Drugs Are Not Part Of The Latest Recommendations For Treating Mechanical Back Pain
What the researchers found was surprising: for acute and subacute low back pain, the best and safest treatments are not medicines. The ACP made the following strong recommendation:
Most patients with acute or subacute low back pain improve over time regardless of treatment and can avoid potentially harmful and costly treatments and tests. First-line therapy should include nondrug therapy, such as superficial heat, massage, acupuncture, or spinal manipulation. When nondrug therapy fails, consider NSAIDs or skeletal muscle relaxants.
Because most mechanical back pain improves no matter what, we dont want to prescribe treatment that can cause harm. Because some medications carry significant risks, we really shouldnt be recommending these right off the bat. Rather, we should be providing guidance on heating pad or hot water bottle use, and recommendations or referrals to acupuncturists, massage therapists, and chiropractors. These therapies were somewhat effective, and are very unlikely to cause harm.
When Should I See My Doctor
If you have back pain and have lost feeling or movement in your limbs or are having problems controlling your bowels or bladder, call triple 000 immediately and ask for an ambulance.
You should see your doctor or other health care professional for further advice if:
- your pain bothers you
- your back pain doesnt improve after a few weeks or worsens
- you have symptoms such as weight loss, tingling or numbness in the legs, or problems with bladder and/or bowel control
- you have osteoporosis
You should see your doctor as soon as possible, if you have a history of cancer, are prone to infection, or use intravenous drugs.
For most people, back pain will resolve in a few weeks with appropriate self-care. After 2 months, 9 out of 10 people will recover from back pain.
Less Common Causes Of Low Back Pain
Inflammation of the joints of the spine sometimes causes back pain. Osteoarthritis is the common form of arthritis and usually occurs in older people. Ankylosing spondylitis is another form of arthritis that can occur in young adults and which causes pain and stiffness in the lower back. Rheumatoid arthritis may affect the spine but you are likely to have other joints affected too.
Various uncommon bone disorders, tumours, infection and pressure from structures near to the spine occasionally cause low back pain .
The rest of this leaflet is mainly about nonspecific low back pain – the common type of low back pain.
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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.
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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How Can Back Pain Be Prevented
In most cases, you can prevent back pain by making changes to your lifestyle.
Doing exercise helps to keep your back flexible and strong. Exercise improves your posture and helps your muscles to support your spine. Exercises that can help prevent back pain include:
- low-impact aerobic exercise
- strengthening exercises, such as lifting weights, climbing stairs or hiking hills
- stretching exercises, such as Pilates and yoga
Maintaining a good posture is important when you sit at home, in your workplace, or in your car. Try not to slouch, and use equipment that supports your back, such as a lumbar support or footstool if you need.
Keeping a healthy weight is also important. Excess fat can strain your back and lead to back pain, sciatica and inflammation.
Practise safe lifting in your home or workplace. Whenever you pick up a heavy load, squat down, hold the object close to your body, and lift with your legs.
In addition:
- Quit smoking Smoking increases your chances of developing persistent back pain.
- Relax Learning relaxation techniques and mindfulness can help to reduce stress and muscle tension in your back.
- Avoid high heels wearing high heels can place strain on your back.
How Is Low Back Pain Diagnosed
Your doctor or healthcare professional will likely use a combination of physical examination and analysis of your medical history to diagnose your back pain. For instance, if youve had a back injury in the past, this new bout of back pain may well be related to that. Whats more, the physical examination might involve stretches to test flexibility, as well as feeling the area for inflammation.
If required, your doctor or physical therapist can request a CT scan, MRI, or X-Ray to get a better idea of the extent of your back injury. From there, your healthcare professional will be able to devise a treatment plan.
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Understanding The Lower Back
The lower back is also called the lumbosacral area of the back. It is the part of the back between the bottom of the ribs and the top of the legs.
Most of the lower back is made up from muscles that attach to, and surround, the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a disc. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel-like centre. The discs act as shock absorbers and allow the spine to be flexible.
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.
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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.
How To Treat Lower Back Pain From Deadlifting
There are actually quite a few easy steps you can take when treating a sore back from deadlifts. Heres what you need to do for deadlift back pain recovery.
Step #1: Stay Active
The absolute worst thing you can do after hurting your back is doing nothing. Often, when we break our back, our first inclination is to stay home and rest it. DONT!!!
Staying at home and sitting down is only going to exacerbate the problem. As you sit there, the inflammation is going to grow and further stiffen the muscle. All this is going to cause more pain.
Second, youre not doing anything to help expedite the muscle restrengthening needed to get back to full capacity.
