The Importance Of An Accurate Diagnosis
The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI , or CT scan is unnecessary.
There may also be certain clues in a patients medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to , a condition in which a bulging disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg, which can go to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.
A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.
When tumor or infection are suspected, the doctor may order blood tests, including a CBC and sedimentation rate. .
When To Seek Medical Attention For Back Pain
Most episodes of lower back pain eventually resolve on their own, but there are times when you should seek urgent medical attention. Some of these situations include:
Patient is a child
Weakness, numbness and/or tingling sensations develop in the legs and/or feet
Loss of bladder or bowel control
Pain is severe, constant, suddenly or progressively worsens, and/or doesnt go away
Pain interrupts sleep
While some situations may warrant immediate intervention, most cases are not urgent and can be scheduled at a time convenient for the patient.
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.
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Maintain Correct Posture During Activities
To protect your lower back from injury, its important to maintain proper posture when performing physical activitiesespecially if you play sports or have a job that requires repetitive motions. Avoid slouching as much as possible and aim to keep your spine erect. When lifting, bend and straighten from the knees, not the waist. And be sure to move your hips when twisting from side to side.
How Is Back Pain Treated
Acute back pain usually gets better on its own. Acute back pain is usually treated with:
- Medications designed to relieve pain and/or inflammation
- analgesics such as acetaminophen and aspirin
- non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be sold over the counter some NSAIDS are prescribed by a physician
- muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles
- topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
Exercising, bed rest, and surgery are typically not recommended for acute back pain.Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.
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Maintain Correct Posture When Sitting
You can avoid lower back pain by maintaining proper posture when sitting. If you have a desk job, keep your feet planted on the floor and use a chair that provides lower back support. Also, avoid hunching forward to see your computer screen and reaching far in front of you to use your mouse or keyboard.
Lumbar Flexion Rotation Stretch
The flexion rotation stretch is started by lying on one side. Usually, your painful side is down on the table. Straighten your bottom leg, and tuck your top leg behind your bottom knee.
Reach your top hand to your top shoulder blade, and rotate your spine so your top shoulder moves backwards toward the floor. Hold this position for a second or two, and then return to the starting position. Repeat 10 repetitions, and note any changes in your symptoms.
Still dealing with symptoms? You may need to try a lumbar flexion progression. Check out the final step in this program to learn how to get started on that.
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Don’t Rest An Achy Back
Doctors used to prescribe bed rest for back pain. But now we know that lying still is one of the worst things you can do. It can make back pain worse and lead to other complications. Don’t rest for more than a day or two. It’s important to get up and slowly start moving again. Exercise has been found to be one of the most effective ways to relieve back pain quickly. Try swimming, walking, or yoga.
When To See A Doctor
People can often treat back pain with home remedies and some patience. However, a person should speak with a healthcare professional about chronic or severe back pain.
A healthcare professional may recommend physical therapy, medication, or other treatments. People with existing health conditions or who take regular medications should speak with a medical professional before trying herbal medications or supplements.
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Prone Lying Prone Props And Press Ups
In the case of sudden onset of acute low back pain, you should try the emergency back pain exercises first. Lie on your stomach for a few minutes, then prop onto your elbows for a minute or two. Monitor your symptoms for centralization.
After a few minutes in the propped up position, try a few press ups. Try to keep your hips and back relaxed as you use your arms to press your upper body up. Try to press up as far as possible to restore the normal forward curve in your low back. Say to yourself, “Further, further, further” as you press up. Move your spine through the full, pain-free, range of motion. Perform 10 repetitions and monitor your symptoms.
If your pain does not fully centralize with the press up exercise, you may need to move on to the next exercise: the press ups with your hips off center.
Exercises To Fix Back Pain At Home
After stretching the area and getting an understanding of your individual range of motion and pain tolerance the next step to fixing back pain at home is to strengthen the surrounding musculature.
This is important to reduce the likelihood of injury again and restore full range of motion in the future pain-free.
