“Oh, My Aching Back:” Causes and Treatments of Low Back Pain

September 16, 2014

 

by Dr. D’Wan Carpenter

Low back pain is a common stated complaint in most doctors’ offices. Low back pain is in the top 3 list for reasons people miss work in America. So what should you know?

For starters, low back pain has many causes. It can be from a muscular sprain/strain, myofascial pain (tightness and spasm of muscles), facet joints, sacroiliac joints, protruding discs compressing spinal nerves (which give radiating pain down one or both legs), or spinal stenosis (narrowing of the spinal canal which puts pressure on the spinal cord). If you have sudden or rapidly progressing leg weakness, new bowel or bladder incontinence, numbness in the genital area you need to be evaluated immediately by a healthcare professional as this can be the signs of an emergency.

While this list is not all inclusive, it represents the most common causes. The good news is most acute back pain, occurring 3 months or less, gets better on its own in almost 90% of cases although recurrence is possible. The other 10% of cases become chronic and are generally causes by one of three sources:

  1. Intervertebral disc-the disc in between two vertebral bodies in the spine
  2. Zygopophyseal joint (facet joint)-the joint created by the bottom of one vertebra and the top of the next vertebra below
  3. Sacroiliac joint (SI joint)-the joint created by the sacrum (the bottom of the spine) and the ilium (upper part of the pelvic bone)

Low back pain, whether acute or chronic, can limit your function with daily activities, interfere with sleep, and work performance.

Everyone wants to know, what can be done about this pesky back pain?

In most cases, pain medications such as non-steroidal anti-inflammatories (NSAIDs) like ibuprofen can relieve much of the pain. In conjunction, physical therapy for stretches, body mechanics training, and home exercises are often helpful. Osteopathic manipulative treatment (OMT) by an osteopathic physician can help restore the body’s overall function and help promote self-healing. Injections can be indicated particularly in the three main chronic causes. (To find a DO near you http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx) Epidural steroid injections (injections into the spinal canal with anesthetic solution and corticosteroid solution) can help relieve the inflammation caused by a protruding disc. SI joint injections are both diagnostic and therapeutic. Zygopophyseal/facet joint nerve block is diagnostic and can be followed by radio-frequency ablation (procedure where radio-frequency waves create heat that burn the identified pain causing nerves around the facet joint)of the nerve for long-term pain relief. Surgery may be indicated if all of the above measures fail, but keep in mind this should be last resort as surgery comes with its own risks.

Take home message:

  1. Remember when lifting heavy items particularly up from the floor, use the leg muscles and not the back to avoid injuries related to improper lifting
  2. Numbness in the genital area, back of legs and buttocks, bowel or bladder dysfunction, and leg weakness can be signs of an emergency and requires immediate evaluation.
  3. Avoid bed rest, but instead modify activities and decrease activity if necessary as complete bed rest can cause weakness of muscles which may exacerbate the condition.
  4. A thorough exam by your doctor is the best way to diagnose the cause of low back pain. Schedule a visit with your doctor especially if your low back pain is not getting better so that you can get the appropriate treatment you need.

dwan

D’Wan Carpenter, DO is a graduate of University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (now Rutgers School of Medicine) in Stratford, NJ in 2010. Dr. Carpenter is currently finishing her last year of residency in Physical Medicine and Rehabilitation in Taylor, MI with plans to focus on outpatient medicine to include treatment of joint pain, back pain, and neck pain with use of ultrasound injections, physical therapy, and manipulative techniques.

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

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