Low back pain is the second most common reason for medical office visits in the United States, affecting millions of individuals. People often present with nonspecific or “mechanical” back pain, without a specific cause. Three most common identifiable causes of lower back pain include muscle or ligament strain, degenerative disc disease, and arthritis of the facet joints. Rarer, serious causes include a cancer mass, a vertebral compression fracture, infection in the spine or spinal cord, or other spine pathology.
Risk factors of chronic low back pain include obesity, smoking, lack of physical activity, repeatedly strenuous physical work, low education, worker’s compensation insurance, job dissatisfaction, and psychological factors such as anxiety or depression.
Low back pain can occur with a range of symptoms, from a mild, dull ache to sharp, localized pain. Symptoms may occur on one or both sides of the back, may be present at rest or only upon movement, and change in character depending on positioning. Alarm symptoms in acute back pain include new urinary incontinence, loss of sensation in the pelvic region (“saddle anesthesia”), and abrupt loss of sensation or motor function in one or both legs; this rare constellation of symptoms can indicate a surgical emergency.
Your Doctor will perform a thorough physical exam to assess musculoskeletal strain, spinal cord and nerve function, reflexes, and straight leg raise to look for disc herniation. Imaging such as X-Ray, CT, and MRI are not typically indicated in the first 4-6 weeks of back pain unless certain features are present. Findings that would prompt sooner imaging include progressive neurologic deficit or disabling symptoms, history of osteoporosis or prolonged steroid use, unexplained fever or weight loss, history of cancer, IV drug use, or recent trauma.
Treatment varies widely depending on the nature of your pain, and whether your back pain is acute or chronic. Most patients with acute low back pain improve within 3 to 6 weeks with symptomatic pain relief, activity restriction, ice, and rest. It is encouraging to note that the vast majority of patients with back pain due to spinal nerve irritation or disc herniation improve with only conservative care – only about 10% will require surgical intervention.
Quality Physical Therapy is often very effective; persistence and commitment to the full course of therapy will yield best results for your back. Chiropractic treatment and therapy sessions can be a helpful addition as you recover from an injury. Continuing to maintain a level of physical activity is important in a healthy recovery. Avoid prolonged inactivity as it leads to deconditioning. Aim for 20 minutes of back exercises, several times per day, resting your back in between.
Acetaminophen (Tylenol) and Non-steroidal Anti-inflammatory drugs (Ibuprofen, Motrin, Aleve) are the most common medications people use for back pain. Surgery is reserved for only the most severe cases. Conditions known to benefit from surgical intervention include Spinal Stenosis, some fractures, refractory cases of Disc Herniation, Epidural abscesses from infection, and other physical causes for spinal cord compression. Evidence from randomized controlled trials suggests surgical fusion for degenerative disc disease or chronic low back pain has not shown significant benefit.