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.
What Is The Treatment For Chronic Nonspecific Low Back Pain
Initial treatment is similar to sudden-onset attacks. That is, aim to keep as active as possible. Also, painkillers can help. In addition to the painkillers listed above, your doctor may advise a course of an antidepressant medicine in the tricyclic group – for example, amitriptyline. Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including back pain.
Also, a national guideline , referenced below) recommends one or more of the following treatments should be considered. Each of these treatments has some evidence from research trials to suggest that they will help to ease symptoms in some people :
- Structured exercise programme. This means a programme of exercise supervised by a professional such as a physiotherapist. This is likely to be in a group setting. Exercises may include aerobic activity, movement instruction, muscle strengthening, posture control and stretching. It typically consists of up to eight supervised sessions over 8-12 weeks with encouragement to keep on doing the exercises at home between sessions.
- Manual therapy. Typically this includes several sessions of massage, spinal mobilisation and/or spinal manipulation. With spinal mobilisation the therapist moves the joints of the spine around in their normal movement range. In spinal manipulation, the therapist moves joints beyond the usual range of movement.
- A course of acupuncture. It is not clear how this may work.
Avoid Prolonged Static Posture
It is important to pay attention to the joints and muscles of your spine and hip. Prevent fatigue and stresses on these joints by following simple tips, such as:
- Avoid excessive sitting or consider using a standing desk while you work. When you sit for a long duration, the pressure on your spinal discs increase. Aim to get up every hour and walk a short distance to take the load off your discs.
When you have a flare-up of symptoms, consider less exertive activities, such as reading a book, listening to music, or crafting. These activities can help divert your mind from the pain and let your back rest at the same time.
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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 .
What To Do When Low Back Pain Occurs
If you are currently experiencing low back pain, gentle self-care exercises should be started to restore mobility and decrease pain. Since poor posture is a major cause of low back pain,maintaining proper posture is important. Use a small pillow or towel roll to support the spine while sitting. Remember, if pain prevents you from exercising or if pain persists for more than 2-3 weeks, a visit to a physician, physical therapist, or other healthcare provider is necessary.
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Symptoms Of Lower Back Pain
The symptoms of lower back pain can vary from person to person. It may come on suddenly, perhaps after youve lifted something heavy or moved in a way thats hurt your back. Or it may come on gradually over time or for no clear reason. Some people get a dull pain in their back, while others describe it as more of a tearing or burning pain. You may find certain things make the pain worse, and other things help to relieve it. The pain can range from mild to severe.
If you have sciatica, pain can spread from your back or buttock down your leg, sometimes as far as your foot or toes.
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.
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Prevention Of Lower Back Pain
Looking after your back can help to reduce your risk of getting back pain. It can help to do the following.
- Get plenty of exercise. Keeping active with regular exercise can help to prevent back pain coming back, or reduce your risk of getting it in the first place.
- Take care with lifting and carrying heavy items. Dont lift or carry more than you can manage, and make sure youre using the right technique. This means slightly bending your back, knees and hips when lifting, rather than stooping from your back.
- Keep a good posture. If you work at a desk, make sure your chair, desk and computer screen are set up correctly. Your employer should be able to assess your workstation.
- Move regularly dont sit in the same position for long periods of time.
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.
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 .
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Should I Use Ice Or Heat
Both heat and ice can help in different circumstances. Heres a quick guide:
- Use ice if your pain occurs as a result of a direct injury, for example, after a fall, knock, sprain, or strain. Apply an ice pack for 10 minutes several times during the day. The cold lowers body temperature and helps to constrict blood vessels, reduce swelling, and inflammation. Cold will also help to reduce muscle soreness. But dont apply ice directly to the skin as this can cause an ice burn, instead always wrap in a cloth or towel
- Use heat if your pain is more ongoing . Taking a hot bath or placing a hot water bottle on the affected area can often help
- Use a combination of ice and heat to help manage your pain. For example, use heat to warm up stiff muscles in the morning or before you go to bed and apply an ice pack for pain, where theres inflammation through exertion, during the day. The cold will help to reduce inflammation and the heat aids in tissue healing
Stretch #1 Knees To Chest
More than anything this stretch it to make sure you are in a position to move forward to more complex and intense movements. But it also allows an opportunity to get simple range of motion in the legs and pelvis to stretch the surrounding musculature.
