How Is Lower Back Pain Diagnosed
Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.
Your provider may order:
- Spine X-ray, which uses radiation to produce images of bones.
- MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
- CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
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Electromyography to test nerves and muscles and check for neuropathy , which can cause tingling or numbness in your legs.
Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain . Urine tests check for kidney stones, which cause pain in the flank .
Stop Trying Passive Treatments
Passive treatments like heat, ice or ultrasound may feel good, but their effect is usually only temporary. Most research indicates that active self-care exercise and postural correction is an effective remedy for low back pain.
A visit to your physical therapist can help determine which exercises are best for your specific condition.
Press Up With Hips Off Center
The press ups with hips of center is simply a press up with your hips moved to one side or the other. To do this, prop onto your elbows and shift your hips to one side. Most often, people benefit from moving their hips away from the painful side.
Once your hips are off to one side, perform a press up. You may notice that you are not able to press up as far as you did with the regular press up, but still, try to press up as far as possible. Perform 10 repetitions of the press up with your hips off center, and monitor your pain for centralization. If your symptoms persist, you may need to take the next step in the progression: lumbar side glide in standing.
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What Are Some Common Lower Back Pain Causes
The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital or acquired meaning the disorder develops later in life.
- Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies , ligaments, muscles or soft tissues.
- Organic lower back pain is attributed to disease, such as spinal cancer.
- Idiopathic refers to an unknown cause.
These are some of the things your doctor might look for or rule out when you schedule a visit for back pain.
The common symptoms of lower back pain.
Sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. Theyre often related to overuse.
Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear .
Herniated disc. The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves
The Changing Face Of Spinal Surgery
Only a small percentage of patients with back pain are candidates for surgery, but for these patients, advances in techniques have made recovery a much easier road, says Boden of The Emory Orthopaedics and Spine Center.
Fifty years ago, a spine fusion meant a two-week hospital stay, a body cast or brace for months, and a minimum of six months away from normal activities. A spinal fusion is performed by fusing the vertebrae together with bone grafts to eliminate motion between two adjacent vertebrae where motion is causing lower back pain.
Today, minimally invasively techniques allow for smaller incisions, less blood loss, and faster recovery time, Boden says. Some spine fusion techniques can be done on an outpatient basis.
Fifty years from now, Boden predicts that disc replacement will be an alternative to spinal fusion. Moreover, gene therapy will be able to prevent or reverse disc degeneration, and genetic research will help discover genetic sources of back pain, he says.
“Gene therapy for disc regeneration may be more than five years off, but less than 20,” he predicts.
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Stretch #3 Lumbar Rotation
This is the first stretch in the series that is progressive assuming the previous movements were tolerable.
Laying on your back with your knees bent and feet flat, put your knees and feet together as if you had a mermaid tail. Next, take a deep breath in a and as you exhale slowly drop your knees to the side, inhale bringing the legs back up to the starting position and exhale again as you drop them to the other side.
You do not need to have your knees touch the floor, work within your own pain-free range of motion.
Working this movement side to side creates a rotational motion in the lumbar spine and can help reduce tension if you are trying to fix lower back pain at home. This is a great exercise because it is an unassisted stretch that targets the low back which can be a difficult area to alleviate pain on your own.
Lower Back Pain And Cancer
Cancer involving the lumbar spine is not a common cause of back pain. However, in people who have a prior history of cancer, for example, in the breast or prostate, or who have weight loss or loss of appetite along with back pain cancer needs to be considered.
Night pain can be a clue to cancer in the spine. A benign tumor called osteoid osteoma, which most often affects young people, causes pain that tends to respond well to aspirin. Multiple myeloma is a malignancy that occurs when the plasma cells in the bone marrow begin spreading uncontrollably. It is most common in older people, and can cause pain in many parts of the spine. When tumor or infection are suspected, blood tests may be ordered, including a CBC , sedimentation rate , and protein electrophoresis .
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Chronic Conditions That Cause Back Pain
Conditions that can lead to chronic low back pain include spinal stenosis, spondylitis, and fibromyalgia. Spinal stenosis is narrowing of the normal spinal canal through which the spinal cord passes. Spondylitis is chronic inflammation of the spine. Fibromyalgia is a muscle disorder that features chronic muscle pain and tenderness.
