Chronic Conditions That Cause Back Pain
Conditions that can lead to chronic low back pain include spinal stenosis, spondylitis, and fibromyalgia. Spinal stenosis is narrowing of the normal spinal canal through which the spinal cord passes. Spondylitis is chronic inflammation of the spine. Fibromyalgia is a muscle disorder that features chronic muscle pain and tenderness.
Heres What The Study Couldnt Tell Us
The study was missing a few potentially helpful low-risk medicines. Topicals such as the lidocaine patch or capsaicin ointment were not included, which is a shame, as these can provide relief for some people, and carry little risk. I would also be interested to know if over-the-counter topical therapies containing menthol and camphor are better than placebo for low back pain. Suggestions for the future research, and the next update!
I plan to write about chronic low back pain in a future post, because there was a guideline update for that specific issue as well.
S To Reduce Back Pain
No type of back pain should be overlooked.
Your whole body relies on the health of your back and spine so you want to make sure you treat your pain the right way the first time.
Most pain will go away quickly but if it continues for more than a week or two then you need to seek medical attention.
In this blog, we take a look at 6 important steps to take immediately after experiencing back pain.
We use our back every day to complete regular activities such as sitting up, lifting, and reaching.
Your back is in use all day long making the tendons, muscles, and ligaments in your back work hard.
That’s why the health of the muscles is very important.
These three soft tissue structures need to work synergistically for you to function without pain.
Since they are in constant motion it is common for them to tear, pull or get over-stretched.
And if you’ve ever had a back strain, you know they are nothing to joke about.
When someone says their back is sprained they mean the ligaments are overstretched or torn. Now if they say it is strained then that means a muscle or tendon was overstretched or torn.
People tend to use back strain and back sprain interchangeably but they are in fact different and because of that, the course of treatment and length of that treatment differs also.
Either injury can happen so fast and is easy to do.
Signs that you have torn, strained, or pulled a muscle in your back:
- A sore or tender lower back
- Sudden pain
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What Are The Warning Signs Of A Serious Problem
Very rarely back pain or pain that travels down the leg is a sign of a serious problem.
If you have any of the following symptoms, you should seek urgent medical attention:
- difficulty controlling or passing urine
- loss of control of your bowels
- numbness around your back passage or your genitals
- serious weakness in your legs so you find standing really difficult
- severe and ongoing back pain that gets worse over several weeks.
The above symptoms could potentially be linked to a rare but serious condition that needs urgent medical attention.
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.
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When Is Lower Back Pain An Emergency
Most episodes of lower back pain eventually resolve on their own, but there are times when you should seek urgent medical attention. Some of these situations include:
- Patient is a child
- Pain is severe, constant, suddenly or progressively worsens, and/or doesnt go away
- Pain interrupts sleep
While some situations may warrant immediate intervention, most cases are not urgent and can be scheduled at a time convenient for the patient.
Do Follow Your Chiropractors Instructions
Unfortunately, many people begin to feel better very quickly after seeing their chiropractor and believe that they are on the road to healing. They stop their appointments and return quickly to their regular routine.
This is an almost fool proof way to find yourself back at square one and possibly in more pain than before. The same advice should be followed with your chiropractor as you get from your doctor regarding antibiotics always use until completion, even if you feel better earlier than expected.
Following your chiropractors instructions for your treatment and lifestyle changes is the best way to ensure that you dont have a repeat performance of the low back pain blues!
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Even The Nonprescription Pain Relievers Are Not Risk Free
Medicines like ibuprofen and naproxen can be helpful, but they can cause stomach inflammation and ulcers, as well as possible bleeding, and even kidney damage, especially in the elderly. Muscle relaxants can be sedating, and can interact with other common medications. Benzodiazepines and opiates not only can cause sedation, making it hard to think clearly and function normally, they are also addictive. Basically, for acute and subacute low back pain, the risks of these medications outweigh the benefits. Other medications, like acetaminophen, steroids, antidepressants, and anti-seizure medications, were not significantly helpful for acute and subacute low back pain at all.
Reflexes And Motor And Sensory Testing
Testing knee and ankle reflexes in patients with radicular symptoms often helps determine the level of spinal cord compromise. An altered knee or ankle reflex alone does not suggest the need for invasive management because this finding is generally transient and fully reversible.8
Weakness with dorsiflexion of the great toes and ankle may indicate L5 and some L4 root dysfunction. Sensory testing of the medial , dorsal and lateral aspects of the foot may also detect nerve root dysfunction.1
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Other Sleep Hygiene Tips
Here are some other ideas for how you can get better rest at night and reduce your back pain:
Put yourself on a sleep schedule. It may be hard to resist sleeping in if you toss and turn all night. Still, setting regular bedtimes and wake times can help your body fall into a more natural sleeping pattern. Aim to get around eight hours of sleep per night.
Having trouble with a sleep schedule? Try following a nightly routine. Start this routine about 30 to 60 minutes before your set bedtime. Choose two soothing activities that help put your mind into a relaxing space.
Ideas include taking a bath, doing some gentle yoga, and engaging in quiet hobbies like reading or knitting.
Skip caffeinated drinks like coffee and other stimulants. If you just have to drink a cup, finish your last one before noon.
Save hard exercise for the morning or early afternoon hours. Doing anything too rigorous before bed may raise your adrenaline levels and even your body temperature. These two factors make it even harder to sleep.
