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How To Manage Lower Back Pain

What Causes Degenerative Discs And Herniated Discs

How to manage lower back pain

Why is the lower back a target area for pain? “Generally speaking, the lower back is subject to a lot of mechanical stress and strain,â says Gunnar Andersson, MD, PhD, professor and chairman emeritus of the Department of Orthopedic Surgery at Rush University Medical Center in Chicago. âThe reason is the weight of the upper body, which always puts loads on the lower back.”

Supporting all that upper body weight is the spine, which is made up of more than 30 small bones called vertebrae stacked one on top of the other. A spongy piece of cartilage, called a disc, sits between each vertebra. It acts as a shock absorber, preventing the bony vertebrae from grinding against one another.

With age, these cushioning discs gradually wear away and shrink, a condition known as degenerative disc disease. Discs can also tear or become injured. Sometimes the weakening of a disc can put pressure on its jelly-like center. Wisneski describes this process as similar to a bubble forming on your car’s tire.

“You hit a bump in the road, then all of a sudden that tire goes pop,” he says. In the case of your back, that pressure can lead to a herniated disc , in which the center of the disc bulges.

A herniated disc in the lower back can put pressure on the nerve that extends down the spinal column. This commonly causes pain to radiate to the buttocks and all the way down the leg. This condition is called sciatica.

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.
  • Heat and/or ice may help ease pain, reduce inflammation, and improve mobility for some people
  • Gentle stretching upon advice by your healthcare professional
  • 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.

    Why Your Mental Health Matters When Dealing With Lower Back Pain

    The mind-body connection plays a huge role in chronic pain. Major depression can make a person three times more likely to develop chronic lower back pain.21 People who have a history of childhood trauma often develop chronic pain, Jamison explains. We can carry traumatic events, whether big or small, with us into adulthood.

    They can manifest as feelings of powerlessness, and that could keep you from addressing a pain problem early on, before it has a chance to progress into a chronic situation.22 While some people may just want to focus on the now and treat the pain as quickly as possible, it can be helpful to use psychotherapy to address past issues that may be contributing to the physical pain, Jamison says.

    Its important to take care of your mental health when living with chronic pain, but some people resist getting help because of whats called provider fatigue. As Jamison explains it, you might have little or no interest or motivation to see a psychologist because youve already seen a host of other providers. And if youve tried numerous treatments and medications, all to no avail, making the effort to locate a mental health provider may feel overwhelming.

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    Walking And Yoga Can Offer Relief And Comfort

    Standing desks and ergonomic chairs can help put your spine in a better position.

    Jonathan Lurie, M.D.

    Low back pain is often hard to avoid. Many jobs require long periods of sitting or other types of activities that can stress our backs. However, there are things you can do to avoid more serious injury.

    National Institutes of Health-supported researcher Jonathan Lurie, M.D., provides a few recommendations for people with low back pain. Dr. Lurie is a physician-researcher at the New Hampshire-based Dartmouth Institute for Health Policy and Clinical Practice.

    The Good Stuff: Stellar Back Pain Stretches

    Better Management of Chronic Lower Back Pain ...

    What can you do to relieve lower back pain? Will exercise help? Does stretching help lower back pain?

    When you live with back pain, simple exercises can help reduce tension and improve your range of motion. Try these stretches to relieve your back pain.

    You can perform the following back pain exercises at home without any equipment. The American College of Sports Medicine recommends holding static stretches for 10 to 30 seconds and stretching two to three times a week. Stretching daily is most effective.

    Before you begin, remember to move slowly and carefully. Quick movements or bouncing could exacerbate your pain. Stretching shouldnt be painful. If an exercise hurts, please stop immediately. As always, consult your doctor before starting new activities.

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    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.

    Back Pain And Incontinence In Women

    Depending on the cause of back pain or incontinence, symptoms may vary. Women often struggle with stress incontinence after giving birth and leak while participating in activities that add stress to the bladder, such as laughing, sneezing, or lifting a heavy object. However, kidney problems such as stones can also cause frequent urination or urge incontinence when the urge to urinate suddenly strikes.