What Are Some Complementary Alternative And Emerging Treatments For Lower Back Pain
In some cases, doctors suggest therapies that are not considered standard of care. They probably wont be covered by insurance, but they may be worth considering. Examples include:
Platelet-rich plasma . PRP treatments use a small sample of your own blood that has concentrated amounts of blood building blocks known as platelets. Your doctor then injects the PRP directly into a damaged disc. The theory is that PRP injections use your own healing system to accelerate improvement of injured tendons, ligaments, muscles, and joints. PRP treatment has a longer track record in knee osteoarthritis, but a recent review article in the Journal of Spine Surgery suggests it may have a useful role for back pain, too. PRP needs a lot more research before it can be considered a proven technique.
Stem cells. In this emerging treatment, your doctor injects stem cells harvested from your hip into the intervertebral disc or discs causing your pain. Doing so may lessen pain and the degenerative effects of aging, though, like PRP, more research is needed before stem cells for lower back pain could eventually become the standard of care.
Acupuncture. Your doctor probably doesnt perform acupuncture , but may support you trying it as a complementary therapy. Acupuncture involves careful insertion of fine, sterile needles into specific points on your body. This may stimulate the release of your natural pain-killing chemicals.
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Try To Boost Your Mood
No, the lower back pain isnt in your head, but obsessing over it could be making it worse. Fear, anxiety, and catastrophizing can amplify pain, says Dr. Mackey. Because brain circuits that process pain overlap dramatically with circuits involved with emotions, panic can translate into actual pain. Start by accepting that you have pain, Dr. Mackey says. Then say to yourself, it will get better. If you struggle with overall mental wellbeingsay, you have anxiety or depressionin addition to your physical aches, it could be worth seeing a therapist to manage negative thought processes while exploring other lower back pain treatments.
Preventing Back Pain In Children
Back pain in secondary-school-age children has been linked to heavy schoolbags and ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from poor posture, carrying overloaded bags, and an unhealthy lifestyle.
The best schoolbag for your child is a well designed backpack. This should be worn over both shoulders to balance out the weight. A heavy satchel or shoulder bag can put stress on your childs spine.
Encourage your child to exercise regularly, or plan joint activities, such as a walk in the countryside or a trip to a swimming pool.
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Acupressure For Lower Back Pain
It sounds too easy to be true, but this amazingly simple technique is a powerful tool for lower back pain relief, sometimes instantly.
Acupressure, which can be done on your own at the comfort of your home, increases the production of endorphins, the bodys natural pain relievers.
Heres how to do it:
1. Place your fingertip between your nose and upper lip.
2. Apply deep pressure and hold this pressure for several seconds, then release. Repeat 5-10 times.
3. Next, place your fingertip between your inner ankle bone and Achilles tendon.
4. Apply deep pressure, hold for several seconds, then release. Repeat 5-10 times.
5. Finally, make a fist. On the outside of your hand near the pinkie finger locate the spot where the skin folds and bulges, and press there .
Referred Pain To And From The Lumbar Spine
Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back. Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve.. Sources of referred pain to the low back may include abdominal aneurysm , tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine. On the other hand, pain can be referred from the low back and be felt in another location, as is often the case with . For example, it is not rare for a patient with a slipped disc in the lower back to have pain in the back of the thigh, or in the calf or even the foot, and not have any low back pain. This situation requires a doctor to sort out the type of pain and to do the examination required to show that the pain is actually coming from the spine .
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Stretch Your Hamstrings Twice Daily
One often overlooked contributor to lower back pain is tight hamstrings. If your hamstring muscleslocated in the back of your thighsare too tight hamstrings your lower back and sacroiliac joints will be stressed, leading to more pain. Hamstring stretching should be done carefully and at least twice per day for 15-30 seconds each time.
There are many gentle stretching exercises that should not hurt.
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Expert Q& a: Back Strain Or Arthritis
Understand the difference between spinal arthritis and other types of back pain, and try these pain-relieving tricks.
