Lower Back Pain
(Lumbar Back Pain)
Medical Author: William C. Shiel Jr., MD, FACP, FACR
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10 Health Tips for Autumn Leaves Clean-Up
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
 In many parts of the country, raking leaves is a necessity during the fall
months. Both for those unaccustomed to physical activity and regular exercisers,
the dynamics of raking can lead to strain and injury to the back, shoulders, and
wrists, according to the American Academy of Orthopaedic Surgeons (AAOS).
The U.S. Consumer Product Safety Commission reports that over 12,000 Americans
were treated for injuries directly related to leaf raking in 2004. Raking
requires a number of different activities, including twisting, bending, lifting,
and reaching, that utilize several different muscle groups. Improper use of lawn
tools along with the potential for tool-related accidents further compounds the
risk of injury to the bones and muscles.
You can ease the strain and pain of raking--fall's most taxing task by
taking the following precautions to minimize your risk of sustaining an injury...
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What is the anatomy of the low back?
The first step to understanding the various causes of low back pain is learning about the normal
design (anatomy) of the tissues of this area. Important structures of the low
back that can be related to symptoms there include the bony lumbar spine (vertebrae), discs
between the vertebrae, ligaments around the spine and discs, spinal cord and
nerves, muscles of the low back, internal organs of the pelvis and abdomen, and
the skin covering the lumbar area.
The bony lumbar spine is designed so that vertebrae
"stacked" together can provide a movable support structure while also protecting
the spinal cord (nervous tissue that extends down the spinal column from the
brain) from injury. Each vertebrae has a spinous process, a bony prominence
behind the spinal cord, which shields the cord's nervous tissue. They also have
a strong bony "body" in front of the spinal cord to provide a platform suitable
for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone
in between the buttocks. On each side, the sacrum meets the iliac bone of the
pelvis to form the sacroiliac joint of the buttocks.
The discs are pads that serve as "cushions" between each
vertebral body. They help to minimize the impact of stress forces on the spinal column. Each disc is
designed like a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring (annulus
fibrosus). The central portion of the disc is
capable of rupturing (herniating) through the outer ring, causing irritation of adjacent nervous tissue and sciatica, as described below.
Ligaments are strong fibrous soft tissues that firmly attach bones to bones.
Ligaments attach each of the vertebrae and surround each of the discs.
The nerves that provide sensation and stimulate the
muscles of the low back as well as the lower extremities (the thighs, legs,
feet, and toes) exit the spinal column through bony portals called
"foramen."
Many muscle groups that are responsible for flexing, extending, and rotating
the waist, as well as moving the lower extremities, attach to the lumbar spine
through tendon insertions.
The aorta and blood
vessels that transport blood to and from the lower extremities pass in front of
the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels
are lymph glands and involuntary nervous system tissues, which are important in
maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the pelvic
area of women. The prostate gland is a significant pelvic structure in men. The
kidneys are on either side of the back of the lower abdomen, in front of the
lumbar spine.
The skin over the lumbar area is supplied by nerves that come from nerve roots
that exit from the lumbar spine.
Next: What is the function of the low back? »
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