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 .
You Have Numbness Tingling Or Weakness
Back pain accompanied by sensations of numbness, tingling or weakness could be a sign of nerve irritation or damage. This is especially true if the pain persists after taking over-the-counter pain relievers. Nerve pain is serious and can result in permanent damage or disability if left untreated.
Learn More: Listen to a podcast on pinched nerves.
Lower Back Pain Caused By Infection
Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.
During Your Exam Your Doctor Will:
Look at your posture and range of motion
Note any movement that causes pain
Examine the curvature and alignment of your spine
Feel for muscle spasm
Check your sensation
Test your reflexes and muscle strength
Your doctor may order a plain x-ray, CT scan or MRI. The CT scan or MRI provides the doctor with many snapshots of your spine, and can help confirm a suspected diagnosis. The findings of an imaging test are compared to the information the doctor gathers during the taking of your medical history, and physical and neurological examination results. An accurate diagnosis is one of the first steps in determining the best treatment options.
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
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Complications Related To Sciatica
If you develop a loss of bladder or bowel control, contact your doctor right away. This can be a sign of a medical emergency that requires surgery to avoid permanent damage. Fortunately, this complication is rare. Most cases of sciatica go away within a few days or weeks and cause no lasting harm.
When Is Surgery Considered
Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.
How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and youve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.
The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.
Surgical options to relieve sciatica include:
Microdiscectomy: This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.
- Laminectomy: In this procedure, the lamina that is causing pressure on the sciatic nerve is removed.
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What Are The Symptoms
The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one sided, it can occur on both sides. Patients may also experience numbness or tingling in the leg or a feeling of weakness in the leg.
Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements , standing on one leg or climbing stairs.
What Are The Most Common Causes Of Lower Back Pain
The most common causes of lower back pain are mechanical or structural problems with the spine, spinal discs, muscles, ligaments, or tendons. Other common causes of back pain include inflammatory conditions, such as rheumatoid arthritis, and other medical conditions, such as osteoporosis, fibromyalgia, kidney stones or infections, endometriosis, and tumors. Pregnancy is also a common cause of back pain.
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Possible Symptoms That Accompany Lumbar Radiculopathy Includes
- Presence of pins and needles sensation
- Presence of muscle spasms in the lower back and buttocks.
Lumbar radiculopathy can also be classified based on the duration it could be acute or chronic.
Acute Form: this kind of pain is sharp and It begins all too sudden. It could be as a result of a ruptured disc.
Chronic Form: this kind of pain comes gradually and it is as a result of the narrowing of the spinal canals where the nerves passes through along its course. The chronic pain could also be as a result of the piriformis muscle compressing the sciatic nerve, thereby making it irritated and inflamed.
Commit To A Progressive Exercise Program For Long
When your doctor gives you the go ahead, make sure to make a focused effort to follow through with a controlled and progressive exercise program. Without it, your symptoms are likely to return and get worse over time.
There are many options to help provide enough pain relief for you to engage in exercise and physical therapy, such as use of ice and heat, pain medications, and possibly an epidural steroid injection. Physical therapists and spine specialists can tailor a pain relief treatment to make exercise tolerable.
How Can I Permanently Fix Sciatica
Therapy and workouts: You can heal sciatica permanently by taking the help of physiotherapy. These therapies can have sciatica pain relief exercises to get rid of it completely. These therapies contain physical movement like walking, stretching, swimming. If you want to reverse sciatica, then do aerobatics daily.
Lower Back Or Buttock
A common cause of pain in the lower back or buttock region is a condition called sciatica. Sciatic pain often radiates from the lower back down through the buttock and leg. Many patients who stick to a regular program of gentle exercises and physical therapy have great results recovering from sciatic pain and preventing future episodes.
Piriformis syndrome is considered a neuromuscular disorder occurring when the piriformis muscles force compression upon the sciatic nerve. Runners tend to experience injuries to the piriformis because of the repetitive back and forth shifting of their body weight while running. The pain may be felt in the buttocks or it may present itself as pain traveling down the back of the leg. The sciatic nerve has various branches for pain to travel along, which may make it hard to diagnose. Another cause of lower back pain, buttock pain, hip pain or even leg pain may be attributed to dysfunction in the sacroiliac joint . The symptoms of an SI joint dysfunction may feel very similar to pain caused by sciatica.
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How Do I Get Rid Of Sciatica In My Groin
Do daily stretches to relieve pressure on your groin nerves. Apply a cold pack to reduce swelling or a hot pack to relax muscles. Consider using a standing desk or posture corrector to reduce pressure on your hips and groin and prevent nerve pinching. Take over-the-counter pain medications like ibuprofen .
Things To Know About The Piriformis Stretch
The piriformis is a difficult to reach muscle that runs from your sacrum to your thigh bone. When it begins to push against your sciatic nerve, often due to too much sitting, it can cause excruciating pain. A tight or inflamed piriformis is what is known as piriformis syndrome.
Here are five things you should know about your piriformis, and how to keep it healthy.
