Mechanical Lower Back Pain
Because it represents 97% of cases, mechanical low back pain deserves to be discussed first. To determine the factors that bring out the pain, the doctor will consider the following causes of mechanical low back pain:
- Spondylolisthesis .
- Osteoarthritis .
- Spinal stenosis .
Low back pain that gets worse with sitting may indicate a herniated lumbar disc . This is because certain positions of the body can change the amount of pressure that an out-of-place disc can press on a nerve. This is one reason we suggest to people with low back pain to periodically get up and stretch or walk around rather than continually stay sitting. Acute onset, that is, pain that comes on suddenly, may suggest a herniated disc or a muscle strain, as opposed to a more gradual onset of pain, which fits more with osteoarthritis, spinal stenosis, or spondylolisthesis.
What Are The Treatments For Lower Back Pain
Lower back pain usually gets better with rest, ice and over-the-counter pain relievers. After a few days of rest, you can start to get back to your normal activities. Staying active increases blood flow to the area and helps you heal.
Other treatments for lower back pain depend on the cause. They include:
- Medications: Your provider may recommend nonsteroidal anti-inflammatory drugs or prescription drugs to relieve pain. Other medications relax muscles and prevent back spasms.
- Physical therapy : PT can strengthen muscles so they can support your spine. PT also improves flexibility and helps you avoid another injury.
- Hands-on manipulation: Several hands-on treatments can relax tight muscles, reduce pain and improve posture and alignment. Depending on the cause of pain, you may need osteopathic manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief and restore function.
- Injections: Your provider uses a needle to inject medication into the area thats causing pain. Steroid injections relieve pain and reduce inflammation.
- Surgery: Some injuries and conditions need surgical repair. There are several types of surgery for low back pain, including many minimally invasive techniques.
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.
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Specialized Physical Therapy For Back Pain
Physical therapy is a type of treatment that uses targeted exercises to improve your strength and flexibility. By strengthening the muscles that support your back, you can take pressure off your spine and reduce back pain. Physical therapy can help you ease and manage pain so you can do everyday activities. And physical therapists are experienced in helping treat both acute and chronic back pain. Theyll guide you through exercises designed to manage your specific symptoms.
Physical therapy is often the best treatment option for back pain. Improving your muscle strength and learning how to perform daily activities without straining your back can resolve your chronic pain. It typically takes about six weeks to complete a back pain physical therapy program, though many people start feeling pain relief after their first visit.
What Are The Signs Of A Back Injury
Signs you may have injured your back include:
- pain or tenderness
- pain that worsens with movement, coughing, sneezing or laughing
- stiffness or difficulty moving
- pain that radiates down one or both legs
It is important to find out the cause of your symptoms so they can be treated properly.
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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.
When Should I See My Doctor
Apart from the signs of a serious back injury, you should see your doctor if:
- your problems have not improved at all within a few days
- your problems have not improved completely within 6 weeks
Your doctor may be able to help you manage any pain and may refer you for physiotherapy or other investigations.
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What Are The Warning Signs Of A Serious Problem
Very rarely back pain or pain that travels down the leg is a sign of a serious problem.
If you have any of the following symptoms, you should seek urgent medical attention:
- difficulty controlling or passing urine
- loss of control of your bowels
- numbness around your back passage or your genitals
- serious weakness in your legs so you find standing really difficult
- severe and ongoing back pain that gets worse over several weeks.
The above symptoms could potentially be linked to a rare but serious condition that needs urgent medical attention.
Who Treats Back Pain
Different types of health care providers treat back pain, depending on the cause:
- Pain specialists, who are physicians including anesthesiologists with specialized training in evaluation, diagnosis, and treatment of all different types of pain.
- Family or primary care doctors.
- Orthopaedists, who treat and perform surgery for bone and joint diseases.
- Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
- Neurosurgeons, who perform surgery for disorders and diseases of spine, brain, and nerves.
- Rheumatologists, who specialize in treating musculoskeletal diseases and autoimmune disorders.
- Physical therapists, who specialize in movement and strengthening muscles.
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Steroid Injections For Severe Back Pain
Cortisone injections are usually a temporary solution. While they can be effective at reducing inflammation and providing short-term relief, its recommended that patients try less invasive options first.
Common sprains and strains arent candidates for steroid injections. Rather, these are reserved for more extreme cases of chronic back pain like debilitating nerve pain and ruptured discs.
What Are The Symptoms Of Lower Back Pain
Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.
Pain may be sharp or dull and achy, and it may radiate to your bottom or down the back of your legs . If you strain your back during an activity, you may hear a pop when it happened. Pain is often worse in certain positions and gets better when you lie down.
Other symptoms of lower back pain include:
- Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
- Posture problems: Many people with back pain find it hard to stand up straight. You may stand crooked or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
- Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.
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Common Causes Of Chronic Back Pain
Chronic back painis usually age-related, but can also result from a prior injury. The mostcommon causes include:
- Arthritis of the spinethe gradual thinning of the cartilage inside the spine
- Spinal stenosisnarrowing of the spinal canal that may lead to nerve pain
- Disc problems, such as a herniated or bulging disc
- Myofascial pain syndromeunexplained muscle pain and tenderness
In some cases, its difficult to pinpoint the cause of chronic back pain.If your doctor has exhausted all diagnostic options, its time to seek asecond opinion from a back pain specialist, recommends Nava. Itsimportant not to make rushed decisions or undergo extensive medicalprocedures until the origin of the pain is found. Not only may they nothelp they could make the pain worse, warns Nava.
If the source of the pain is not known or cant be treated, your bestoption may be to work with your doctor on reducing the flare-ups and makingthe pain manageable with nonsurgical treatments.
