Persistent Low Back Pain: When You Should Seek Attention

Low back pain is one of the world’s leading musculoskeletal ailments. According to the National Institutes of Health, 8 out of 10 people will suffer from significant low back pain which leads them to present to their doctor at some point in their lives. Those other two just happen to be lucky! The fact of the matter is that the vast majority of individuals suffer from some variety of low back pain. If you have ever wondered why physical therapy and chiropractic offices have become vastly more common than Starbucks in most major cities, the statistic above should explain this phenomenon to you now. Back pain is so common that it creates an astounding number of jobs and its very own professions that are dedicated towards identifying sources of low back pain and treating them.

If every individual with back pain for any duration of time presented to a doctor, therapist, or chiropractors office, these offices would be flooded and understaffed. It is essential to identify when your back pain does not fall under the “normal” category and when it is time to seek attention. In the following article I outline some of the more common causes of back pain and when it is essential to seek attention. The low back has many components to it, each with its own purpose. Looking at one “unit” of the spine, we have the vertebrae and in between those vertebrae are discs. You can think of these as a number of hamburgers stacked on top of one another- the buns are made of bone, and the meat is the soft cushion that is the disc. A series of joints (facet joints) connect these burgers (vertebrae) providing stability to the spine. Of course, overlying the spine is a vast array of muscular tissue. Each one of these components of the spine can cause pain. I often tell my patients in jest, “Backs were made to provide stability… but they were also made to hurt.” With so many pain-provoking components present in the spine, it is of no wonder that 8 out of 10 people experience low back pain.

The most common cause of low back pain is a muscle strain. Lumbar strain is, by far, the most common cause of low back pain. This type of strain can occur while performing a wide variety of activities that involve a sudden motion, such as sudden rotation, going from flexion to extension, or a wide variety of other movements. After a strain, even slight movements can cause severe spasms and pain. The severity of the pain with movements often leads people to present to the doctor within one to two days of their initial pain. Generally, in the initial phase, I recommend that patients treat their symptoms with ice, rest, and occasional anti-inflammatory medications as long as they don’t have any contraindications to these. On occasion when the pain is severe I will prescribe a muscle relaxant. I always tell patients, however, that if the pain persists for two weeks they need to come and see me because at this point, a muscle strain becomes less likely and further evaluation and possible imaging may be required. In general, for those of you who have back pain, if this persists past two weeks it is generally a good idea to bring this up to your primary care physician or see a physiatrist trained in pain management.

Next we will discuss the often feared herniated lumbar disc. This is another common cause of low back pain and most often will present with radiating lower extremity pain. The same herniated disc in two different individuals can actually present in different ways. No two individuals behave the same when it comes to low back pain, despite the similarities in cause. I always reassure my patients that almost 80 percent of individuals with herniated lumbar discs can improve with a solid physical therapy program and epidural steroid injections when warranted. Nonetheless, if you have low back pain that begins radiating into either or both legs, it is time to get this checked out by a physician. Your treating physician can direct your care at this point. Generally symptoms will improve with appropriate treatment. Weakness in either one of your legs or any changes to bowel or bladder function may be a sign that you need to consult with a surgeon. Rest assured though, in the vast majority of cases of individuals with herniated discs, improvement is had without major surgery.

Finally, we discuss arthritis as a cause of pain. Almost every individual on the planet, at some point or another, will develop degenerative joint changes. Because we place so much stress on our spines on a daily basis, the small facet joints that hold our spine together are privy to degenerative changes. I often find that patients will present to me from their primary care doctor with significant concerns. I will often hear, “I was told my back is terrible. It is full of arthritis.” When I explain the prevalent nature of arthritis in the back to individuals they tend to feel a sense of ease. One of the most common questions I hear in this group of patients involves how to prevent facet joint arthritis from getting worse and how to avoid surgery. The best way to avoid future complications related to facet joint arthritis (known as spondylosis in the medical world) is to work on your core strength! Many people take this advice for granted, because it seems quite obvious. Nonetheless, I always recommend that these patients consult with a good spine trained physical therapist for a core strengthening program. This can make a world of different in patients who adhere to an exercise regimen. Nonetheless, just as for disc-related concerns, I always impress upon individuals that if back pain is lasting more than two weeks and not improving it is time to consult with a physician. Another major signal that you should contact your physician is any constant back pain that occurs at night and interferes with sleep. This can be a sign of something more sinister that needs to be evaluated.

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