What Is The Prognosis For Low Back Pain
The outlook for low back pain absolutely depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that are irritating the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.
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 .
Five Common Causes Of Lower Back Pain
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No matter what you do, you cant get comfortable. Sitting hurts, standing hurts, laying down hurts. You wake up with pain, and you go to bed with pain. You find yourself taking days off from work when the pain is at its peak, regularly taking over-the-counter pain medication, and you have shelved your once regular work-out routine. If youre living with persistent lower back pain, then you can likely relate to these shared experiences. One of the most frustrating aspects of living with chronic back pain is not knowing where the pain comes from, or how to make it go away. Below, we list five of the most common causes of this discomforting condition that affects ten percent of the worlds population.
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Back Pain Expert Philip Sell On The Questions To Ask
We asked Philip Sell, consultant orthopaedic and spinal surgeon, what he would want to know if he was suffering from back pain.
What is the cause of my back pain?In 85% of cases, were unable to be precise about why people have back pain. This can be frustrating. It may be more helpful to think about what you can do to make your back better quicker. Research has shown that occupational factors or physical factors only play a small part in back pain. Your genes are probably the most significant factor in back pain.
When should I visit my GP with back pain?See your GP as soon as possible if the back pain is combined with difficulty in passing urine or numbness between the legs or around the bottom. For people over the age of 55 with new back pain, a previous history of cancer surgery or loss of weight should also be medically checked as soon as possible.
Should I be resting?You may feel its the wrong thing to do, but keep mobile and active. Resting, bed rest in particular, can prolong the duration of an episode of back pain. Most acute episodes of back pain will settle on their own, often within days rather than weeks. Taking pain relief and keeping active will stop stiffness setting in and keep muscles in good condition.
Can Lower Back Pain Be Related To Weather
If you feel like your lower back pain worsens on days when its cold or the weather is changing, you are not imagining things. Back pain can indeed be related to barometric pressure and outdoor temperature. Changes in pressure can sometimes cause pain in arthritic joints, including the spine. Muscles and joints in general react to the environment, which can make them stiffer and more likely to suffer an injury.
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Back Pain Due To Irritable Bowel Syndrome
A frequent complaint and diagnosis are colon spasms or irritable bowel, a syndrome that occurs more often in women, also during the menstrual cycle. When you suffer from abdominal pain and bloating, it is possible that you suffer from IBS or irritable bowel syndrome. One of the symptoms is a very painful lower back.
Pain in the lower abdomen and the lower back occurs in various ways. Depending on the condition, you can feel the pain in a specific part of the abdomen, for instance at the bottom. Sometimes the entire abdomen can be painful with a painful feeling in the sides and the lower back or in the lower back and the pelvis. This does not always mean it is serious. Many women have this periodically. A hot water bottle and pain killers are still the best cure. In the event of serious pain, you must contact a GP.
Signs That Its Time To Call A Doctor For Your Back Pain
Most people have experienced back pain at some point in their lives. It’s actually the leading cause of disability worldwide and the most common reason people call out of work. Back pain can come in many different forms, ranging from a dull ache that lasts only a few days to severe pain that lasts for weeks.
Depending on the intensity of the pain, there are many treatments you can try at home to help. But how do you know when it’s time to stop home remedies and see a physician?
If any of the following applies to your back pain, then it’s time to make an appointment with a doctor as soon as possible.
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Muscle Strain And Ligament Sprain
A low back sprain or strain can happen suddenly, or can develop slowly over time from repetitive movements.
- Strains occur when a muscle is stretched too far and tears, damaging the muscle itself.
- Sprains happen when over-stretching and tearing affects ligaments, which connect the bones together.
For practical purposes, it does not matter whether the muscle or ligament is damaged, as the symptoms and treatment are the same.
Common causes of sprain and strain include:
- Lifting a heavy object, or twisting the spine while lifting
- Sudden movements that place too much stress on the low back, such as a fall
- Poor posture over time
- Sports injuries, especially in sports that involve twisting or large forces of impact
While sprains and strains do not sound serious and do not typically cause long-lasting pain, the acute pain can be quite severe.
Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
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Should I See A Chiropractor For My Back Pain
Spinal manipulation is used by chiropractors and osteopathic physicians to treat low back pain in selected patients. Spinal manipulation applies hand pressure to areas of the low back to relax irritated muscle and lessen the intensity of the pain.
Traction, using pulleys and weights to lengthen and stretch the spine can result in temporary relief. Both techniques will not treat any underlying causes of back pain, but rather offer a temporary relief from lower back pain.
Why Is Lower Back Pain Such A Common Problem
The bottom part of your back typically has just five vertebrae fewer than your neck and mid-back. And these vertebrae do a lot of heavy lifting! Your lower back is where your spine connects to your pelvis, bearing the weight of your upper body. This area experiences a lot of movement and stress, which may lead to wear, tear and injuries.
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Nonspecific Low Back Pain
This is the most common type of back pain. The majority of cases of sudden-onset low back pain are classed as nonspecific. This is the type of back pain that most people will have at some point in their lives. It is called nonspecific because it is usually not clear what is actually causing the pain. In other words, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe. This type of back pain is discussed further below.
