04/23/2020
Why is your lower back so prone to injury?
Article by Dr. Surya Raguthu
The lower back is subject to injury while lifting a heavy object, twisting, or a sudden movement—any of which can cause muscles or ligaments to stretch or develop microscopic tears. Over time, poor posture or repetitive stress can also lease to muscle strain or other soft tissue problems. And while a muscle strain sounds simple, in the lower back the pain from a simple strain can be severe.
Pulled-Back Muscle and Lower Back Strain
The lumbar spine has 5 motion segments. Most twisting and bending are divided among those segments, although the majority of the motion takes place in the lowest two segments, called L4-L5 and L5-S1. The structures in these two lowest segments are the most likely to wear down over time or be injured.
Despite growing research efforts, non-specific low back pain (LBP) remains a major public health burden throughout the industrialized world. Epidemiological data indicate a point prevalence ranging from 19 % to 27 % and a lifetime prevalence of about 60 %. Although a rapid decrease in pain and incapacity often occurs within the month following the onset of symptoms, most patients still experience LBP and related disability 1 year after.
A lot of studies have attempted to identify the risk factors for the occurrence of LBP, notably, to be able to propose preventive interventions. Supposed risk factors for the onset of chronicity of LBP can be categorized into several categories, i.e., individual (e.g., genetic predisposition, gender, age, weight, height, body mass index, physical activity, spine mobility, and smoking, etc. psychosocial factors (e.g., stress, anxiety, depression, pain behavior, etc. which are sometimes related to the work activity (e.g., work monotony, etc. and occupational factors (e.g., lifting, bending and twisting, prolonged static posture, whole-body vibration). Whereas the presence of a previous episode of LBP is recognized to be a powerful risk factor for a new one, literature reviews have reported only no, low, or conflicting evidence of a relation between LBP and the other supposed risk factors.
One of the treatments Lumbar selective nerve root block. When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain. Occasionally, an imaging study (e.g. MRI) may not clearly show which nerve is causing the pain and an SNRB injection is performed to assist in isolating the source of pain. In addition to its diagnostic function, this type of injection for pain management can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).
Selective Nerve Root Block (SNRB) for Diagnosis and Back Pain Management
In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root.
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