Low Back Pain

What is Low Back Pain?

Low back pain can affect the back anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body's weight. Because of these roles, it is easily injured when you lift, reach, or twist.

Almost everyone has low back pain at one time or another.  The good news is that most low back pain will go away in a few weeks with some basic self-care. But if your pain is severe or lasts more than a couple of weeks, see your doctor.

How does one know if he/she has Low Back Pain?
Low back pain is commonly provoked by physical activities and relieved by rest, often due to stress or strain to the back muscles, tendons and ligaments and is usually attributed to strenuous daily activities, heavy lifting, or prolonged standing or sitting. It is often a chronic dull aching pain of varying intensity that affects the lower spine and might spread to the buttocks. The pain often progressively worsens during the day because daily physical activities such as bending, twisting, lifting, prolonged sitting and standing often aggravate the pain. Neurological symptoms such as sharp shooting pain that runs from the low back area down to the legs may also be present.

What are the symptoms?
Depending on the cause, low back pain can cause a range of symptoms. It may:
•    Be dull, burning, or sharp.
•    Be felt at a single point or over a broad area.
•    Come on gradually or suddenly.
•    Occur with muscle spasms or stiffness.
•    Cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee.

These symptoms can occur on their own or along with low back pain. Leg symptoms are often caused by lower spine problems that place pressure on a nerve that leads to the leg.  A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs, along with loss of bladder or bowel control.

Doctors say back pain is:
•    Acute if a spell (or episode) of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of home treatment.
•    Recurrent if acute symptoms come back. Most people have at least one episode of recurrent low back pain.
•    Chronic if your back bothers you most of the time for longer than 3 months.


Who are at risk & what are the risk factors of having Low Back Pain?
Persons who are required to lift, reach, push, pull, and carry objects and those whose work requires prolonged static positioning are at risk of having low back pain.

Low back pain is often triggered by some combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine. Less commonly, low back pain is caused by illness or spinal deformity.

A risk factor is something that increases your chances of having back pain. More risk factors mean you have a higher chance of having back pain.

Risk factors that you cannot change include:
•    Being middle-aged (risk drops after age 65).
•    Being male.
•    Having a family history of back pain.
•    Having had a previous back injury.
•    Being pregnant. A woman's back is significantly stressed by carrying a baby.
•    Having had compression fractures of the spine.
•    Having had previous back surgery.
•    Having spine problems since birth (congenital spine problems).

Risk factors that you can change with lifestyle changes or medical treatment include:
•    Not getting regular exercise.
•    Doing a job or other activity that requires long periods of sitting, lifting heavy objects, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment.
•    Smoking. Smokers are more likely than nonsmokers to have low back pain.
•    Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proven. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility.  These can lead to low back pain.
•    Having poor posture. Slumping or slouching alone may not cause low back pain, but once the back has been strained or injured, bad posture can make pain worse.
•    Being under stress. Stress and other emotional factors are believed to play a major role in low back pain, particularly chronic low back pain. Many people unconsciously tighten their back muscles when they are under stress.
•    Having long periods of depression.
•    Using medicines long-term that weaken bones, such as corticosteroids.

What happens when you have Low Back Pain?
Long-lasting (chronic) pain not only makes you tired, irritable, and less productive and active, but it can trigger other problems. If your back pain causes you to use your body in different ways (for example to limp or to sit differently), pain can develop in other areas of the body. Pain can also cause biochemical changes in your body that tend to keep the pain going. Without specialized treatment, chronic pain syndrome can become disabling.

How is Low Back Pain Diagnosed and who do you consult?
Diagnosis of low back pain may be difficult. It begins with careful definition of the character and the precise location of pain, which may be localized (at the site of pathology and associated with tenderness); diffuse (arising from a deperlying tissue); radicular (arising from the back area down to the legs); or referred (due to spinal or visceral disease that shares the same spinal segment distribution as the site where the pain is perceived).

Mechanisms that intensify the pain are also important diagnostically: limitation of back motion because of pain and tenderness of the paravertebral muscles is common in all conditions, but increased pain following Valsalva's maneuver (coughing or sneezing), limitation of straight leg raising, loss of reflexes, and sensory change are more characteristic of conditions affecting spinal nerve roots and sciatic nerve.

Once a person already experiences pain on low back area, consulting a Physiatrist or a Rehab Doctor will be of great help. Also, correction of static or dynamic postural abnormalities is helpful. An exercise program consisting of abdominal and back strengthening exercise is necessary. 


What are the available treatment options?
If you have moderate to severe that lasts more than a couple of days, back or leg symptoms that have gotten worse or have not gone away after 2 weeks of home treatment, or improved symptoms that flare up again, see your doctor. A physical exam and possibly an imaging test may produce new information about your condition and help direct your treatment decisions.
If no serious cause of mild to moderate low back pain is apparent (as in 85% of cases), your health professional will probably advise you to continue with home treatment.  Consider seeing a physical therapist for back-healthy exercises to use every day, as long as they don't make your symptoms worse. A medicine to reduce swelling, moist heat application, massage, cognitive-behavioral therapy, learning how to best use your back in a “back school” program, chiropractic therapy, or biofeedback may also help prevent your symptoms from becoming chronic.

