The commonest cause of low back pain is vertebral dysfunction, which then has to be further analysed. Muscle or ligamentous tears or similar soft tissue injuries are uncommon causes of back pain alone: they are generally associated with severe spinal disruption and severe trauma such as that following a motor vehicle accident.
In the lumbar spine most problems originate from either the apophyseal joints or the intervertebral discogenic joint, or from both simultaneously. The disc can cause pain, either intrinsically from internal disruption or extrinsically by pressure on adjacent pain-sensitive structures, leading to radicular pain (if the nerve root is involved) or non-radicular pain.
Degenerative changes in the lumbar spine (lumbar spondylosis) are commonly found in the older age group. This problem, and one of its complications, spinal canal stenosis, is steadily increasing along with the ageing population.
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