If you dont already have a primary care doctor, the Healthline FindCare tool can help you find a physician in your area.
For pain relief
Use an ice or a cold gel pack before hopping into bed. It may help reduce inflammation in your back and relieve pain. Apply the cold pack to your back for 15 to 20 minutes before sleep.
What Are Some Common Lower Back Pain Causes
The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital or acquired meaning the disorder develops later in life.
- Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies , ligaments, muscles or soft tissues.
- Organic lower back pain is attributed to disease, such as spinal cancer.
- Idiopathic refers to an unknown cause.
These are some of the things your doctor might look for or rule out when you schedule a visit for back pain.
The common symptoms of lower back pain.
Sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. Theyre often related to overuse.
Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear .
Herniated disc. The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves
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Stop Trying Passive Treatments
Passive treatments like heat, ice or ultrasound may feel good, but their effect is usually only temporary. Most research indicates that active self-care exercise and postural correction is an effective remedy for low back pain.
A visit to your physical therapist can help determine which exercises are best for your specific condition.
Diagnosis Of Lower Back Pain
Your physiotherapist or GP will usually be able to diagnose lower back pain from your symptoms and by examining you. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility. You may want to go straight to see a physiotherapist if a self-refer service is available in your area. If its not, you can see your GP who can advise and refer you.
Usually further tests wont help. But if you have other symptoms, your GP may recommend tests including:
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Prone Lying Prone Props And Press Ups
In the case of sudden onset of acute low back pain, you should try the emergency back pain exercises first. Lie on your stomach for a few minutes, then prop onto your elbows for a minute or two. Monitor your symptoms for centralization.
After a few minutes in the propped up position, try a few press ups. Try to keep your hips and back relaxed as you use your arms to press your upper body up. Try to press up as far as possible to restore the normal forward curve in your low back. Say to yourself, “Further, further, further” as you press up. Move your spine through the full, pain-free, range of motion. Perform 10 repetitions and monitor your symptoms.
If your pain does not fully centralize with the press up exercise, you may need to move on to the next exercise: the press ups with your hips off center.
Dont Sit For Long Periods Of Time
Our bodies are not designed for sitting for long periods of time. Sitting is not only linked to many health problems, but it also wreaks havoc on your lower back.
While many people must sit because of desk jobs, there are steps you can take to limit the damage done to your lower back, and the best position to sit with a herniated disc, including:
- Get up and stretch or walk every 30-60 minutes. Set a timer if you must!
- Use a standing desk
- Use a yoga ball or kneeling chair instead of a regular office chair
- Walk on your breaks, rather than sit in the cafeteria
- Walk, pace, or just stand up when making phone calls or talking with coworkers
You might not be able to avoid sitting at your job, but you dont have to ruin your back in exchange!
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Can Back Pain Lead To Complications
The good news is that most people recover from back pain within a few weeks.1 See your doctor if you experience additional symptoms, such as:
- loss of bowel and/or bladder control
- severe pain that gets worse instead of better over time
- problems with passing urine or bowel movements
- numbness or a pins-and-needles sensation in your legs, back or elsewhere
- unexplained weight loss
- back redness or swelling
For some people, back pain becomes an ongoing problem. Around 1 in every 2 people who experience back pain will experience it again, and for 1 in 5 people, back pain may last beyond 8 to 12 weeks. Possible complications that result from persistent, long-term back pain include:
- dependence on strong pain medicines, such as opioids
- reduced quality of life
- more difficulty finding work and keeping active
See your healthcare professional if your back pain is unresolved and limits your movement and activities. A health care professional can help you find ways to manage your pain and regain a better quality of life.
Lumbar Side Glide In Standing
If the press up with hips off center failed to offer significant relief or centralize your symptoms, you should then try the lumbar side glide exercise.
This exercise is done standing about a foot from a wall with your painful side away from the wall. Lean your shoulder against the wall with your elbow tucked into your ribs, and slowly push your pelvis underneath your ribcage.
Perform 10 repetitions of the side glide, and watch for changes in your pain. If your pain continues or fails to centralize, try the next exercise: the lumbar flexion rotation stretch.
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What Are The Risk Factors For Developing 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.
Maintain Correct Posture When Sitting
You can avoid lower back pain by maintaining proper posture when sitting. If you have a desk job, keep your feet planted on the floor and use a chair that provides lower back support. Also, avoid hunching forward to see your computer screen and reaching far in front of you to use your mouse or keyboard.
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Looking At Two Kinds Of Back Pain
Lets talk about the most common forms of back pain: acute and subacute . Most of these cases are due to harmless causes. We lump them into the mechanical back pain diagnosis, which includes muscle spasm, ligament strain, and arthritis. A handful will be due to potentially more serious causes such as herniated discs , spondylolisthesis , a compression fracture of the vertebra due to osteoporosis , or spinal stenosis . Rarely, less than 1% of the time, we will see pain due to inflammation , cancer , or infection.
When someone with acute low back pain comes into the office, my main job is to rule out one of these potentially more serious conditions through my interview and exam. It is only when we suspect a cause other than mechanical that we will then order imaging or labs, and then things can go in a different direction.
But most of the time, were dealing with a relatively benign and yet really painful, disabling, and expensive condition. How do we treat this? The sheer number of treatments is dizzying, but truly effective treatment options are few.
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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