While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis.
Symptoms: Lower back pain and stiffness that is the most pronounced in the morning and in the evening.
Includes any combination of the below symptoms:
- Pain that interrupts sleep
- Pain that is most pronounced first thing in the morning and again toward the end of the day
- Localized tenderness when the affected area of the spine is pressed
- Aching, steady or intermittent pain in the lower back that is aggravated by extended activity
- Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)
Possible cause: Facet joint osteoarthritis
Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.
Symptom: Leg pain that occurs primarily when walking and standing upright
Includes any combination of the following:
- Unable to walk far without developing leg pain
- Lower back pain relief is achieved quickly after sitting down
- Symptoms fluctuate between severe and mild/none
- Symptoms develop gradually over time
- Weakness, numbness and tingling that radiates from the low back into the buttocks and legs (sciatica)
Likely causes: Lumbar spinal stenosis or degenerative spondylolisthesis
Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.
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Symptoms: Sudden onset of back pain, limited flexibility, height loss
Includes any of the following:
- Sudden onset of back pain
- Standing or walking will usually make the pain worse
- Lying on one's back makes the pain less intense
- Height loss
- Limited spinal flexibility
- Deformity and disability
Possible cause: Compression fracture (e.g. from osteoporosis)
As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.
Less Common Causes of Lower Back Pain
While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:
- Sacroiliac joint dysfunction
- Piriformis syndrome
- Spinal tumor
- Ankylosing spondylitis
Finally, it is important to note that one’s attitude and situation also have an effect on pain levels and duration. For example, people who are depressed, under stress, or have a compensable back injury are more likely to have their pain become chronic. Patients who are stress free and have little complicating psychological factors are more likely to improve with appropriate treatment for their conditions.