For example, multiple studies have shown that merely walking can effectively treat low back pain as a complete exercise regime with resistance training. The range of improvements was found in overall pain reduction, quality of life, and confidence to return to normal activities.
Walking could be the best first exercise choice after an injury as its low impact and doesnt require bending or mobility. Further, you can combine walking with other protocols to troubleshoot the issue from multiple angles.
A range of times have been found to be effective but generally falls somewhere between 30 to 60 minutes. This walking should be done at a moderate intensity or brisk walk.
Step #2: Follow a Mobility And Strengthening Routine
1. The McGill Curl Up
2. Bird Dogs
3. Side Plank
Step #3: Perform Posterior Chain Movements
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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.
Rub On Medicated Creams
Skin creams, salves, ointments, or patches may help when your back feels stiff, sore, and tense. Many of these products contain ingredients such as menthol, camphor, or lidocaine that can cool, heat, or numb the affected area.
Put on creams right where you hurt. Ask someone to apply it if you have trouble reaching the spot.
âIt’s not going to be a mainstay at providing significant relief, but it can calm things down,â Ray says.
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When Are Diagnostic Tests For Lower Back Pain Necessary
Many patients do not need X-rays in the first few weeks of pain because their pain will end up resolving. Many more do not need CT scans or MRI imaging, which are overly sensitive and often reveal abnormalities not related to the patients pain. These forms of imaging can be extremely useful, however, if a person has chronic or severe pain, and/or neurological symptoms. Blood tests may be ordered if an infection or tumor is suspected.
What Causes Lower Back Pain
Many injuries, conditions and diseases can cause lower back pain. They include:
- Strains and sprains: Back strains and sprains are the most common cause of back pain. You can injure muscles, tendons or ligaments by lifting something too heavy or not lifting safely. Some people strain their back by sneezing, coughing, twisting or bending over.
- Fractures: The bones in the spine can break during an accident, like a car crash or a fall. Certain conditions increase the risk of fractures.
- Disk problems: Disks cushion the vertebrae . Disks can bulge from their position in the spine and press on a nerve. They can also tear . With age, disks can get flatter and offer less protection .
- Structural problems: A condition called spinal stenosis happens when the spinal column is too narrow for the spinal cord. Something pinching the spinal cord can cause severe sciatic nerve pain and lower back pain. Scoliosis can lead to pain, stiffness and difficulty moving.
- Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain. Ankylosing spondylitis causes lower back pain, inflammation and stiffness in the spine.
- Disease:Spine tumors, infections and several types of cancer can cause back pain. Other conditions can cause back pain, too. These include kidney stones and abdominal aortic aneurysm.
- Spondylolisthesis: This condition causes the vertebrae in the spine to slip out of place. Spondylolisthesis leads to low back pain and often leg pain as well.
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Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
Chronic Lower Back Pain
When back pain continues for more than three months, it is considered chronic. Although for most people an episode of back pain is over by that time, in some cases it progresses and can have a major impact on ones ability to function. For some patients, physical therapy with local heat or ice application , combined with a home exercise program and education in proper positions for lifting and other movement techniques can make a major difference. Patients must learn to tolerate a certain degree of pain, or they may allow themselves to become more disabled than necessary. Patients at the Hospital for Special Surgery have had success with graded exercise to work through the pain, gradually increasing the exercise quota at each session so they can learn to tolerate more exercise in spite of the pain, and get back to work and activities. Read more detail on this topic in .
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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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Tips For Dealing With Lower Back Pain
By Robert Greenleaf, MD, Spine Surgeon
Lower back pain is extremely common and one of the top reasons for missed workdays. Thats because the lower back supports the weight of the upper body and is subject to a lot of stress and strainespecially during everyday movements like lifting and twisting.
One of two things typically causes lower back pain: a sudden injury or the wear and tear of aging, arthritis and physical activity. No matter the cause of your lower back pain, here are 10 recommendations that can help you relieve it and prevent future problems.
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Signs Your Back Pain Might Be An Emergency
In our 20s and 30s, normal back pain often can be attributed to factors of daily life, such as sitting too long, picking up children, or overdoing it while exercising.
In our 40s and older, work injuries and the beginnings of arthritis and degenerative conditions are more common.
Back pain is so common, in fact, that many patients shrug off symptoms that might indicate a medical emergency.
Approximately 80% of adults will experience back pain in their lives, so its important to be able to identify the severity of your symptoms and track how long the pain lasts.
If back pain can be associated with a specific activity, such as lifting or twisting wrong, and the pain goes away within 72 hours after resting and applying ice, its usually nothing to worry about. However, if pain creeps on gradually, appears suddenly, or doesn’t go away, you might have a more serious condition.