Doing this exercise to fix lower back pain at home you will want to start with finding a comfortable place to lay down on your back.
Slowly bring your knees to your chest and grab the front of your knees with your hands pulling your legs closer to your body as able. You should feel a sensation in the glutes and hamstring as well as the lower back where you are experiencing pain.
Hold this stretch for 30 seconds, take a break, and then repeat to give your low back relief.
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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 Is The Outlook
Most of us will have a bout of nonspecific low back pain at some point in our lives. The severity can vary. However, it is difficult to quote exact figures as to outlook . This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:
- Most nonspecific back pains ease and go quickly, usually within a few weeks.
- In about 4 in 10 cases, the pain has completely gone within four weeks.
- In about 7 in 10 cases the pain has completely gone within one year.
However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.
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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.
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.
Watch:Wall Hamstring Stretch for Low Back Pain Relief Video
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Find Relief Through Ice And Heat
Break out that bag of frozen peas for the first 48 hours after the pain sets in, and put it to use for 20 minutes a session, several sessions per day. After those two days are behind you, switch to 20-minute intervals with a heating pad.
Localized cooling shuts down capillaries and reduces blood flow to the area, which helps ease the swelling, says Lisa DeStefano, DO, an associate professor at Michigan State Universitys College of Osteopathic Medicine in East Lansing. Cold also thwarts your nerves ability to conduct pain signals. Heat, on the other hand, loosens tight muscles and increases circulation, bringing extra oxygen to the rescue.
First A Few Quick Tips
Stretch your lower back with safety and care. Be especially gentle and cautious if you have any type of injury or health concern. Its best to talk with your doctor first before starting any new types of exercise.
You can do these stretches once or twice a day. But if the pain seems to get worse, or youre feeling very sore, take a day off from stretching.
Be mindful of your bodys limits and dont push your body to do too much. Listen to your body and do what feels best for you in each moment.
As you go through these stretches, take your time and pay close attention to your breathing. Use your breath as a guide to make sure you dont strain or overdo it. You should be able to breathe comfortably and smoothly throughout each pose or stretch.
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Dysfunction Of Sacroiliac Joints
Dysfunction of the sacroiliac joints is also called sacroiliitis. You have two sacroiliac joints, one on each side of your spine where it connects with the top of your pelvis. Sacroiliitis is inflammation of this joint. It can affect one or both sides.
Pain in your lower back and buttocks is the most common symptom. The pain is usually made worse by:
- unexplained weight loss
- pain after a fall or injury
If you need help finding a primary care doctor, you can browse doctors in your area through the Healthline FindCare tool.
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:
- Muscle strain.
- 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.
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When Is Not Helpful
Back pain is one of the most common reasons why people visit a health care provider. The good news is that the pain often goes away on its own, and people usually recover in a week or two. Many people want to stay in bed when their back hurts. For many years, getting bed rest was the normal advice. But current studies recommend no bed rest at all and stress that staying in bed longer than 48 hours not only wont help but it may, in fact, actually delay your recovery. Heres why:
Staying in bed wont help you get better faster.If youre in terrible pain, lying down for a day to help ease the distress may seem like a good idea, but moderating your activities and staying active in a limited way is a more effective way to control your symptoms. Research suggests that if you can find comfortable positions and keep moving, you may not need bed rest at all.Research shows that:
- Lying down longer than a day or two day isnt helpful for relieving back pain.
- People can recover more quickly without any bed rest.
- The sooner you start moving, even a little bit, or return to activities such as walking, the faster you are likely to improve.