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Low Back Pain

There Are Many Causes Of Back Pain

Some common causes are poor posture, muscle tension and spasm, muscle strains, ligament sprains, disc herniation “slipped disc”, joint inflammation, and degeneration (arthritis). Some people develop back pain secondary to trauma from a slip, fall or accident. Trauma can cause simple sprains or strains or more serious fractures or dislocations. Back pain can also be a sign of a more serious or systemic (internal) condition. Ulcers or other intestinal problems, kidney disease, pregnancy or other gynecological conditions, heart disease, and cancer can refer pain into the back. If back pain seems unrelated to an injury or activity, or is in any other way unusual, a visit to the doctor is recommended. Emotional stress or long periods of inactivity may worsen back pain. People in poor physical condition (including obesity) or those who’s work that includes heavy labor or long periods of sitting or standing have a higher risk of developing low back problems; they also get better more slowly.

There are two forms of back pain, acute and chronic. Acute pain comes on suddenly and intensely, usually from doing something incorrect or secondary to an unexpected event. The pain usually lasts a short period. Chronic pain is recurring; any little movement can set it in motion and, for whatever reason, it lingers on and on for what can seem like an eternity. Multiple acute episodes of back pain can lead to chronic low back pain.

Experts agree, the best way to reduce the amount of back pain in our society is to prevent it. It has been estimated that 80% of the adult population in the United States will experience a disabling low back disorder some time in their life.

The lower back supports most of the body’s weight and therefore is a vulnerable region of the body. The stability of the lower back depends on the integrity of the vertebral joints, intervertebral disks and the supportive soft tissue (ligament and muscle). To understand why the back is commonly injured you must consider that normally each of us has 24 moveable bones which make up the spinal column, including the neck and chest areas, which are held together by ligaments and muscles. Nerves, which exit between each vertebra, travel to all regions of the body and are essential for normal function of every tissue, organ and system in the body. Add the disks (which act as shock absorbers), and joints that guide the direction of movement of the spine, and stack them on top of each other and place the physical stress of every day life, no wander the back is vulnerable to repetitive trauma and pain.

 

Causes of Low Back Pain

There are many causes of low back pain. Sometimes the simplest of movements will have painful results. A simple sneeze has been known to cause a serious back injury. In addition, arthritis, congenital disorders, poor posture, obesity, and psychological problems due to stress can be the source of back pain. Complicating the issue further is the fact that back pain can also directly result from internal problems such as kidney stones, kidney infections, blood clots, or bone loss. Even with modern technology, it is difficult to pinpoint the exact origin of most back pain. Most people feel that x-rays can detect were the pain is coming from however, x-rays only visualize the bones and shadows of the supportive tissues (disc, ligament, muscle). Quite often more sophisticated diagnostic studies such as MRI (Magnetic Resonance Imaging) CT scans or discograms are necessary to make the proper diagnosis.

 

Symptoms

Low back pain is most commonly localized to the lumbar spine, but it may extend to other areas, particularly the legs. Affected parts of the back may feel tender or sore to the touch, and the pain may increase with movement. Pain can be felt as sharp or knife-like, a burning sensation, or as a dull muscular ache. Symptoms can range from mildly uncomfortable to completely disabling. Pain or numbness traveling down the legs is also known as sciatica. Sciatica is a different subject all together and is covered in more detail under “Sciatica.”

Lower back pain can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, the skin covering the lumbar area.

 

Diagnosing the Cause of Low Back Pain

The most important part of caring for patients with neck pain is an accurate diagnosis. Dr. Magaziner uses his years of clinical experience, using a thorough examination and sophisticated diagnostic tools to arrive at his diagnosis. Some of the diagnostic tools are: X-ray, Fluoroscopy, Magnetic Resonance Imaging CT Scans, Discograms, Diagnostic Nerve Blocks, Bone Scan and Ultrasound. However, the most important diagnostic tool is the hands on physical examination.

 

Treatment

It has been said that most episodes of mild back pain will improve without any treatment. However, this doesn’t necessarily mean the lower back injury has been completely rehabilitated. Many conditions will feel better over time, but with out correction of the underlying cause of the pain the condition could get worse with time and become more chronic. Over-the-counter medications such as acetaminophen and ibuprofen can provide temporary relief. Medication alone does not fix the cause, it merely helps to reduce the inflammation or muscle spasm. It’s a good idea to avoid overly strenuous or repetitive activity, but bed rest should generally be avoided.

