Dear GeezerJock Doc: I have recently developed increasingly severe low back pain. Do you have any suggestions?

GeezerJock Doc: Almost everyone will suffer from back pain in his or her lifetime. To really understand the problem, we must review the structures that are involved that can cause the pain.

The anatomy of the lower back is complex and vulnerable to injury. The spine comprises the vertebral bodies — the bones that actually form the spinal column. Between each vertebra is a disc. These discs help transmit the load between the vertebra during activity. The nerves controlling muscles and sensation in the lower body run through a canal in the bones, and then exit below the vertebrae and the discs to travel to their destination.

The most common back condition is mechanical low back pain. This is really a description of a condition of pain when one cannot find any true structural cause. A person with this problem will complain about pain in their lower back without distant radiation. That is to say the pain stays only in the back area and does not travel down the legs. A very common cause for this in athletes is tightness of the muscles in the hip region, the hamstrings, quadriceps, hip flexors or adductors. Often all that is needed to treat this kind of pain is rest, activity modification, stretching or “core” abdominal strengthening.

Discogenic back pain is a condition when pain is generated either as a result of a degenerated disc or a rupture. A ruptured disc is also known as a herniated disc. The classic complaint from a ruptured disc is pain that travels down the leg below the knee, that grows worse with activity or lifting. Most acute disc injuries resolve with conservative treatment, rest, therapy, and strengthening. If the pain persists and is accompanied by numbness and weakness, surgery may be required.

Spinal stenosis is a condition in which the space for the nerves is diminished, and as a result of pressure or inflammation on the nerves, pain is generated. This pain is centered in the buttocks and will travel down the back of the legs with exercise. The pain disappears with the cessation of activity and flexing forward. There are a few causes of stenosis. If the joints in the spine become arthritic and spurs form, they leave less room for the nerve roots. If a person has degenerative discs they can bulge into the space occupied by the nerves and leave less room for the nerves and generate symptoms.

Occasionally, stenosis can be caused by trauma. The treatment initially is conservative: therapy, nonsteroidal anti-inflammatory pills and possibly epidural steroid injections. These are injections done by a licensed physician, usually an anesthesiologist or pain management specialist. These injections are given into the spine into the epidural space, they then are capable of decreasing the inflammation around the nerve roots and decreasing or relieving the symptoms. This treatment can sometimes be used for disc herniation. If you think you have any of the above conditions and need to be treated, you should seek out a medical professional with an interest in low back pain and injuries.

Ask the Doctor Written by orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise  and getting older. Submit questions to geezerjockdoc@geezerjock.com or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.