    While studies show that in some patients the cause of back pain and incontinence is linked to weight gain or sedentary lifestyles, both conditions can also be caused by chronic illnesses like type 2 diabetes and arthritis.

    When it comes to giving birth, 50% of women report stress urinary incontinence. Postpartum back pain and incontinence may impact moms for up to twelve months after their babies are delivered due to pelvic floor weakness.

    Pelvic floor muscles often become weakened due to the added stress of supporting a growing infant and from supporting the body during labor. Once weakened, pelvic floor muscles are less able to function under increased pressure from the abdominal muscles during physical activities, leading to leaks. Pelvic floor muscles also play a role in spinal stability.

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    Back Pain Culprit: Your Bag

    Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.

    What Are The Risk Factors For Developing Low Back Pain

    How to self-manage low back pain

    Anyone can have back pain. Factors that can increase the risk for low back pain include:

    Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

    Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. Weekend warriorspeople who go out and exercise a lot after being inactive all weekare more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.

    Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

    Genetics: Some causes of back pain, such as ankylosing spondylitis , have a genetic component.

    Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.

    Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.

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    Risk Factors Of Developing Severe/chronic Low Back Pain In Older Adults

    Although most LBP is self-limiting and begins to improve after a few days and resolves within a month , some patients are susceptible to chronic LBP that lead to significant disability. While age is a well-known risk factor for chronic LBP , other factors may perpetuate LBP in older adults . The understanding of these factors can help identify high-risk patients and improve their LBP management. Since older adults usually face both age-related physical and psychosocial issues, comprehensive assessments and treatments are needed to effectively manage LBP in seniors.

    Factors affecting the development of severe or chronic low back pain among older adults

    Managing Low Back Pain And Incontinence

    If youre experiencing back pain, incontinence, or even both, go speak to your doctor. They may be able to rule out any serious conditions contributing to the issues and they can put together a proper treatment plan.

    In some cases, incontinence can be treated and with physical therapy to relieve pain and Kegel exercises to strengthen pelvic floor muscles may go away over time. In other cases, incontinence can only be managed.

    Generally, medications can assist with back pain and urinary issues, but a back brace or postpartum compression garment are all-natural solutions for relieving pain as well.

    Lifestyle changes can be beneficial for assisting with both back pain and incontinence symptoms. Try to become more active, with at least 30 minutes of moderate exercise about three times a week. Try swimming, riding a bike, or simply even walking to get moving.

    Also, a healthy diet to relieve pressure on your digestive tract. Caffeine, items high in sugar, spicy foods, and alcohol can increase incontinence symptoms. Try adding more water, fruits, vegetables, and whole grains to your diet to relieve constipation and pressure on the bladder. The added nutrition may help with your low back pain as well.

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    How Common Is Lower Back Pain

    Around four out of five people have lower back pain at some point in their lives. Its one of the most common reasons people visit healthcare providers.

    Some people are more likely to have lower back pain than others. Risk factors for lower back pain include:

    • Age: People over 30 have more back pain. Disks wear away with age. As the disks weaken and wear down, pain and stiffness can result.
    • Weight: People who are obese or carry extra weight are more likely to have back pain. Excess weight puts pressure on joints and disks.
    • Overall health: Weakened abdominal muscles cant support the spine, which can lead to back strains and sprains. People who smoke, drink alcohol excessively or live a sedentary lifestyle have a higher risk of back pain.
    • Occupation and lifestyle: Jobs and activities that require heavy lifting or bending can increase the risk of a back injury.
    • Structural problems: Severe back pain can result from conditions, such as scoliosis, that change spine alignment.
    • Disease: People who have a family history of osteoarthritis, certain types of cancer and other disease have a higher risk of low back pain.
    • Mental health: Back pain can result from depression and anxiety.

    Stretch Your Hamstrings Twice Daily

    Upper &  Lower Back Pain Management

    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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    Use Hot And Cold Therapy

    Your back pain may be due to sore muscles. Bad posture, previous injuries, and general overexertion can all contribute to this. For temporary relief to sore muscles, try using hot and cold packs.

