Low back pain is pain affecting the lower part of the back. It is described as:

• Acute if it has lasted less than 6 weeks
• Sub-acute if it has lasted 6-12 weeks
• Chronic if it has lasted more than 12 weeks

Disc problems

People who have a back problem often talk about having a ‘slipped disc’. However, major disc problems are not actually too common.When they do occur, it is normal because the disc has torn and ‘prolapsed’ or ‘herniated’, so that it presses against sensitive nerves from the spinal cord.

Sciatica

Sciatica is the name given to pains running down the back of the leg because nerve roots that make up the sciatic nerve have been compressed or irritated – either by a disc prolapse, from extra bone caused by arthritis, or due to a combination of the two.

Facet Joint Problems

Spine movement is made possible by joints between the vertebrae consisting of two flat faces or ‘facets’ on the bone. If these degenerate, the two halves of the joint grate painfully against each other.

Osteoarthritis

This condition, also known as osteoarthrosis, is a long-term degeneration of the joints, which makes them less able to withstand stress. It’s a wear-and-tear problem that affects most of us as we get older and which can give rise to pain in some cases.

Inflammatory Joint Diseases

There are many inflammatory diseases (e.g. ankylosing spondylitis and rheumatoid arthritis) that cause joints to become inflamed and seize up. These diseases can either directly affect the joints in the back, or cause problems with other joints that lead to pain in the back.

Osteoporosis

There are many inflammatory diseases (e.g. ankylosing spondylitis and rheumatoid arthritis) that cause joints to become inflamed and seize up. These diseases can either directly affect the joints in the back, or cause problems with other joints that lead to pain in the back.

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Coccydynia is a pain in the coccyx (tailbone), which is the last bone at the bottom of the spine.

What are the symptoms and signs?

Patients often describe pain right at the tailbone (i.e. between the buttocks), especially when sitting on hard surfaces and when getting up from a seated position. Patients may also experience pain during defecation, intercourse or when riding bicycles or motorcycles with hard saddles. Predominantly seated sports such as cycling, and rowing can lead to this condition.

How common is it?

It typically affects those in their middle years and is more common in those who are overweight or obese. It probably accounts for less than 1% of all back pain, but interestingly it is more prevalent in women.  This may be related to the positioning of the female coccyx lying more posteriorly in the female pelvis and therefore being more prone to external trauma. It is also more common in women because of injuries related to giving birth.

What are the causes?

By far the most common cause is trauma e.g. due to childbirth or a fall, or a rough landing on a water slide.

Much rarer but more serious causes can include:

• coccygeal infection
• fracture
• arthritis
• tumours

However, in about a third of patients, coccydynia is idiopathic (i.e. cause unknown). Investigative tests & imaging used to confirm the diagnosis may include blood tests; X-rays and MRI scans.

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