If your pain is severe, your doctor may recommend short-term use of an opiate painkiller, epidural steroid injection, or muscle relaxant.  These medications have potential harms and side effects, but these may be balanced out if the medicines help you. Talk with your doctor about the expected benefits and side effects of any medicine.

If your pain is caused by another health problem, such as a herniated disc, spinal stenosis, ankylosing spondylitis, osteoarthritis, cancer, or infection, your doctor will make specific treatment recommendations.

If you have a herniated disc, your doctor may recommend surgery. Most doctors will wait to consider surgery until after you have tried nonsurgical treatment for 1 to 3 months without improvement (but usually before more than 6 months have gone by). Surgery is eventually considered for about 1 out of 10 people who have a herniated disc.


Do’s and Don’ts in Caring for your Neck and Back

Do’s : Sleeping

•    Do lie on back with a pillow under knees.
•    Do lie on side with knees bent.  A pillow between knees may prove comfortable.

Ø    Bed mattress should support the normal curves of the spine.  Sleep on a firm mattress; put a bed board (3/4” plywood) under a soft mattress.
Ø    Frequent changes of position will minimize discomfort.
Ø    Choose the position that feels most comfortable for you.

To assume sitting from lying

From lying position, roll from back to side with knees bent.  Then swing legs over edge of bed while pushing up with elbows and hands.

Do place a pillow or rolled up towel at your back for support.  The pillow should be comfortable and fit the shape of the normal curve in your low back.

Do keep one or both knees higher than your hips.  A small stool is helpful.  For the short rest periods, a contour chair offers excellent support.

To assume standing from sitting

Do scoot to the edge of the chair with your arms at the armrest.
Then push from armrests of chair while straightening knees.

Lifting

Do, face the object and bend your knees.  Keep the object close to your body and maintain your NORMAL spinal alignment.  Avoid sudden movements and twisting.

Do bend with your knees, not your back!

Lift with your legs and hold objects close to your body.  Lift objects only chest-high; stand on a stool, if necessary.  Make sure you lift properly.  Bend your knees and use your leg muscles to lift.  Avoid sudden movements.  Try not to lift anything heavy over your head.

Do move the object by pushing, pulling, sliding or rolling rather than lifting it when possible (pushing is better than pulling)

Do perform push or pull.

Do ask for assistance when the load is too heavy and plan ahead to avoid sudden load shift.


Working

Frequent breaks during work are important to allow tensed muscles to relax and to decrease stress on the spine. Lying down or stretching for 15-20 minutes during the middle of each day will accomplish
these goals.

Do stand with one foot up; change position often. Stand with your back's three natural curves in their normal, balanced alignment.  Walk with good posture, keeping head high, chin tucked in toes straight ahead.  Wear comfortable, low-heeled shoes.

Do get a hard seat for your automobile. Sit close enough to the wheel while driving so that your legs are not fully extended when you work the pedals. Move your car-seat forward to keep knees level with hips. Sit straight. Drive with both hands on the wheel.

Reaching

Do stand in a footstool or ladder to reach for an object that is above the head or to place an object above the head and move the object close to your body before lowering it.

Don’ts : Sleeping

Don't sleep or lounge on soft, sagging, non-supporting mattresses or cushions. Sway back and back strain may result.
Don't lie on back without pillow under knees.
Don't lie on sides without pillow in between knees.

To assume sitting from lying

Do not get up from bed without turning to side first so that back muscles will not be strained. Muscles of the arms should be utilized when assuming sitting from lying.

Sitting

Don't slump/slouch while in front of the computer and don't sit in a chair without any lumbar support because these might cause muscle strain on low back area.

Avoid leaning forward and arching your back to prevent neck and upper back pains.

Don’t sit in a chair that’s too high or too far from your work.

To assume standing from sitting

Do not stand from a chair without holding to or pushing to chair’s armrest.  If the chair doesn’t have any arm rest at all, pushing against your lap may be a good alternative.
Lifting

Do not bend forward from the waist.  Bend the hips and knees.  Keep your head and shoulders erect and maintain the NORMAL alignment of your spine.

Do not lift heavy objects alone.

Working

Do avoid becoming over-fatigues.  Avoid sitting in any position for longer than twenty minutes.  Do not sit in a soft chair and deep sofas.

Driving

Do not sit in your car without a lumbar support.  Don’t sit too far to the wheel while driving so that your legs and arms are not fully extended when you work on the pedals.

Reaching

Do not simultaneously reach and twist your body.  Do not reach for an object that is placed too high from you without using a footstool or ladder.


How can The Medical City help you?

At The Medical City we have a complete roster of competent physicians who may assess and treat people with different types of low back pain.  For further inquiries or if you may want to seek consult, please call:

Center for Patient Partnership at (632) 988-1000 / (632) 988-7000 ext. 6444
   
Physical Medicine and Rehabilitation at (632) 988-1000 / (632) 988-7000 ext. 6382

Note:  This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.  If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.