    Some people find that heat helps soothe aching muscles. Some relief methods include:

    • Taking a warm bath
    • Putting a hot water bottle over the aching area
    • Using a heat pack on the affected area

    On the other hand, cold compresses can also help bring relief. You can use an ice pack or a bag of frozen vegetables on the aching area. Remember not to apply ice directly onto your skin, as it can cause cold burns. Wrap the ice in a clean cloth or towel first.

    You can also alternate between hot and cold therapy. Hot and cold compression packs are usually available at drug stores.

    The Details: But Wait Lower Back Pain Gets More Complicated

    Not only is chronic back pain hard to live with, it can also be difficult for practitioners to diagnose due to the overlap of symptoms with other conditions. Traditional diagnostic methods usually begin with a full physical exam and overview of your medical history.

    From there, depending on the severity and duration of the pain, your doctor may request blood work to look for signs of inflammation or infection imaging studies such as X-rays, CT scans, or MRIs to look for structural damage or bone or DEXA scans to check for any bone disorders or bone infections and electrodiagnostics to check nerve function with electromyography or nerve conduction studies.11,12

    Your observations can provide some of the most important clues to help your doctor make the right diagnosis. Take notes about your condition and bring them with you to your appointment so that you can precisely describe the pain youre experiencing.

    Include details about the pain, such as whether its burning, stabbing or aching the time of day when your pain is at its worst and what youre doing at that time and the exact location or locations of the pain within the lower back region.13

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    Try To Boost Your Mood

    No, the lower back pain isnt in your head, but obsessing over it could be making it worse. Fear, anxiety, and catastrophizing can amplify pain, says Dr. Mackey. Because brain circuits that process pain overlap dramatically with circuits involved with emotions, panic can translate into actual pain. Start by accepting that you have pain, Dr. Mackey says. Then say to yourself, it will get better. If you struggle with overall mental wellbeingsay, you have anxiety or depressionin addition to your physical aches, it could be worth seeing a therapist to manage negative thought processes while exploring other lower back pain treatments.

    Is It Always Necessary To Determine A Cause

    How To Manage Chronic Lower Back Pain

    Many physicians dismiss a diagnosis of nonspecific low-back pain23 and instead pursue specific diagnoses of the anatomic structures responsible for the pain.24 There are two problems with this approach. First, the tests used to identify anatomic sources of nonspecific low-back pain have unacceptably low validity,25 so the diagnoses are nominal. For example, the clinical utility of describing patients as having neuropathic back pain has not been established screening questionnaires used to detect this condition have unclear evidence for validity,26 and there is evidence that drugs for neuropathic pain lack clinical effectiveness. One recent high-quality randomized controlled trial involving patients with sciatica in Australia reported that pregabalin, a drug for neuropathic pain, was not effective for either acute or chronic radicular pain compared with placebo.27 Second, structural diagnoses encourage the use of structure-based treatments that have been shown to be ineffective. Despite evidence of their ineffectiveness, treatment with injections of anesthetics, corticosteroids, sclerosing agents, stem cells and blood products into back structures that are thought to be generating the pain waste billions of dollars each year. For example, almost 1 million lumbar facet injections were funded by the Centers for Medicare and Medicaid Services in the US in 2011.28

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    When To Get Medical Help And Advice

    Nine out of 10 people find their lower back pain improves within four to six weeks. You may find that you feel better sooner than this, in a few weeks. But contact your GP if the pain is severe, getting worse over time or isnt improving after four to six weeks. Also, contact your GP urgently if you feel unwell or have a high temperature. And if you have had cancer or osteoporosis, your GP may want to check that there isnt a more serious cause.

    Seek medical attention right away if you:

    • have numbness or tingling around your bottom or genitals
    • cant control when you pee or cant go at all
    • lose control of your bowels
    • are unsteady when you walk, your legs feel weak or your foot is dropping or dragging

    These may be signs that the nerves at the bottom of your spine are being squashed. This is called cauda equina syndrome and needs urgent treatment.


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