Have You Considered This?
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. Do you the differences of low back pain in men when compared to women?
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 the differences of low back pain in men. 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 both an extremely flexible as well as a supportive structure.
Usually anatomical structures that are supportive are not very 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).
This means that the back is always under some degree of stress which causes it to “wear out” 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 more difficult concepts in human anatomy is regarding the importance of fascia in low back pain. Fascia is the connective tissue that encircles, separates, connects, and protects specific organ tissues.
Connective tissue is the material of the human body that joins specific tissues one with another.
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.
Fascia 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 low back 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 (LDJD):
The human spine has multiple joints at each level called facets. The facet joints have synovial cartilage, ligaments, tendons, and joint capsules.
Any or all of the structures associated with the facet joints 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 facet joint cartilage wears out, through the “wear and tear” of life activities, the joint begins to deform.
The result is pain and other symptoms related to the 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 serious pain in most people.
The same factors that cause Lumbar 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 (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 physical 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 for a herniated disc 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.
A twist and bending of the lower back can cause 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
- Pharmacologic Treatments
None of the above listed procedures can remove disc fragments. The mechanisms of healing for the non-invasive therapies are reduction of pain through endorphin release, increasing the nutrient supply, decreasing disc degeneration, reducing inflammation, realignment of the spine, and reducing pain neuro-transmission.
B) Invasive Therapies (all topics with article links are highlighted):
- Epidural Injections
- Facet Injections
- Trigger Point Injections
- Fiberscopic Laser Discectomy
- Open Discectomy
- Open Laminectomy
- Open Laminectomy with fusion and internal fixation
- Open Discectomy with prosthetic disc replacement
If you are considering surgery for your low back pain see my article “Should I Have Lower Lumbar Surgery For My Chronic Pain?” (Click here for the link) All the procedures attempt to reduce the compression on local structures, correct degenerative anatomy, and stabilize the spine.
The differences of 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 low back pain syndrome has occurred, there are abundant treatment modalities that can be employed to reduce the 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 useful. If you have further questions or comments pleaseleave it below.
To your health!