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Fully 80 percent of the population in most developed countries have at least one round of debilitating lower back pain at least once in their lives. For 10 to 15 percent of the population, lower back problems recur time and time again through their teenage and adult lives. Many people have back problems that originate at the lumbosacral joint, which is where the lowest, fifth lumbar disc meets the first sacral disk of the spine, L5/S1. In plain language, this is the part of the lower back where the spine branches transitions to the pelvis and the legs. Actually this structure isn't a single "joint." It includes a disc between the lumbar and sacral spine, and two facet joints (also known as zygapophysial joints) that guide the motion of this part of the spine. 

Lots of things can go wrong with this part of the spine. The disc can be herniated. When this happens, the inner contents of the disc leak out and touch the adjacent nerve. This condition is known as lumbar herniated disc.

Or the disc itself can degenerate. This condition is known as lumbar degenerative disc disease, or DDD. Another common possibility is for the facet joints to fracture so that they cannot hold the lumbar disc in place. It slips over the sacral disk in a condition known as L5-S1 isthmic spondylolisthesis. This part of the spine can also be damaged by stenosis, or narrowing, or degenerative arthritis.

The spinal cord doesn't extend down into the lumbar spine. There is no danger of paralysis when this part of the spine is damaged. On the other hand, there is no end to the pain that can be generated by damage to this part of the spine. However, that doesn't mean that just because your lower back is killing you, you don't have a potentially serious condition. There are some times you just shouldn't try to do home pain care, and you need to see a doctor right away:

  • Sudden bowel or bladder problems, either an inability to "go" or an inability to hold it in, coming about suddenly, can be a sign of an urgent medical problem.
  • Intense back pain along with stomach pain so that you can't stand up is also a potential sign of an emergency medical condition.
  • Weakness in the legs with problems in bowel or bladder control also are a sign to go the doctor immediately.

However, chronic lower back pain can be dealt with in a number of ways at home:

  • Take pain relief as prescribed. If you need more pain relief, go to see the same doctor to ask for a change in your prescription. Avoid taking too much Tylenol (acetominophen) to avoid liver damage.
  • Deep point massage (acupressure) is helpful in managing pain, but it won't cure your back problems.
  • Motion style acupuncture treatment (receiving acupuncture while exercising) is used in some Asian treatment centers.
  • It takes about two months of consistent home exercise to restore strength and range of motion in the lower back. You can't do the exercises on again-off again and expect to get better. Consistency is key. Your doctor can give you the specific exercises you need to do. You may need one session with a physical therapist or a trainer.
  • Your doctor may be able to prescribe a bio-feedback machine that tells you when you are moving in ways that support the recovery of your back.
  • Device-based therapy, the use of an exercise machine like the David Spine Concept system, is successful about 75 percent of the time. These machines are found at well-equipped gyms. You shouldn't try to work out your own routine on ordinary gym equipment unless you yourself are a physical therapist or trainer.
  • If you are doing well enough to exercise and you haven't been given specific exercises to strengthen your back, work out with a Swiss ball and elastic bands rather than on machines, at least at first. Do gentle exercises with minimum exertion until you are sure you can exercise without causing yourself pain.
  • If you play contact sports, going back into the game before an injury anywhere else in your body increases your risk of lower back injury. The problem is that you can't respond to a hit or a kick or a tackle quickly enough to prevent stress on your spine. A first injury tends to lead to a second or a third.

If there is any good news about lower back pain and all of the conditions discussed here, it's that they usually go away eventually even without treatment, if you can avoid injuring your back again. It may take weeks, months, or even a year or two, but nearly everyone eventually gets better.

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