There are 100 million Americans with chronic pain (defined as pain that exists continuously for 3 months or more). A huge subset of those people have low back pain. Of those people, the majority are men.
Although there is overlap in what causes back pain in men and women, there are some differences too. Women with back pain are a group with several unique characteristics (click here to see my post of this subject).
This post will focus on men and low back pain. Low back pain in men is primarily a degenerative process that is related to life activity, fitness level, and genetic predilection. Let’s begin with a brief discussion of the anatomy and physiology of the low back.
A Brief Review Of The Anatomy And Physiology Of Low Back Pain
The low back has a very integrated array of muscles, ligaments, tendons, nerves, veins and arteries. They are arranged in sheets and bundles. The close relationship of these structures mean that they affect each other easily.
The spine is a flexible and supportive structure. Usually things that are supportive are not flexible and vice versa. For that reason the spine is easily affected by forces that disrupt its normal function. Furthermore, the lower back is the most concentrated area for these disruptive forces.
The lower back is difficult to rest. Its function is engaged even when lying flat on your back (though less so). Because of this the back is always under some degree of stress and will wear down over time. The speed of the “wear and tear” breakdown of the lower back is a combination of genetic resilience, life activity, disease development, body weight, and trauma to the area.
Let’s consider 3 of the most common causes of low back pain in men.
3 Common Causes Of Low Back Pain In Men
1) Lumbar Myofasciitis (LM):
One of the most difficult concepts in human anatomy is regarding fascia. Fascia is the connective tissue (connective tissue is any tissue of the human body that connects specific tissues one with another) that encircles, separates, connects, and protects specific organ tissues.
Most muscles of the lower back have a layer or more of fascia covering them. The fascia can be shiny, opaque, or even white in appearance. It usually possesses few large blood vessels (though it may encircle them) and few large nerves (it may encircle them too).
It has no properties of self-movement but may “hitch a ride” with the muscle it encircles or covers. Because of its close proximity to muscle and other tissues, injury to it can cause it to affect the structures it is attached to.
Excessive stretch or contraction, direct compression, high or low temperatures, infection, puncture, chemical exposure, abnormal growths, and autoimmune phenomena can all inflame the musculo-fascial complex commonly called Myofasciitis.
The most common cause for this in the lower back is excessive stretch or compression of an already overloaded system. That is why morbid obesity has such a high incidence of low back problems. The obese person lives with a lower back that is under constant strain (even at rest).
The person who suffers from Lumbar Myofasciitis has low back pain that is worsened with any activity that engages the movement of the lower back. Multiple structures may be inflamed in addition to the muscle and fascia of the lower back.
The symptoms are related to which structures are inflamed. LM can mimic other disorders of the lower back. A thorough history and physical will usually reveal that LM is the cause for the pain. In more complex cases an MRI of the lower back area is the most useful diagnostic test for this disorder.
2) Lumbar Degenerative Joint Disease:
The human spine has multiple joints at each level called facets. The facet joints have cartilage, ligaments, tendons, and joint capsules. Any or all of these structures can be affected in LDJD. Furthermore…muscles, nerves, discs, and periosteum (the membrane that covers most bones) can be affected due to their close proximity.
DJD is primarily a “wearing out” process. As the joint wears out through the “wear and tear” of life activities, the joint begins to deform. The result is pain and other symptoms related to structures close by being affected.
As you can see from the previous anatomy images, the structures of the lower back are closely related and effect one another quite easily. LDJD occurs in nearly everyone but is not a source of major pain in most people. The same factors that cause Myofasciitis can cause LDJD.
There seems to be a genetic predilection for some people to develop LDJD. LDJD also occurs more commonly in morbidly obese people due to the constant excessive weight load of obesity.
Diagnosis requires a thorough history and physical with an MRI of the lower back. LDJD cannot be seen from the surface and must have diagnostic testing to make an accurate diagnosis. Without diagnostic testing a diagnosis of LDJD cannot be made (the joints have to be imaged to do so).
3) Lumbar Herniated Disc From Lumbar Degenerative Disc Disease (click here to see my post on this subject)
Vertebral discs are the primary weight bearers of the spine. They are made up of 2 specialized forms of cartilage and can bear enormous amounts of weight relative to their size. Men are prone to this form of low back pain due to the excessive weight loads that men traditionally subject themselves to (however, more and more women are developing this disorder as their behavior becomes closer to men).
A herniated disc occurs when the interior of the disc “squirts” through the outer circular rings of the disc. It usually causes compression of the nerves in close proximity. The classic presentation is a person with severe low back pain that radiates down the back of their leg. The pain can be incapacitating.
Obesity, familial tendencies, activities that place a heavy load on the spine, and activities that cause excessive twisting of the lower back can all cause herniation. Twisting causes disc herniation at a much lower weight load than a straight lift using the lower back.
A thorough history and physical will often diagnose a herniated disc. However, to be able to decide on the best therapeutic strategy, an MRI with Gadolium contrast is necessary. Any decision for treatment without an MRI with Gadolium is considered an insufficient evaluation. If fragmentation of the disc has occurred surgical treatment will be necessary.
What Are The Common Treatments Of Low Back Pain In Men?
I break treatment into non-invasive and invasive therapies:
A) Non-invasive Therapies (all topics with article links are highlighted):
- Weight Loss
- Therapeutic Exercise
- Physical Therapy
- Chiropractic/Osteopathic Spinal Manipulative Therapy
- Cold Laser Therapy
- Bioelectrical Therapy
- Cold Packs/Hot Packs/Substances that heat, cool, or irritate the skin
- Transcutaneous Medicines
- Transcutaneous Electrical Neural Stimulation
- Massage Therapy
- Cognitive Psychotherapy
None of the listed procedures can remove disc fragments. The mechanisms of healing for the non-invasive therapies is reduction of pain (usually through endorphine release), increase nutrient supply, decrease disc degeneration, reduce inflammation, and realignment of the spine.
B) Invasive Therapies (all topics with article links are highlighted):
- Epidural Injections
- Facet Injections
- Trigger Point Injections
- Fiberscopic Discectomy
- Open Discectomy
- Open Laminectomy
- Open Laminectomy with fusion and internal fixation
- Open Discectomy with prosthetic disc replacement
Low back pain in men is usually related to a degenerative process. Though bodily degeneration is a natural accompaniment to aging, the speed of the process can be reduced through weight loss and fitness training. Once a painful syndrome has occurred there are abundant treatment modalities that can be employed to reduce pain.
The cause of the low back pain must be accurately diagnosed before an effective treatment regimen can be properly initiated. This always requires a thorough history, physical, and diagnostic testing by a licensed medical practitioner. This monograph is not intended to be medical advice but is informational only.
I hope you have found the information presented here useful. If you have further questions please comment below page.
Wishing you much joy and healing.