Symptoms: Pain in the lower spine along the lumbar spine. It may be worse with bending, twisting or getting into a seated position. Sometimes patients with low back pain have irritation of the nerve root due to arthritis or a disk protrusion, but most of the time the muscles that support the back are the cause of the pain. Radiation of pain, numbness or tingling or muscle weakness in specific areas can be due to radiculopathy or a “pinched nerve.”
Sciatica: Pain that occurs when one of the 5 nerve roots branches of the sciatic nerve are irritated. This causes sharp burning pain that extends down the back or side of the thigh, usually down to the foot or ankle. You may also feel numbness or tingling.
When to seek help: Most patients who have low back pain can be seen and treated by their primary care provider. If the pain is caused from a serious condition, a surgeon may be recommended. Please contact your primary care physician if you have any of the following:
1) Age 70 or older with new onset of back pain
2) Pain that does not improve even when laying down at night
3) Weakness in one or both legs
4) Loss of control of bowls or bladder
5) Back pain accompanied by unexplained fever or weight loss
6) History of cancer or weak immune system
7) History of osteoporosis
8) Back pain as a result of falling or an accident, especially if older than age 50
9) If pain does not improve within 4 weeks.
Diagnosis: In addition to a physical exam and taking a history, your doctor may order tests to help determine the cause of your low back pain if it is not improving. Some possible tests include x-rays, CT (Cat scan), or MRI. Xrays can be helpful to look for vertebral compression fractures or alignment problems. MRI or CT scans give more detailed images of the soft tissues and bony structures of the back.
Bulging disk: With time, the body breaks down bulging disks, taking pressure off the nerve. A bulging disk is usually not an indication for surgery.
Treatment: Remaining active is one of the best things you can do to help the pain. Prolonged bed rest may actually make the pain worse. Studies have shown that people with low back pain recover faster when they remain active.
Using a heating pad can help low back pain during the first few weeks. Sometimes alternating between ice and heat is helpful. Most physicians will recommend that patients with low back pain continue working if it is possible to avoid prolonged standing, sitting, heavy lifting or twisting.
Medications: Pain medications such as aspirin, Tylenol, ibuprofen, or Aleve may be helpful. In addition, we often use muscle relaxants such as baclofen or Flexeril for pain but they can cause drowsiness. You should be careful if you need to drive and are taking a muscle relaxant or narcotic pain medication that can interfere with your ability to drive or operate heavy machinery.
Exercises: We usually don’t recommend stretching routines or back exercises right after a new episode of back pain because sometimes this can make the pain worse. As symptoms are improving, a program of exercises can help increase flexibility.
Physical therapy: A healthcare provider may recommend physical therapy if the pain persists for more than 4-6 weeks. They will work to help strengthen muscles of the back and stretch out other muscles that could be contributing to the back pain.
Osteopathic manipulation: An osteopathic physician (Doctor of Osteopathic Medicine) may use manual techniques to treat acute or chronic back pain. The theory is that reduction in range of motion to one part of the body can contribute to low back pain and low back pain may contribute to reduced range of motion. Improving range of motion of the body may reduce the pain and break the cycle of pain.
Massage/Yoga: Relief of pain can also be achieved with massage or yoga with the goal of improving range of motion and thereby allowing the body to heal itself.
Acupuncture, injections, manual traction, and braces may all be useful in some patients.
Sometimes surgery is recommended for the treatment of low back pain.
Prevention: Staying active and flexible can help prevent low back pain. Regular exercise can help strengthen the muscles of the hips/torso and abdominal muscles. Avoiding activities that involve repetitive bending, twisting or high impact activities that increase stress on the spine can also be helpful. Bend and lift correctly – at the knees rather than back. Stretch out the hamstrings, quadriceps, piriformis and glute. muscles regularly.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO