The back's muscles and any of the ligaments can be injured or irritated.
What causes trouble may be a sudden movement in the heat of a tennis match or a game of touch football, or a fall, twist, or sudden muscle contraction to avoid a fall. Sudden pain usually follows a clear-cut injury, though there may be a delay of hours or even a day or two. Specific movements tend to aggravate pain, and muscle injury may bring with it a palpable muscle spasm.
Muscle spasms can also happen without muscle injury, as a reflex phenomenon from irritated deeper structures, including torn ligaments, infections, tumors, or chronic disc irritation, or herniation. The way you move, your posture, and other tests permit the doctor to separate a primary muscle spasm from that caused by some underlying disease.
Many so-called disc abnormalities are actually a combination of the aging process and cause no symptoms. Although pain from an abnormal disc may come on suddenly, the process by which it was caused generally occurs gradually, sometimes taking years to develop.
Discs begin to dry up, or become desiccated, starting in young adulthood. The most likely places for changes to begin are the discs at the junctures called L4-L5. No one knows exactly why these two discs are the most vulnerable, but one speculation is that it is due to the sheer stress accentuated by the presence of the lumbar curve.
As a result of this process of wearing out or degenerating, the disc slowly loses its ability to bounce back. In the first stage of anatomic abnormality, the soft interior (nucleus pulposus) of the disc bulges outward. This causes pressure on the nerve, which irritates it. If stenosis, or narrowing, of the spinal canal is also present, the likelihood of pain increases.
While some people with a stage-one bulge may never appear in the doctor's office complaining of back pain, the classic stage-one patient comes to the doctor because of sudden, acute onset of pain. The reason for the pain is not so much the bulging disc itself but the fact that the back muscles are in spasm, usually on one side of the back. This is why a person with this kind of backache characteristically walks tilted over sideways and with great difficulty.
Risks and Factors
The cause of the muscle spasm lies in the fact that the bulging disc is pressing against the ligament that holds it in place. Since this ligament contains nerves, the result is pain. Because of the initial pain, the back muscles go into spasm as part of the body's effort to immobilize the painful area. Rather than improving matters, the result is more pain. After several episodes of this type, the bulge may become what is called herniated, indicating that the problem has worsened involving the sciatic nerve and spinal nerve root compression.
Severe pain and palpable tension in the muscles of the lower back.
Diagnosis is based upon the clinical history, physical exam and x-rays.
The old standby, aspirin, is extremely useful. It not only relieves pain but reduces inflammation, and it is one of the safest drugs on the market.
The nonsteroidal anti-inflammatory drugs (NSAIDS) are also frequently prescribed. They work in a similar fashion to aspirin (do not take aspirin if you have GOUT) and may be more convenient, because some need to be taken only once or twice a day. Some of these drugs are now available over-the-counter.
Cortisone and other steroid drugs are occasionally used for a short period to reduce pain and inflammation. They can be quite effective in relieving the symptoms of acute back pain, but they can also cause serious side effects and are not useful as a long-term approach. When pain is more severe, more potent painkillers may be prescribed, again for a brief periods.
Narcotic analgesics, such as Percodan and Demerol, are very rarely needed and usually not prescribed for more than a few days at a time. There is a debate about the role of muscle relaxants and tranquilizers in treating back pain. It is not clear whether they are any more effective than NSAIDS.