors associated with the development of low back pain are as follows. 

1. Poor posture of the body
2. Diseases including rheumatoid arthritis and osteoarthritis 
3. 나쁜 리프팅 바디 역학
4. 퇴행성 디스크 질환 
5. Whiplash injury
6. Sciatica nerve pain (spinal nerve roots L4-S3)
7. Herniated intervertebral disc 
8. Piriformis syndrome 

Normal Healing Cycle and Chronic Conditions

The normal healing cycle is made of 4 distinct stages called hemostasis, inflammation, proliferation, and maturation stages. Each stage has distinct mechanisms and progresses to the next phase in a sequential and timely manner. The description of the 4 stages of the healing cycle is given in the following table. (3, 4)

Table 1 Stages of the Normal Healing Cycle
Number of Stages	Name of Stages	Description of Mechanisms
Stage 1	Hemostasis	The mechanisms during this stage of the healing cycle include the vasoconstriction of the blood vessels and the formation of a thrombus or a blood clot to limit the loss of blood at the site of injury.
Stage 2	염증	The cardinal signs of inflammation are warmth, loss of function, redness, swelling, and pain. During this stage of the healing cycle, immune and inflammatory cells are recruited to the site of injury. These cells release substances such as cytokines and inflammatory mediators for modulating inflammation.
Stage 3	분아 증식	The mechanisms during this stage of the healing cycle include the formation of new blood vessels or angiogenesis, synthesis of collagen and extracellular matrix, and re-epithelization. In chronic conditions, the formation of fascia restrictions, muscle trigger points, muscle spasms, and scar tissue are associated with the persistence of this stage of the healing cycle.
Stage 4	성숙	During this stage, the healing cycle attains completion as the inflammation and proliferation stages are resolved. In chronic conditions, the healing cycle does not reach completion and moves back and forth between proliferation and inflammation.

 

Effective and Ineffective Treatments of Low Back Pain

The effective and ineffective treatments of low back pain are listed in the table given below. 

Table 2 Low Back Pain Treatment
Ineffective Treatments of Low Back Pain	Effective Treatments of Low Back Pain
Following are the traditional therapeutic pain-relieving strategies that many people opt for in order to treat low back pain. These strategies not only provide temporary pain relief but can also aggravate low back pain and associated symptoms.  Application of heat and ice Electrical stimulation of the site of pain or injury Use of foam roller and massaging on the site of pain or injury Stretching of the lower back Mobilization of the lower back Strength exercises during the inflammatory stage of the wound healing cycle	Resolution of the inflammation stage of the healing cycle can be achieved in the following ways. Adequate rest is integral to the treatment and management of low back pain.  Magnetic therapy is useful for the treatment of low back pain. Magnetic therapy modulates angiogenesis and mechanisms related to proteoglycans and collagen via the application of magnetic fields. MagnaHeal is a useful device that employs magnetic fields of the neodymium magnet and anti-inflammatory substances for the treatment of low back pain. (5, 6) MagnaHeal 1 has a magnetic force length of 2 inches making it useful for mild inflammation. MagnaHeal 2 has a magnetic force length of 3 inches making it useful for severe inflammation. In contrast to a pro-inflammatory diet, an anti-inflammatory diet is useful for the modulation and reduction of inflammation. An anti-inflammatory diet is composed of fruits, vegetables, legumes, whole grains, fish, and unsaturated fats. (7) It is also important to identify and address the nutrient deficiencies in the body, which may contribute to delayed healing in chronic conditions. AskASTR program is developed to serve this purpose.
	Resolution of the proliferation stage of the healing cycle can be achieved in the following ways. Release of fascia restrictions of the superficial and aponeurotic fascia using the A1 Tool. Release of superficial muscle trigger points and superficial scar tissue using the A3 Tool. Release of deep muscle trigger points, deep scar tissue, and fascia restrictions of the endomysium, perimysium, and epimysium using the A5 Tool.
	Lifestyle modification and implementation of healthy habits are also useful for effective treatment and management of low back pain.  One shall perform pain-free back exercises. One shall stay active and engage in pain-free activities. One shall stabilize the body core. One shall maintain a proper posture throughout. One shall adapt to proper lifting body mechanics.

 

결론

Low back pain is a common occurrence among the adult population across the globe. It can be associated with soft tissue lesions, inflammatory conditions, nerve root or cord compression, and malignancy of the spine. Effective treatment strategies for alleviation of low back pain involve the resolution of the healing cycle, proper posture, core stabilization, and proper lifting body mechanics. 

참고문헌 

1. Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. https://doi.org/10.12688/f1000research.8105.2 
2. Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/ 
3. Pahwa, R., Goyal, A., & Jialal, I. (2022). Chronic Inflammation. In StatPearls. StatPearls Publishing.
4. Velnar, T., Bailey, T., & Smrkolj, V. (2009). The wound healing process: an overview of the cellular and molecular mechanisms. The Journal of international medical research, 37(5), 1528–1542. https://doi.org/10.1177/147323000903700531
5. Yuksel, C., Ankarali, S., & Yuksel, N. A. (2018). The use of neodymium magnets in healthcare and their effects on health. Northern clinics of Istanbul, 5(3), 268–273. https://doi.org/10.14744/nci.2017.00483
6. Arabloo, J., Hamouzadeh, P., Eftekharizadeh, F., Mobinizadeh, M., Olyaeemanesh, A., Nejati, M., & Doaee, S. (2017). Health technology assessment of magnet therapy for relieving pain. Medical journal of the Islamic Republic of Iran, 31, 31. https://doi.org/10.18869/mjiri.31.31 
7. Stromsnes, K., Correas, A. G., Lehmann, J., Gambini, J., & Olaso-Gonzalez, G. (2021). Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines, 9(8), 922. https://doi.org/10.3390/biomedicines9080922