In 1994 United States Department of Health and Human Services published the Clinical Practice Guideline for Acute Low Back Problems in Adults. In the Patient Guidelines, the Agency for Health Care Policy and Research recommend that the first three things a patient should do for acute lower back pain is:

  • Use Ice.
  • Use OTC (over the counter) Medication.
  • Receive Spinal Manipulation.

Dr. Magaziner’s philosophy is to start with the more conservative treatments (less invasive) first such as rest, medication, bracing, ergonomic changes, physical therapy, acupuncture, chiropractic and laser therapy. If the condition does not respond to conservative care some possible treatments include: joint injections, Radiofrequency Neurolysis, Endoscopic Laser abalation, prolotherapy, PRP, and stem cell grafts. As a last resort Endoscopic Laser surgery may be necessary.

Chiropractic Care

Many experts and recent clinical studies have demonstrated that chiropractic care is a safe and effective treatment for lower back problems. Since the majority of back pain in our society is related to functional abnormalities and chiropractic physicians treat the functional causes of back pain, it makes sense why chiropractic care is so effective. Chiropractors use various examination procedures and diagnostic tests to determine the underlying cause of a patient’s symptoms. Chiropractors use their hands to locate the regions of spinal malfunction and then correct these malfunctions with spinal manipulation. According the United States Department of Health and Human Services, Manipulation, defined as manual loading of the spine using short or long leverage methods, is safe and effective for patient’s with acute low back pain.

Exercise and Physical Therapy

Rehabilitation of the low back is a comprehensive process. An accurate diagnosis and early intervention is key. When someone develops back pain his or her first reaction is to rest in bed. However, experts have found that more than two days of bed rest can be detrimental to a person’s condition. It has been said, “for every week of bed rest, it takes two weeks to rehabilitate.” Physical therapists use a rehabilitation plan divided into two phases a pain control phase and a training phase. The pain control phase may include ice, heat, electrical stimulation, ultrasound and passive exercises. The training phase may utilize back school, movement training and lumbar stabilization exercises.

Acupuncture

Acupuncture is a centuries-old Chinese healing technique that employs needles placed at specified points on the body. The strategically placed needles effect energy systems in the body called “meridians.” There are many studies, which demonstrate the effectiveness of acupuncture for lower back pain.

 

Pain Management Options

For most people, drugs help control pain and discomfort and may be helpful in the acute phase of treatment. But any medication can have side effects. Back pain experts say that over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) — including acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen (Nuprin, Motrin IB and Advil) — can be of value in reducing the pain. More severe pain may require prescription medications such as oxycodone-release (Oxycontin), acetaminophen with codeine (Tylenol with Codeine), and meperidine (Demerol). Peter Rheinstein, M.D., director of the medicine staff in FDA’s Office of Health Affairs, says the many effective NSAIDs available on the market today means there is less need for narcotics. However, caution is suggested with all NSAIDs because than can cause gastrointestinal bleeding. It’s advisable to consult with a doctors about other treatment options for managing their back pain.

Dr. Magaziner’s philosophy is to start with the more conservative treatments (less invasive) first such as rest, medication, bracing, ergonomic changes, physical therapy, acupuncture, chiropractic and laser therapy. If the condition does not respond to conservative care some possible treatments include: joint injections, nerve blocks, prolotherapy, PRP, and stem cell grafts. As a last resort surgery may be necessary.

 

Surgical Procedures

Unlike in the past, many physicians recommend back surgery only for certain conditions that do not improve after other treatments have been tried. If there is a significant structural abnormality with significant symptoms producing objective physical signs and conservative treatment has failed, a patient becomes a candidate for surgery. There are many other circumstances that may require surgery. Some cases require immediate surgical intervention. It is important to obtain the correct diagnosis early in a condition to prevent any permanent damage. More recently, with the advancement of endoscopic procedures, minimally invasive spinal surgery is possible in some cases. Dr. Magaziner performs an Endoscopic procedures on cases that have been determined to be a candidate. Through a scope you can decompress nerves, remove herniated discs, remove bone spurs and scar tissue.

If you experience persistent back pain, numbness or tingling in the lower extremities, muscle weakness, or changes in urination, these may be signs of serious nervous system compression and immediate medical attention may be required.