Question: I am a 35-year-old man who has had pain in my lower back for the past couple of weeks, and Id like to know some methods for low back pain relief. Because my mother and an aunt both have arthritis, Im also wondering if I’m developing arthritis, too.
A: It’s possible, but very unlikely, that you have arthritis of the spine. The most common cause of acute low back pain in people your age is back strain. This condition is caused by strain to the muscles or ligaments supporting the spine or a herniation of the lumbar disks . It is not always possible to differentiate between the two causes, nor is it necessary. In the vast majority of cases, the pain improves and subsides over several weeks.
Assuming your problem is simple back strain , the following advice can help you achieve low back pain relief:
Doyt Conn, MD
Emory University School of Medicine
Atlanta, Georgia
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Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- Discectomy, such as a or removal of a portion of a
- a bone graft that promotes the vertebrae to fuse together
- removal of the lamina to create more space and reduce irritation and inflammation
References and useful links
- 1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
- Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.
- Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.
Low Back Pain Shouldn’t Sideline You
Explore the common but under treated and misunderstood issues that accompany chronic back pain in our Back Pain Series. Part 1 explains the latest treatments that could relieve that aching back.
Many Penn State alumni fondly remember David K., now 34, as the student who crawled to class. Mired by back pain throughout his four years of college, David saw tons of doctors from top neurosurgeons to psychologists for the pain. Instead of listening to the popular college music of his day like REM, he listened to the soothing sounds of pain expert John E. Sarno, MD, on cassette tapes called Mind Over Back Pain when he drove his Mustang around the college campus.
“If you don’t have chronic back pain, you can’t possibly imagine what it feels like,” he says. “It’s unbearable — literally.” He says that there were many times he couldn’t walk and would have to crawl from his fraternity house all the way to class so he would not miss a midterm or final exam. “My fraternity brothers made a lot of fun of me,” he says. “Still do.”
About 80% of Americans — or four in five — experience low back pain at some point in their lives and understand David’s plight all too well. Many people with chronic low back pain are working age and for them, back pain is the most frequent case of lost productivity. Treatment for back pain costs roughly $100 billion a year, according to the American Academy of Orthopaedic Surgeons in Rosemont, Ill.
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Bonus Tip: Soothe The Pain With Cold And/or Hot
Don’t underestimate the pain reduction of simply applying cold packs and/or hot packs to help reduce your lower back pain.
- Cold therapy helps reduce inflammation and pain. Some examples include wrapping ice in a cloth, a pack of frozen peas from the freezer, or a cold gel pack. Always keep at least one layer between your skin and the ice/cold pack.
- Heat therapy helps improve blood flow, relaxation, and pain relief. Heat therapy can come in many forms. It’s best to try several to find what works best for you. Taking a warm bath or shower, soaking in a hot tub, or using a heating pad or heat wrap are all ways to bring warmth to your lower back.
Whether applying ice or a heat pack, limit applications to 15 or 20 minutes with at least 2 hours of rest in between to protect your skin. Never sleep with a heating pad or frozen pack as this can lead to permanent skin damage.
Hopefully these overlooked remedies can help you try some new approaches to better manage your lower back pain and find lasting relief.
Stretch #5 Hip Flexor Stretch
Building off of the concept of posterior chain it is important to consider the anterior chain as well.
Deficits in strength and flexibility can lead to several issues and lower back pain is most commonly coupled with weak and tight hip flexors. The hip flexors are the iliacus and psoas muscles. They are primarily responsible for lifting the femur into flexion .
When the pelvis is tilted forward through sitting, poor exercise technique, etc. there is a higher likelihood that the hip flexors will be in a shortened position as they attach to the lower spine and inside of the pelvis.
Over time this can cause weakness and tightness and encourage lower back pain. Fixing this issue at home takes time, but can be done through a hip flexor stretch.
Kneeling on the ground with the front foot put far out in front of you lunge forward while keeping your trunk over your hips and head up. The stretch will occur in the front of the thigh and hip toward the medial part of the leg that you are kneeling on. Hold this stretch for 30 seconds breathing in and out then switch to the other leg.
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