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How To Identify Lower Back Pain

Identify The Location Of Your Pain

Tests to Identify the Cause of Lower Back Pain or Sciatica

Where you feel the pain may not be where the problem is. If a nerve root is affected, for example, the pain may radiate down an arm or leg, as is the case in radiculopathy.

If you have trigger points or other myofascial pain, you might experience referred pain or pain located in an area that is seemingly unrelated to the actual site of the problem. And, pain may be located in more than one area of the body.

For this and other reasons, healthcare providers often use a body diagram to track the location of the pain as it changes over time. In the initial assessment, the body diagram also helps your healthcare provider or PT to get right down to business by providing a quick snapshot of the main thrust of your complaint.

As part of your medical interview, your healthcare provider might use the information you provide in the body diagram to probe for more details.

Back Strains And Sprains Are The Most Common Causes Of Acute Back Pain

Upset mature middle aged woman feels back pain massaging aching muscles, sad senior older lady suffers from low-back lumbar pain sitting in incorrect sedentary posture, backache radiculitis concept

Back pain has a wide range of presentations and causes. Pain differs widely from person to person for reasons that are puzzling. This makes back pain one of the most challenging conditions for both the patient and healthcare provider.

Some individuals feel a constant ache across their lower back when they bend over, while others have a shooting pain down one leg. Some people find that their pain responds better to over-the-counter pain relievers, while others swear by heating pads.

If you experience back pain, you know how inconvenient it is to your home and work life, and youve felt the twinges it elicits during everyday tasks. Pain on a daily or chronic basis pervades or affects all areas of our lives, including our ability to work, have fun, and interact with the people around us. While its almost inevitable for adults to experience back pain at some point in life, it can become a regular occurrence for some. If back pain is getting in the way of your daily activities for at least a week, and if its starting to limit your work, home, and personal life, you should seek professional help. Daily or chronic pain needs evaluation by your doctor and often an interdisciplinary team of health care professionals.

Which Health Care Specialties Treat Low Back Pain

Physician specialties that evaluate and treat low back pain range from generalists to subspecialists. These specialties include emergency medicine physicians, general medicine, family medicine, internal medicine, gynecology, spine surgeons , rheumatology, pain management, and physiatry. Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.

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Back Pain Is A Complicated Personal Experience

The intensity and manageability of pain are very different for every person. For example, one person with a herniated disc may experience excruciating pain while another person with the same condition has no symptoms at all. Similarly, a muscle strain can range from mild to debilitating.

See Pain Generated by the Spinal Disc

With some conditions, back pain can flare up and then subside, only to flare up again after a few weeks or months and gradually intensify over time. Because only you know your level of pain, your treatment will most likely be more successful if you are an active participant in making decisions about your medical care.

Your back is subjected to various strong forces throughout the day, such as from twisting, sudden jolts, or poor posture when sitting hunched over. Any of your spines many interconnected and overlapping structures are capable of becoming injured and producing back pain. Common anatomical causes of back pain include:

  • Large muscles that support the spine
  • Spinal nerves that exit the spinal canal and may go to the legs or elsewhere
  • Facet joints that connect the vertebrae along the back of the spine
  • Intervertebral discs that provide shock-absorption for the bones

For more information, see Spinal Anatomy and Back Pain.

Bones, ligaments, tendons, and other anatomic structures are also capable of causing back pain.

See Causes of Lower Back Pain

The Cause Of Your Lower Back Pain Is Not The Bulging Disc The Pinched Nerve Or The Muscle Spasm

How To Identify Back And Neck Pain

Yes, one or more of these tissues may be a pain generator. But not the real cause of your pain. The actual cause of your pain is what makes the disc, nerve, or muscle painful in the first place.

This is almost always overlooked. The medical model for treating lower back pain dictates that we find a tissue we think is at fault, then treat that tissue. This sometimes results in pain relief but the pain comes back. Because whatever caused the disc, nerve, joint, or muscle to become painful in the first place is never addressed.

Most of the time what causes the tissues of the lower back to become painful is not a major injury.

