Back Pain or "Lumbago"

The word lumbago refers to low back pain.  Low back pain sometimes occurs with sciatica.  Sciatica refers to the leg pain.  Back pain (lumbago) is usually due to degenerative disc disease whereas leg pain (sciatica) is most often caused by a pinched nerve.

Degenerative disc disease (DDD) is a term used by doctors to describe disc problems.  It is actually a misnomer.  It is not always degenerative and is not actually a disease.  The term "degenerative disc disease" is the label applied to almost any problem that affects the disks in the back. 

Disc disease is the leading cause of lower back pain in young adults. With age, the problem becomes more common.  We all have some degeneration, or “wear and tear,” in our vertebral discs.

At birth, a vertebral disc is about 80 percent water and functions as a shock absorber between the vertebral bones. As the disc ages, the water content decreases and the disc becomes stiffer and more fragile. Tears develop in the outer shell of the disc and the softer tissue inside can leak out.

Magnetic resonance imaging (MRI) is most commonly used to diagnose disc disease.

Twenty-five to thirty million Americans suffer from chronic low back pain, the number one cause of lost days from work in the U.S. Certain jobs, excess weight, alcohol use, and smoking all increase the chance of disc disease.

Leg Pain or "Sciatica"

The term sciatica simply means leg pain.  It is the pain that travels along the path of the sciatic nerve and is caused by damage to the small roots that form the nerve.

The sciatic nerve is the longest and largest nerve in the body.  It is three-quarters of an inch in diameter and two feet long.   It originates in the sacral plexus in the pelvis and extends to the lower leg.  The sciatic nerve and its nerve branches serve motor and sensory functions (movement and feeling) in the thigh, knee, calf, ankle, foot, and toes.

If the roots forming the sciatic nerve are injured or inflamed, one develops symptoms called sciatica. The pain extends from the back, down the leg and to the foot.

Q. What if the MRI Scan shows a herniated disc? What do I do then?

A. If you have a herniated disk, you should see a spine specialist.  The doctor will first diagnose the cause of the problem.  Unless there is severe pain or weakness, conservative care will usually be recommended.  Exercise and pain medications are used first.  Chiropractic or acupuncture may be helpful.  If these do not help, a steroid shot may be advised.  Surgery is usually the last resort.

Q. When is leg pain an emergency?

A.  You should see a spine specialist immediately if you have any of the following:  severe pain extending down your leg; if the leg pain increase when you lift your knee to your chest or bend over; if you have had a recent injury; if the pain lasts more than three to six weeks; if your back pain becomes worse at night or wakes you up from sleep;  if the pain is accompanied by a fever; or, if  you have bladder or bowel problems.  Night pain can be caused by some tumors. Bladder and bowel problems may indicate the presence of a cauda equina syndrome, that is a compression of all of the nerves in the low back, which needs to be fixed immediately.

Q. Are there other causes of sciatica?

A. Not all leg pain is caused by herniated discs.  Other causes of leg pain include: fibromyalgia (a generalized pain syndrome); sacroiliitis (inflammation of the sacroiliac joint); lumbar facet syndrome (damage to the small joints in the back);  piriformis syndrome (a pinched nerve deep in the muscles of the buttock); Iliolumbar syndrome (inflamed ligaments of the pelvis); or, lumbar spinal stenosis (a narrowing of the space for the nerves).  Each of these problems are treated differently.  Most can be handled with needle procedures.

Q.  What is a Drop Foot

A. Drop foot is not a disease but a symptom.  It is caused by weakness of the muscle that lifts the foot up at the ankle (the tibialis anterior muscle).   The drop foot may be temporary or permanent. Drop foot is most frequently caused by injury to the L5 nerve root.  The L5 nerve is usually injured by a bad L4-L5 disc.  Occasionally, a drop foot can be caused by an injury to the peroneal nerve.  The peroneal nerve is a branch of the sciatic nerve and can be injured during hip or knee surgery. It can be injured by a deep bruise or a bad  laceration.  Drop foot can also be caused by Amyotrophic Lateral Sclerosis (ALS) and Multiple Sclerosis (MS). The cause can be determined using MRI (magnetic resonance imaging), and EMG (electromyogram).   A drop foot can be an emergency condition, and you should see your spine doctor immediately if you develop this problem.

The type of treatment is dependent on the cause of the drop foot. An ankle foot orthosis (AFO) brace, can prevent falls. The damaged nerve should, however, be repaired as soon as possible.  If a disc is the problem, it should be corrected immediately.  If the nerve is damaged by a knife wound, repairing it is also urgent.

Q. How can I protect my back?

Strengthening Exercises Stretching Exercises

Click on pictures to enlarge

A.  Strengthening exercises and stretching exercises are recommended as above.

B.  Follow several simple guidelines which have published by the North American Spine Society:

  1. Standing - Keeping one foot forward of the other, with knees slightly bent, takes the pressure off your low back.
  2. Sitting - Sitting with your knees slightly higher than your hips provides good low back support.
  3. Reaching - Stand on a stool to reach things that are above your shoulder level.
  4. Moving Heavy Items - Pushing is easier on your back than pulling. Use your arms and legs to start the push. If you must lift a heavy item, get someone to help you.
  5. Lifting - Kneel down on one knee with the other foot flat on the floor, as near as possible to the item you are lifting. Lift with your legs, not your back, keeping the object close to your body at all times.
  6. Carrying - Two small objects (one in either hand) may be easier to handle than one large one. If you must carry one large object, keep it close to your body.
  7. Sleeping - Sleeping on your back puts 55 pounds of pressure on your back. Putting a couple of pillows under your knees cuts the pressure in half. Lying on your side with a pillow between your knees also reduces the pressure.
  8. Weight Control - Additional weight puts a strain on your back. Keep within 10 pounds of your ideal weight for a healthier back.
  9. Quit Smoking - Smokers are more prone to back pain than nonsmokers because nicotine restricts the flow of blood to the discs that cushion your vertebrae.
  10. Minor Back Pain - Treat minor back pain with anti-inflammatories and gentle stretching, followed by an ice pack.

For more information on back pain, see the North American Spine Society Web Site of the American Association of Neurological Surgeons Web Site.

For Information on fibromyalgia click here.

For Information on sacroiliitis click here..

For Information on the pyriformis syndrome click here.

Click here to see the page on neck pain.

Click here to go the next chapter on procedures.

Northern California Neurosurgery Medical Group, Inc.
A spine care and injury practice with offices in Fremont, California

The information in this site briefly describes our practice and discusses some of the options available to our patients. This web site is not a substitute for good medical care or for a consultation with a spine specialist. It should not be used to plan your treatment. If you need medical help, you can schedule a visit with our doctors by clicking here. The well considered advice of a specialist who has personally examined you is always superior to even the best internet pages.

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Last modified: 01/01/08