There are four categories of low back pain. The first is mechanical back pain which is the most common category. This pain is made worse with movement and made better with rest. It gets worse with prolonged sitting or standing. It generally doesn’t radiate into the legs and there is no evidence of a neurologic problem. The most common causes are ligament dysfunction, postural abnormalities, and osteoarthritis.
The second category is inflammatory spine pain. The pain is worse in the morning and there is extended morning stiffness. Movement and exercise make the pain better. Examples of this type of pain are conditions such as ankylosing spondylitis.
Neurogenic back pain is the third category. This is a mechanical type pain that radiates down the leg, often to the foot. Numbness and tingling are common. The pain can be intense. Neurologic exam shows evidence of reflex change and muscle weakness. Maneuvers designed to stretch the sciatic nerve on exam make the pain worse. The most common causes are disc herniation, osteoarthritis, fractures, and malignancy.
Systemic back pain comes from more serious causes such as infection, malignancy, or diseases affecting internal organs. Pain is constant and unrelieved by rest. Symptoms such as fever, chills, appetite loss, weight loss, and abdominal pain may provide clues to diagnosis.
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