What You Need to Know About Lower Back Pain

Courtesy of Back In Motion Sport & Spine Physical Therapy

At any given time, forty percent of the world’s population experiences lower back pain. Strangely enough, the majority of back pain sufferers live in developed countries.

What Causes Lower Back Pain?
Most lower back pain doesn’t have a definite cause, rather it’s due to non-serious skeletal and muscle issues such as strains or sprains. There are many reasons one why you may feel your back is betraying you with aches and pains. Here are just a few of the reasons your back may hurt.

—Because lower back pain is a musculoskeletal problem, being overweight or suddenly gaining weight, can bring pain.

—Poor posture and poor sleeping positions.

—Playing “rough and tumble” sports, falling, and injury, are all reasons why you might develop lower back pain.

—Lifting a heavy object the wrong way is often the beginning of a back ache,

—Pregnancy. Nearly half of all pregnant women report lower back pain. The pain is mostly due to the changes in the body’s center of gravity, leading to ligament and muscle strain.

—When a woman is experiencing medical problems affecting the reproductive organs, such as ovarian cysts, uterine fibroids and endometriosis, she will most likely feel pain in the back.

—Strange as it may seem, smokers, especially adolescent smokers, are more likely to have back pain than non-smokers.

—Another big contributor to lower back aches and pain, is simply getting older. As we age, the “cushions” between our vertebrae lose moisture and begin to shrink causing musculoskeletal problems. Older adults are the group most affected.

—Prolonged sitting. Today many of us sit for long hours at a time. Too much sitting softens and weakens our back muscles, bringing on back problems.

Lower back pain falls into four distinct categories:
. Musculoskeletal—includes muscle strain, spasm,
herniated disk, spinal stenosis, sciatica, and compression fracture;
. Inflammatory—which is linked to different types of
arthritis such as: ankylosing spondylitis, psoriatic, reactive arthritis;
. Malignancy—a bone metastatic from prostate, lung, thyroid, among others; or
. The infectious—which includes osteomyelitis.

What’s the Difference Between Acute and Chronic Pain?
Although lower back pain has four different categories, it can be a constant ache or a sudden sharp feeling. Pain lasting for a period of less than six weeks is classified as acute; between six and twelve weeks, it is sub-chronic; more than twelve weeks is chronic.

Pain symptoms usually improve within a period of few weeks from the time of onset. The majority of patients report feeling completely better within a period of six weeks.

Getting the Right Diagnosis
Although not all cases of lower back pain require tests and imaging, they’re important tools for making a proper diagnosis—especially when neurological symptoms, worsening pain, or suspicion of conditions such as cancer and infections are present.

Some of the tests used to detect and depict lower back pain are:
. X-rays to give details of your body; taking pictures of the bones in the area suspected to be source of pain. Although they give limited detail, they are often helpful when in deciding the next course of treatment.
. CT Scans are recommended when suspecting infections or complications brought about by cancer. Scans show more details than an X-ray.
. MRIs are recommended when there is a suspicion of cancer or low back infections. An MRI gives greater detail than either an X-ray or CT scan. It’s useful for identifying disc disease and diagnosing spinal stenosis.
. The Straight leg raise is the test most used to determine disc herniation.
. Lumbar Discography helps in identifying specific disc pain in patients suffering from chronic lower back pain.

Your Treatment Options
Medications that Ease Pain
Doctors will often recommend medications to ease lower back pain. Though helpful in easing pain, care must be taken in their use.
. First in line are NSAIDs (aspirin, ibuprofen etc.) or the skeletal muscle relaxants. Although they are effective in treating pain, these medications can promote kidney problems, stomach ulcers and even heart issues when used long-term.
. If pain escalates, opioids such as morphine are usually prescribed. Opioids need to be used with extreme caution because of the risks of addiction and drug interactions.
. Antidepressants can be effective in treating chronic lower back pain, but like most of the pain management drugs, there is a risk of side effects.
. Facet joint and steroid injections are not effective in treating persistent pain; however, they can be useful for sciatic pain or pain stemming from the spinal joints.
. Epidural injections provide the patient with short term improvement, especially for people with sciatica. Long term benefits, however, are doubtful.

Types of Physical Therapy
. Physical activity is increasingly being recommended as a way to manage lower back pain. Unfortunately, there is no clear evidence that it works to alleviate chronic pain.
. Heat therapy has been found to be effective in treating acute and sub-chronic pain, though again, there is little evidence that it helps chronic lower back pain.
. Back belt supports are occasionally recommended, yet there is little evidence of their effectiveness. Nonetheless, they seem to help reduce the number of work days missed.
. The most effective method of pain reduction is exercise therapy. It reduces recurrence rates and improves long term function.

Surgery—Always a Last Resort
. Surgery may prove necessary for someone with a herniated disc that’s causing significant pain. It could also be beneficial to those with spinal stenosis.
. Discectomy, which is the partial removal of the disc causing pain, may provide relief.
. Microdiscectomy is less invasive, but there is no evidence that it will give different outcomes than regular discectomy,
. Spinal fusion can benefit those with localized pain. It is an intensive procedure, and is better than the low intensity, non-surgical treatment options. For those with low back pain displaced vertebra, this may be the needed treatment.

Tips on Caring for Your Back
Standing tall, while using good posture, is one of the best things you can do for your back especially if you have pain when sitting. Good posture strengthens the muscles holding us upright.

Stand more than you sit. Too much sitting, as has been said, weakens the back muscles. One solution: if your job requires you to be sitting for hours at a time, get a stand-up desk. A Texas A&M Health Sciences study showed a 75% reduction in back pain when subjects used a stand-up desk.

It’s important to try to balance your sitting with standing—especially for the relief of back pain. Standing and stretching keeps our bodies flexible.

Move! Movement is what we all need to keep our muscles and joints lubricated and limber. There’s a reason why we in the developed countries have more back problems—we don’t work our bodies day-to-day the way people in the undeveloped countries do.

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