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What Do The Experts Say
Leg and/or lower back pain can have multiple causes. Radiating leg pain and related ailments are the main symptoms of sciatica, whichaffects many people. Widely varying, the pain associated with sciatica is most commonly described as a mild tingling, blunt ache or a burning sensation. It has been reported that the pain could be severe enough to render a person unable to move. Generally unilateral, sciatica pain often starts in the lower back and extending down the leg to your calf, foot or even toes. A person suffering from this ailment may feel pain in one part of the leg or hip and numbness in other parts. Patients with sciatica may also experience lower back pain which is usually less intense than the leg pain. In some cases, your foot may get caught on the ground when walking. Sciatica pain can start slowly and become progressively worse:
- After sitting or standing
- During a certain time of the day
- When straining or holding your breath, like during a bowel movement
- When sneezing, coughing or laughing
- When bending backward or after walking for a few meters
- Pelvic injury or fracture
When Is It Necessary To See A Doctor For Lower Back Pain And Flank Pain Above The Hips
It is necessary to see a doctor for lower back pain and flank pain above the hips if you are experiencing any of the following symptoms: loss of bladder or bowel function, sudden, severe pain, weakness or loss of sensation in your lower body, or pain accompanied by fever, clammy skin, a rapid heart rate, nausea, vomiting, or any other concerning symptoms.
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What Are Some Common Causes Of Lower Back Pain In The Butt Region
Lower back pain in the butt region can be caused by a number of things but is most commonly associated with a muscle strain. This can be caused by overuse or injury, and often results in pain, stiffness, and reduced range of motion. Another common cause is referred pain from arthritic facet joints in the lower back. Other less common causes of lower back pain in the butt region can include Piriformis syndrome, which is a condition that results from compression or irritation of the sciatic nerve. This can lead to pain, tingling, or numbness in the buttocks and down the leg. This is caused by spasms or inflammation of the piriformis muscle and often leads to pain and discomfort in the hip and buttocks.
Spinal Tumor Or Cancer
This is also rare. Ive had one patient in my five-year career , whove had this condition.
Usually the tell, with this is if its been going on for a couple months and there is absolutely nothing that makes it feel better.
Ive never seen someone in so much pain trying to get up from the floor. It was hard to watch.
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What Causes Low Back Pain
Low back pain is rarely related to serious underlying conditions, but when these conditions do occur, they require immediate medical attention. Serious underlying conditions include:
- Infections are not a common cause of back pain. However, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis the intervertebral discs, called discitis or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis.
- Tumors are a relatively rare cause of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
- Cauda equina syndrome is a serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.
- Abdominal aortic aneurysms occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that an aneurysm is becoming larger and that the risk of rupture should be assessed.
- Kidney stones can cause sharp pain in the lower back, usually on one side.
Other underlying conditions that predispose people to low back pain include:
How Long Should I Try Self
Every person with sciatic pain is different. The type of pain can be different, the intensity of pain is different and the cause of the pain can be different. In some patients, a more aggressive treatment may be tried first. However, generally speaking, if a six-week trial of conservative, self-care treatments like ice, heat, stretching, over-the-counter medicines has not provided relief, its time to return to a healthcare professional and try other treatment options.
Other treatment options include:
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Alternative/holistic Treatment Options For Left Back Pain
Alternative/ holistic methods include:
This Traditional Chinese Medicine technique involves inserting thin needles at different points on the body. This practice is believed to trigger the release of pain-relieving chemicals in the body.
Massages are performed by trained therapists using different techniques, including stretching, kneading, and percussion. This is believed to relieve tension, increase blood flow, and relax your muscles.
Chiropractors manually adjust the joints in the spine to relieve pressure.
Tai Chi is a martial art that combines deep breathing and relaxation with slow and gentle movements. This is believed to improve flexibility, balance, and strength.
Osteoarthritis Of The Spine
The bones in your spine are separated by spongy discs, which act as shock absorbers. With age, these discs can wear or shrink, which narrows the space between the spinal joints, or facet joints. The facet joints are a series of small joints in the lower back that contain the same type of cartilage that is found in your knees, explains Louw. Disc changes can lead to more strain on the joints, which can cause the cartilage to wear down and the facet joints in the vertebrae to rub against one another, leading to the pain and stiffness of OA. It is not uncommon for these joints to refer pain into the buttocks, especially with prolonged standing or even walking, says Louw.
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Intensity Spikes During Workouts
Another common reason for pain just above the buttocks is if you recently spiked your intensity in your workout program . Its possible that this can contribute to some discomfort, however, again, this is not a guarantee.
Youll need to test out and see if the symptoms you are having are related to the intensity of your workouts, or not. This requires reducing the intensity and then gauging how you feel 24 hours afterwards.
Youre Having Problems With Your Bowels Or Urination
If your back pain is paired with a loss of control over your bowels or urination, then its time to seek help immediately at a local emergency room. These symptoms point to cauda equina syndrome, where the nerves in the lower spine have become paralyzed. While rare, this syndrome can be permanently damaging to the nerves if left untreated. If you experience these symptoms, especially accompanied by numbness in the legs, then you may need surgery to decompress the nerves and preserve their overall function.
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What Type Of Doctor Should I See For Back Pain
This depends on your condition or symptoms. If you have no obvious injury that would explain your pain, you may want to start by seeing a . This is a specialist in physical medicine who can diagnose back pain and determine whether nonsurgical treatments such as physical therapy may help. Depending on those findings, a physiatrist may also refer you to a , doctor or other type of back specialist, , for additional discussion.