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Common Causes of Chronic Low Back Pain

For patients with low back pain that lasts longer than three months, or patients with predominantly leg pain, a more specific and definable problem for the pain should be sought. There are several very common causes of low back pain and leg pain:

In younger adults (20-60 year olds) the disc is likely to be the pain generator and conditions may include:

Lumbar disc herniation – As a disc degenerates, it can herniate (the inner core extrudes) back into the spinal canal, which is known as a disc herniation (or a herniated disc). The weak spot in a disc is directly under the nerve root, and a herniated disc in this area puts direct pressure on the nerve, which in turn can cause pain to radiate all the way down the patient’s leg to the foot.
Degenerative disc disease - Degenerative disc disease refers to a syndrome in which a compromised disc causes low back pain. Despite its rather dramatic label, degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding, not the exception.
Isthmic spondylolisthesis – This spine condition occurs when one vertebral body slips forward on another because of a small fracture in a piece of bone that connects the two joints on the back side (the pars interarticularis) of the spinal segment.

In older adults (over 60 years old), the source of back pain or leg pain is more likely to be the facet joints or osteoarthritis, and back conditions may include:

Facet joint osteoarthritis - Osteoarthritis (degenerative arthritis) can cause breakdown of cartilage between the facet joints. When the joints move, the lack of the cartilage causes pain as well as loss of motion and stiffness. 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
Lumbar spinal stenosis - Facet joints tend to get larger as they degenerate, and as the joint enlarges, it can place pressure on the nerves as they exit the spine. Standing upright further decreases the space available for the nerve roots, and can block the outflow of blood from around the nerve. Congested blood then irritates the nerve and the pain travels into the legs.
Degenerative spondylolisthesis - As the facet joints in the back of each spinal segment age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other. This slippage is known as a degenerative spondylolisthesis, which is Latin for “slipped vertebral body”.

These descriptions represent the more common causes of low back pain. In addition to the above, there are a number of other, less common causes of low back pain, such as vertebral compression fractures, tumors, infection, and more.

Source: Spine-health.com – www.spine-health.com
Last updated: August 31, 2007

This information and the information on Spine-health.com is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding back pain and neck pain.

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