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Determining The Cause Of Your Lower Back Pain And Fixing It Isnt Rocket Science

Its pretty straightforward. It does take some work though.

This video covers sitting and twisting and sitting for prolonged periods. If your lower back pain is felt while sitting, gets worse as the day goes on, or you spend large periods sitting and turning each day this video will help you.

When you have to sit and twist you need to keep your shoulders and hips square. This eliminates the forces that cause the lower back tissues to become painful.

Type Of Spinal Pain According To Pain Generator

In spite of the hard work done by the International Association for the Study of Pain, there remains a degree of confusion in the medical community regarding the definitions of back pain, referred pain, radicular pain, and radiculopathy. Nevertheless, a precise diagnostic assessment is necessary to indicate the right treatment. An incorrect diagnosis and use of a therapy that is not appropriate could also be related to insufficient diagnostic skills of a non physician specialized in this syndrome, attributed to a clinical and/or instrumental analysis of insufficient depth, or a therapeuthic approach geared towards controlling the symptom rather than the pain generator mechanisms.

Mostly, LBP is considered to be nonspecific, and the mistaken idea that the cause of 80 to 90% of LBP cases is unknown has persisted for decades.

Muscle tension and spasm are among the most common reasons for LBP, for example, in patients with fibromyalgia. In other cases, LBP can be attributed to different pain generators, with specific characteristics, such as radicular, facet joint, sacro-iliac, and discogenic pain, as well as spinal stenosis.

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A Physical Activity And Exercise

  • Advise people to stay active. Level of evidence 1A
  • Advise people with low back pain to exercise. Level of evidence 2B. The literature review shows physical activity results in an improvement in pain and disability in elderly patients with non-specific CLBP. However, high-quality evidence is required in order to conclude the above findings assertively.
  • Consider offering a structured exercise programme tailored to the person. This should comprise up to a maximum of eight sessions over a period of up to 12 weeks. Offer a group supervised exercise programme, in a group of up to 10 people. A one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.
  • Exercise programmes may include the following elements:
  • aerobic activity
  • How To Relieve Back Pain

    How to identify what’s causing your back pain

    The following tips may help reduce your back pain and speed up your recovery:

    • stay as active as possible and try to continue your daily activities this is 1 of the most important things you can do, as resting for long periods is likely to make the pain worse
    • try exercises and stretches for back pain other activities such as walking, swimming, yoga and pilates may also be helpful
    • take anti-inflammatory painkillers, such as ibuprofen remember to check the medicine is safe for you to take and ask a pharmacist if you’re not sure
    • use hot or cold compression packs for short-term relief you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well

    Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.

    Back pain usually gets better on its own within a few weeks or months and you may not need to see a doctor or other healthcare professional.

    But it’s a good idea to get help if:

    • the pain does not start to improve within a few weeks
    • the pain stops you doing your day-to-day activities
    • the pain is very severe or gets worse over time
    • you’re worried about the pain or struggling to cope

    If you see a GP they will ask about your symptoms, examine your back and discuss possible treatments.

    They may refer you to a specialist doctor or a physiotherapist for further help.

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    Ix Referred Pain To 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. For example, a pinched nerve in the neck may cause pain that is felt in the arm or hand. Sources of referred pain 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.

    More Advanced Care Options

    Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

    Implanted nerve stimulators

    • Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
    • Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
    • Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

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    Management Of Acute Low Back Pain

    For acute non-specific low back pain that does not have serious pathology , initial reassurance, advice to stay active and self-management are all that is needed . Self-management can include self-exercises and education from reading booklets or being involved in on-line education for low back pain .

    Non Specific Low Back Pain

    How to Identify and Treat Chronic Low Back Pain with ...

    Non-specic low back pain is dened as low back pain not attributable to a recognizable, known specic pathology .

    Non-specific low back pain is usually categorized in 3 subtypes: acute, sub-acute and chronic low back pain. This subdivision is based on the duration of the back pain. Acute low back pain is an episode of low back pain for less than 6 weeks, sub-acute low back pain between 6 and 12 weeks and chronic low back pain for 12 weeks or more.