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How Is Low Back Pain Diagnosed
Your doctor will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where youre feeling the pain. A physical exam can also determine if pain is affecting your range of motion.
Your doctor may also check your reflexes and your responses to certain sensations. This determines if your low back pain is affecting your nerves.
Unless you have concerning or debilitating symptoms or neurologic loss, your doctor will probably monitor your condition for a few weeks before sending you for testing. This is because most low back pain resolves using simple self-care treatments.
Certain symptoms require more testing, including:
- lack of bowel control
Likewise, if your low back pain continues after home treatment, your doctor may want to order additional tests.
Seek medical attention immediately if you experience any of these symptoms in addition to low back pain.
- problems with the ligaments and tendons in your back
If your doctor suspects a problem with the strength of the bones in your back, they may order a bone scan or bone density test. Electromyography or nerve conduction tests can help identify any problems with your nerves.
The Healthline FindCare tool can provide options in your area if you need help finding a doctor.
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Look Into Getting A New Mattress
How old is your bed? You may be surprised to learn that the average life span of a mattress is less than 10 years. Theres no hard-and-fast rule, says Sean Mackey, MD, PhD, chief of the division of pain medicine at Stanford University, but if your mattress is sagging significantly or is more than six to eight years old, Id think about getting a new one.
Something else to consider: A firm mattress may not do your back any favors, says Carmen R. Green, MD, a physician at the University of Michigan Back & Pain Center. A number of studies over the years suggest that people with lower back pain who sleep on medium-firm mattresses do better than those with firm beds, she says.
What Causes Lumbar Strain
Injury can damage the tendons and muscles in the lower back. Pushing and pulling sports, such as weight lifting or football, can lead to a lumbar strain. In addition, sports that require sudden twisting of the lower back, such as in tennis, basketball, baseball, and golf, can lead to this injury. Certain risk factors, such as excessive lower back curvature, forward-tilted pelvis, weak back, or abdominal muscles, and tight hamstrings, can increase the risk for this injury.
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Rest But Not Too Much
Dont rest too long. A little couch time wont hurt, but light activity speeds recovery, so avoid lying down for long periods of time.
Growing evidence shows there is little or no benefit to bed rest over staying active.
So use this rule of thumb: listen to your body.
Ultimately, your level of pain will determine your level of activity.
If a certain activity led to a pulled muscle dont repeat it for at least a week.
For example, if your back pain started after lifting something heavy, avoid lifting heavy objects for at least a week while your pulled back muscle heals.
Also, avoid sitting for too long. Long periods of sitting can tighten your muscles and cause lower back muscle pain and stiffness.
When you sit and stand, use good posture, avoiding slumping in your head and shoulders.
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
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Fractures And Lower Back Pain
are often very difficult pain problems and indicate the possible presence of . In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma the patient does not have to fall to fracture a vertebrae.
Patients with spinal compression fractures experience spasms and, often, very high pain levels.
In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI can often reveal these fractures.
It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.
Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. may be needed for pain control, for as brief a period as possible.
Find A Physical Therapist
This can make a big difference, especially if youâve had the pain for more than 4-6 weeks. With techniques like electrical stimulation, ultrasound, heat, and muscle relaxation, these specialists help you get more mobile and flexible.
They can also teach you exercises to do on your own to keep your symptoms from coming back. These can help your posture and keep your back and abdominal muscles healthy.
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Low Back Pain Diagnosis
Getting diagnosed with a specific cause of low back pain is the first step to getting treatment. If you land in your doctors office hoping for back pain relief, theyll use a variety of diagnostic tools and methods, such as:
A thorough medical history including any recent injuries, other diagnoses, family history of disease, and your job, activities and other lifestyle considerations
Physical exams, which may include manipulating the painful area or reflex or other neurological tests
Electromyography, which measures muscle and nerve function
ImagingX-rays can show bone spurs and damage to bone, while CT scans and MRIs can depict damage to soft tissue like discs or ligaments
Treating Chronic Back Pain
There are two main types of back pain treatments short-term and long-term. Short-term treatments are like a temporary patch, theyll help you manage your pain for a set period of time, but the pain will eventually return. The goal of long-term back pain treatments is to provide lasting relief. Both types of treatments have their purpose.
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Stretches And Exercises For A Pinched Nerve In The Back
Always discuss any stretches and exercises you may be considering with your doctor before you try them. You want to make sure you dont worsen your symptoms or do anything that causes more pain.
Use a yoga mat, towel, or carpet to lie on when engaging in these stretches. You should do two to three repetitions of these stretches each time, and make sure to take deep breaths while stretching.
What Are The Risks
Long bed rest can lead to slower recovery.Staying in bed for any prolonged period can make you stiff and increase pain. When you dont move and bend, you lose muscle strength and flexibility. With bed rest, you lose about 1 percent of your muscle strength each day. And you can lose 20 to 30 percent in a week. It becomes more difficult to return to any activity. As you become weaker and stiffer your recovery takes longer.
Who needs bed rest?Almost no one! The only people who might require time in bed are those with unstable spinal fractures awaiting surgery.
What can I do for the pain?Hot or cold packs often help. Some people can get pain relief from non-prescription analgesics or anti-inflammatory drugs such as ibuprofen or naproxen . But no medication should be taken for an extended period of time.
When should I see a health care provider?You should see your health care provider right away if:
- You have severe continuous back pain that lasts longer than 48 hours.
- You have severe continuous back pain and fever.
- You have back pain with accompanying pain, numbness or weakness in one or both legs or feet. Your leg symptoms are more disabling than your back symptoms.
- You have back pain and the onset of numbness in your private/genital region or changes in your ability to control your bladder and bowel function.
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