The pathophysiology of mechanical LBP remains complex and multifaceted. Multiple anatomic structures and elements of the lumber spine (eg, bones, ligaments, tendons, disks, muscle) are all suspected to have a role. (See the images below.) Many of these components of the lumber spine have sensory innervation that can generate nociceptive signals representing responses to tissue-damaging stimuli. Other causes could be neuropathic (eg, sciatica). Most chronic LBP cases most likely involve mixed nociceptive and neuropathic etiologies.
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Often, herniated disks, even ones that appear obviously bulging or herniated on imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT), cause no symptoms. Herniated disks that do not cause symptoms are more common as people age. However, herniated disks may cause slight to debilitating pain. Movement often intensifies the pain.
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