Back Pain
Women are often subject to back pain from sitting too much at their desks at work, and pregnancy and child rearing can also create back problems. During the last two trimesters of pregnancy, the weight of the baby changes a woman's center of gravity and increases the curve of the spine. Many women with children strain their back muscles by constantly bending over to child height, or picking up heavy toddlers. Women can be at higher risk of back pain from lifting because their bodies' percentage of muscle mass is less than that of men. Women also have a higher incidence of osteoarthritis and osteoporosis.
Causes of Back Pain in Women
These conditions tend to appear in women more often than men:
- Osteoporosis. This metabolic bone disease weakens bones and leads to fractures. Patients experience back pain when the vertebrae become so weak that they can no longer withstand normal stress.
- Facet joint osteoarthritis. Facet joints are located in the back of the spine and connect the vertebrae. With aging, cartilage between the facet joints can break down, causing increased joint friction, loss of motion, stiffness and pain.
- Hip osteoarthritis. This is a condition where cartilage in the hip joint breaks down and causes pain to spread to the back and legs.
- Fibromyalgia. This muscle pain syndrome can cause general back pain, as well as sleeping difficulties. There are no known anatomical reasons for the pain, but physicians suspect underlying biochemical causes.
- Sciatica. When the sciatic nerve, which runs from the back to the buttocks and into the legs, is pressured by a herniated disc, pain radiates down the leg and into the foot. Usually, only one side of the body is affected. In Piriformis syndrome, a narrow muscle located deep in the buttocks irritates or pinches the sciatic nerve.
- Pregnancy-related back pain. Usually experienced in the last trimester, pain occurs in the lower part of the back and is most likely due to hormonal factors and extra weight.
- Sacroiliac joint dysfunction. The sacroiliac joint connects the triangular bone at the bottom of the spine with the pelvis. The reason for pain in this area is unclear. More often affecting young or middle-aged women, pain from this disorder is felt on one side low in the back or the buttocks.
- Degenerative disc disease. This condition usually starts with a twisting injury to the disc space. The injury weakens the disc and allows too much motion at the vertebrae. Because the disc can't hold the vertebrae section together, the area becomes inflamed and produces low back pain.
- Lumbar disc herniation. As a spinal disc ages, the inner core may begin to squeeze out into the spinal canal. The weakened disc and hernia in the area put direct pressure on the nerve to cause low back and leg pain.
- Stenosis. This condition results from pressure on a nerve as it exits the spinal canal. In foraminal stenosis, the nerve's exit from the spine (or foramin) becomes clogged with debris. In lumbar spinal stenosis, enlarged facet joints cause nerve pressure.
- Spondylolisthesis. This is a condition in which one vertebrae slips over another, pinching a nerve. In degenerative spondylolisthesis, the slippage is caused by spinal instability as spinal joints become arthritic and wear out.
- Scoliosis. This is a curvature of the spine that takes two forms. In one type, a normal spine appears to be curved, and the condition is temporary. For the other type, the curve is fixed and may be caused by a medical syndrome or disease.
- Tumors. Though rare, primary spinal column tumors sometimes occur in young adults. They start in the spine but do not spread. Spinal meningiomas are tumors that occur in tissue that encloses the brain and spinal cord. Metatastic spinal tumors originate in other parts of the body, particularly the breast, prostate, kidney, lung or thyroid.
- Trauma and accidents. As a major cause of back and neck pain, sudden-impact car accidents cause fractures, as well as damage to muscles, ligaments and tendons.
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Treatment
Often the first course of treatment for back pain is a combination of nonsurgical measures (or conservative care) taken to reduce pain and increase movement. These measures may include physical therapy, physiatry (combining physical medicine and rehabilitation), back braces, pain medication and electrotherapy.
Surgical measures are sometimes indicated when convervative care is not sufficient:
- Spinal fusion. For patients with conditions such as degenerative disc disease or spondylolisthesis, lumbar spinal fusion may be recommended. This type of surgery has proven to be a very effective way to stop motion at the vertebral segment, which in turn stops the pain associated with these conditions.
- Artificial disc replacement. This procedure is a reversible, viable alternative to spinal fusion offering the possibility of reducing damage to nearby discs and joints. Artificial disc replacement allows for motion preservation, near normal distribution of stress along the spine and restoration of pre-degenerative disc height.
- Decompression. A small portion of the bone or disc is removed to alleviate pain caused by pinched nerves. Microdecompression involves a tiny incision in the lower back. In open decompression, the incision is longer, two to five inches, and more muscle is affected.
- Rhizotomy. This procedure eliminates back pain by destroying the nerve supply to part of the back.
- Spinal cord tumor removal
- Scoliosis pillowing and reconstruction
- Kyphoplasty or vertebroplasty for osteoporotic fractures
Resources at Cedars-Sinai
- Cedars-Sinai Institute for Spinal Disorders
- Cedars-Sinai Metabolic Bone Disorder Program - part of the Cedars-Sinai Orthopaedic Center
For more information on women's health matters, any of the programs and services listed, or a referral to a Cedars-Sinai physician or program, call 1-800-CEDARS-1 (1-800-233-2771)