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    Xv Useful Links And References

    , Hospital for Special Surgery, Hector Lozada, PT, DPT, OCS, Robert Turner, PT, OCS, MS, Theodore R. Fields, MD, FACP, January 19, 2017.

    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.

    1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health

    What Type Of Back Problemdo I Have

    The reality is 80% of us will suffer from back pain at some point in our lives. And yet, getting the correct treatment to alleviate back pain can be a frustrating and challenging task, for both patients and healthcare providers.

    Anytime such a large percentage of the population suffers from an ailment, you can be certain an entire economy will pop up purporting to be able to solve the problem. For this reason, theres a lot of nonsense out there about new and unique methods to cure back pain. As a general rule, the word cure is misleading and deceptive, and will leave patients frustrated and disenchanted with their progress. However, with the right treatment approach you can effectively manage back pain and reduce the negative impact it has on your life.

    Many of the solutions marketed to patients treat back pain as a single diagnosis. In fact, the term back pain is not really a diagnosis at all, rather a description of a symptom. Treating all patients that present with back pain the same is like prescribing antibiotics to every patient with abdominal pain. Just as there are many diagnoses that cause abdominal pain, there are several distinct types of back pain.

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    Conditions Of Bone And Joint Causes Lower Back Pain

    Bone and joint conditions: Bone and joint conditions that lead to low back pain include those existing from birth , those that result from wear and tear or injury, and those that are due to inflammation of the joints .

    Congenital bone conditions: Congenital causes of low back pain include scoliosis and spina bifida. Scoliosis is a sideways curvature of the spine that can be caused when one lower extremity is shorter than the other or because of an abnormal architecture of the spine . Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit from support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with the absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

    Low Back Pain Clinical Guidelines

    How to Identify and Treat Lumbar Spinal Disorders | Lower Back Pain | Colorado Spine Surgeon

    Guidelines recommend the non-pharmacological and non-invasive management . These include the provision of advice to stay active and the use of patient education and exercise therapy . Guidelines regularly recommend the use of physical exercise for non-specific LBP . Guidelines endorse the cautious use of imaging, of medication, and of surgery . A risk stratification tool is recommended in the National Institute for Health and Care Excellence guidelines , so that treatments can be co-ordinated to each risk subgroup .

    Patients with low back pain can be triaged using a clinical assessment . This should include history-taking, physical examination, and neurological tests to recognize radicular features . With low back pain, patients should be screened for red flags to exclude serious pathologies, and diagnostic tests carried out if suspected .

    Psychosocial risk factors should be assessed to predict poorer outcomes . There can be mutual decisions made with the patient as to whether simpler and less-intensive management is called for. If there is no improvement after 4 weeks, and a serious pathology or radiculopathy is suspected, then specialist consultation is recommended .

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    Mobilization And Manipulation Therapies

    A recent systematic literature review and meta-analysis has examined mobilization and manipulation for treating chronic low back pain . Bias was assessed using the Scottish Intercollegiate Guidelines Network criteria. The confidence in effect estimates was defined using the Grading of Recommendations, Assessment, Development, and Evaluation system. Nine trials provided sufficient data. Following treatment, the standardized mean difference for a decrease in pain was standardized mean difference =0.28, . When mobilization or manipulation was compared to other active therapies, seven trials showed the decrease in disability to be a SMD=0.33, .

    Subgroup analyses showed that mobilization when compared to other active comparators , significantly decreased pain , but not disability .

    Subgroup analyses showed that manipulation when compared to other active comparators , significantly decreased pain and disability .

    A systematic review and meta-analysis of manipulation and mobilization in the treatment of chronic low back pain published in 2018, found moderate-quality evidence that manipulation and mobilization decreased pain and increased function . Manipulation seemed to be more effective than mobilization , although both were safe .

    Understanding Different Types Of Back Pain

    As you may already know through personal experience, back pain can be uniquely complex and difficult to diagnose and treat. There are many types of back pain, and a wide range of treatments that may or may not work for the same condition.

    Here we outline several insights that you may find helpful in your journey to finding and participating in a treatment approach that works for you.

    A common cause of pain in the back is muscle strain. Watch:Lower Back Strain Video

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