Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is touched). Often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, in one spot, and associated with numdness in the area of the leg that the affected nerve supplies.

Herniated discs are produced as the spinal discs degenerate or grow thinner. The jelly like central portion of the disc bulges out of the central cavity and pushes againest a nerve root. Intervertebral discs begin to degenerate by the three decade of life. Herniated discs are found in a third of adults older than 20. Only 3 % of these, however, produce symptoms of nerve impingement.

Spinal stenosis occurs as intervertebral discs lose moisture and volume with age,which decreases the disc spaces. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.

Spinal degeneration is caused by alterations in the disc that progress to degeneration. This coupled with diseases in the joins of the low back, causes spinal canal narrowing. These changes in the disc and the joints produce symptoms and can be seen on an X-Ray. A person with spinal degeneration may have morning stiffness or pain while standing for a long time or walking even short distances.

Cauda equina syndrome is a medicial emergency. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence, or the ability to being urination.

Musculoskeletal pain syndrome that produce low back pain includes myofascial pain syndromes and fibromyalgia.

Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched

Fibromyalgia results in pain and tenderness on 11 of 18 trigger ponits when touched, one of which is in low back area, as classified by the American College of  Rheumatology.

Other skeletal causes of low back pain includes osteomyelitis or sacroilitis (infections of the bones of the spine). This pain is usually worse at night and its worse when sitting or standing for a long period of time.

Tumors, possibly cancerous, can be a source of skeletal pain.

written by maryanne

August  14, 2008