New minimally invasive procedures have lowered the risk of back surgery and shortened recovery time from it. But surgery should be an option in no more than 20 percent of cases, according to many surgeons.
The onset of low back pain usually comes between the ages of 30 and 50, and it worsens as we get older.
Most low back pain is the result of overuse, strain or injury. The most common are muscle strains (muscle fibers are stretched or torn) and lumbar sprains (the ligaments that hold bones together are torn from their attachments).
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Low back pain emanates also from degenerative diseases of the spine. As we age, our bones, including the vertebrae (the bones of the spinal column), tend to lose strength, and the muscles around them that hold them in their proper place tend to lose tone. The intervertebral disks (round, spongy pads of cartilage) between the vertebrae, which allow for flexibility in the back and act as shock absorbers, lose fluid and flexibility.
For those older than age 60, two common sources of low back pain are facet joint osteoarthritis (arthritis of the spine), which causes a breakdown in the cartilage that cushions the spine, and spinal stenosis, a narrowing of the spaces through which the spinal cord and nerves travel.
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Human beings have suffered from low back pain essentially ever since we started to walk erect, which meant that the lumbar (lower back) region of the spine had to support all the weight of our upper body. Records of treatment of low back pain go back thousands of years, to the ancient Egyptians.
Our sedentary modern lifestyles contribute mightily to low back pain. In a recent survey for the American Physical Therapy Association, 54 percent of those who reported low back pain said they spent most of their work day sitting.
Sitting upright in a conventional chair, as most of us do at work, puts pressure on the spinal disks in the lower back -- which we don't experience when standing or reclining, according to a 2006 study.