Referred Pain To And From 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.. Sources of referred pain to the low back 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. On the other hand, pain can be referred from the low back and be felt in another location, as is often the case with . For example, it is not rare for a patient with a slipped disc in the lower back to have pain in the back of the thigh, or in the calf or even the foot, and not have any low back pain. This situation requires a doctor to sort out the type of pain and to do the examination required to show that the pain is actually coming from the spine .
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Types Of Lower Back And Groin Pain:
1. Coming from your hip.
This type of groin pain is due to the hip referring pain into your groin. Often people feel deep groin pain which is originating from their hip. Because the hip is a relatively large joint it often refers pain into the lower back area and this can result in buttocks pain also. Treatment needs to be directed towards the hip joint in this instance. If you think that the cause of your pain is from your hip, then learn more about the causes of hip pain here.
2. Coming from your lumbar spine.
This type of groin pain is due to the lumbar spine referring pain into your groin. Each level of your spine refers through nerve connections to different parts of the body. It is your upper lumbar spine which will refer pain to your groin. You may or may not feel pain in the lower back also. Treatment needs to be directed towards the lower back in this instance. There are more articles on the causes of lower back pain here
3. Coming from your adductor muscles.
This type of groin pain is due to the location of the adductor muscles. When you strain or tear an adductor muscle or tendon you will feel pain anywhere from the midpoint of your inner thigh to deep under your pubic bone. Treatment needs to be directed to the damaged adductor muscle in this instance.
4. Coming from your sacro-iliac joint.
What Are Other Symptoms And Signs Sometimes Associated With Low Back Pain
Low back pain can cause a wide variety of symptoms and signs depending on the precise cause of the back pain as reviewed above. Symptoms that can be associated with low back pain include numbness and/or tingling of the lower extremities, incontinence of urine or stool, inability to walk without worsening pain, lower extremity weakness, atrophy of the lower extremity muscles, rash, fever, chills, weight loss, abdominal pains, burning on urination, dizziness, joint pain, and fatigue.
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The Tricky One: Cancer As A Cause Of Low Back Pain And The Necessity Of Testing Just In Case When The Symptoms Justify It
Sorry I have to use the C word I know its kind of a bummer. But C happens.
A few cancers in their early stages can be hard to tell apart from ordinary back pain a bone cancer in the vertebrae, for instance and these create a frustrating diagnostic problem. They are too rare for doctors to inflict cancer testing on every low back pain patient just in case. And yet the possibility cannot be dismissed, either! This is an unsolveable problem.
Most cancers and ominous problems will inevitably start to cause other, distinctive, ominous symptoms, and it wont be long before someone catches on that theres more going on than just back pain. So it truly is an extraordinary circumstance for back pain to be ominous without causing other symptoms that raise the alarm.
For example, in 2017, the New England Journal of Medicine reported on a creepy case of slowly growing neurological deficit caused by a very stealthy cancer, which took a lot of diagnostic effort to solve.25shudder So sneaky cancers happen but they are crazy rare.
This is an unholy combination of factors: the exact same symptoms can have either an extremely rare but serious cause, or an extremely common but harmless cause that can be greatly aggravated by excessive alarm!
My favourite epitaph: I told you I was sick!
Age And Gender Issues
Age and gender are important factors to consider when diagnosing low back pain. In a young patient, a benign tumor of the spine called an osteoid osteoma may be the culprit. Inflammatory bowel disease in young people can be connected with spondylitis and sacroiliitis . Low back pain from disc disease or spinal degeneration is more likely to occur as people get older. Conditions such as abdominal aneurysm or multiple myeloma are also considered in older individuals.
Osteoporosis and fibromyalgia are much more common triggers of back pain in women than in men. Osteoporosis is a progressive decrease in bone density that leaves the bones brittle, porous and prone to fracture. Fibromyalgia is a chronic disorder that causes widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips.
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Chronic Or Acute Pain
- Acute pain starts suddenly and lasts for up to 6 weeks.
- Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.
If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.
Back pain usually resolves with rest and home remedies, but sometimes medical treatment is necessary.
Treatments For Back Pain From A Specialist
A GP, specialist or physiotherapist may recommend extra treatments if they do not think your pain will improve with self-help measures alone.
These may include:
- group exercise classes where you’re taught exercises to strengthen your muscles and improve your posture
- manual therapy treatments, such as manipulating the spine and massage, which are usually done by a physiotherapist, chiropractor or osteopath
- psychological support, such as cognitive behavioural therapy , which can be a useful part of treatment if you’re struggling to cope with pain
Some people choose to see a therapist for manual therapy without seeing a GP first. If you want to do this, you’ll usually need to pay for private treatment.
Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.
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Is It Possible To Prevent Low Back Pain
Avoiding injury to the low back is a method of preventing low back pain. Additionally, conditioning exercise programs designed to strengthen the lumbar area and adjacent tissues can help to minimize risk of injury to the low back. Specific programs to relieve and prevent back pain can be designed with the help of physical therapists and other treating health care professionals.
Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- Discectomy, such as a or removal of a portion of a
- a bone graft that promotes the vertebrae to fuse together
- removal of the lamina to create more space and reduce irritation and inflammation
References and useful links
- 1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
- 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.
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