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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.
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:
- , 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
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Complementary Alternative Emerging Treatments
In some cases, doctors suggest therapies that are not considered current standard of care. They probably wont be covered by insurance, but they may be worth considering. Examples include:
. 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.
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.
. 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.
How Is Back Pain Diagnosed
Your health professional will first assess your back pain. They may ask questions including:
- When did your back pain begin?
- What activities were you doing differently to normal before your back pain started?
- How would you describe the pain? Is there tingling or numbness?
- What makes the pain better or worse?
If your pain doesnt settle after a few weeks or starts getting worse, ask your doctor or other health care professional about other management options. You may be referred for tests if there is reason to suspect a more serious cause for your back pain.
Unnecessary tests can be expensive, and many investigations will show changes in your spine that reflect the normal passage of time, rather than damage to your spine.
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Lower Back Pain Caused By Infection
Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.
When Should I Call My Healthcare Provider
- Can’t stand or walk
- Temperature over 101.0°F
- Frequent, painful, or bloody urination
- Severe belly pain
- Pain or numbness in your leg
- Pain in a new area of your back
- The pain isnt decreasing after more than a week
- Pain radiating down the leg.
- Pain that is accompanied by fever or chills, leg weakness, or loss of control of the bladder or bowels.
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Find Activities That Make You Happy
Ongoing back pain can wreak havoc on your life, affecting your cherished relationships, finances, and your ability to get stuff done at work and at home. Finding activities that make you happy can help reduce some stress and may relieve some pain.
Some people find that even doing just 3 things that make them feel good each daysuch as enjoying a comforting cup of tea or coffee, calling an old friend, walking the dog, or receiving a longish 30-second hug from a loved onecan make pain more tolerable.
What Are The Symptoms Of Low Back Pain
Low back pain is classified as acute and chronic. Acute low back pain lasts from a few days to a few weeks. Most acute low back pain will resolve on its own. Chronic low back pain lasts for more than 3 months and often gets worse. The cause of chronic low back pain can be hard to find. These are the most common symptoms of low back pain. Symptoms may include discomfort or pain in the lower back that is:
- Protruding or herniated disk
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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.
Can Back Pain Be Prevented
Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress , vibration, repetitive motion, and awkward posture.Recommendations for keeping ones back healthy
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Treatment Options For Acute Lower Back Pain
Most low back pain is due to muscle strain and spasm and does not require surgery. To treat the pain, medications such as acetaminophen , nonsteroidal anti-inflammatory agents , gabapentin or pregabalin can be used. NSAIDs suppress inflammation, pain and fever by inhibiting certain inflammation-causing chemicals in the body. Acetaminophen reduces pain and fever, but does not inhibit inflammation. Gabapentin and pregabalin, medications that have been used for antiseizure activity, also have the ability to block pain. Opioids provide pain relief and may at times be prescribed to manage severe back pain. However, opioids have many problems, such as habituation, constipation and lightheadedness, and are avoided when possible and used for the shortest possible duration. Epidural injection is an option if the back pain does not respond to these treatments. Each person is different in terms of response to medication.
Other nonsurgical treatments for lower back pain include Intradiscal electrothermal therapy , nucleoplasty, and radiofrequency lesioning.
Which Low Back Exercise Is Right For You
If you are experiencing pain on one side of your back or leg, then try the first exercise and monitor symptoms as you exercise. Watch for centralization, which is a decrease in leg or thigh pain and an increase in low back pain. Centralization that occurs while you are performing an exercise is a good sign and indicates that the particular exercise is the correct one for you to be doing.
If your symptoms worsen, fail to centralize, or only centralize partially, move on to the next exercise in the list. Attempt the exercise, and monitor any changes in your symptoms. Remember pain that moves closer to your spine is a good sign.
Before starting any exercise for your back, it is a good idea to check in with your healthcare provider to be sure that exercise is safe for you to do. Your local physical therapist can help you decide on the best exercises for your specific condition.
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