When To See A Specialist For Lower Back Pain
If you’re experiencing lower back pain that’s not responding to rest and self-care, it’s time to consider seeing a spine specialist.
“A spine specialist will likely perform a physical exam as well as one or more imaging scans to diagnose the root cause of your lower back pain. Depending on your diagnosis, he or she will then design a treatment plan aimed at alleviating your pain and preventing it from disrupting the everyday activities you enjoy,” says Dr. Palmer.
Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome describes pain that is felt along the outer hip area. Causes include sports injury, muscle tears, and injury due to motor vehicle accidents. The pain is caused by a combination of inflammation in two distinct areas: the bursa of the hip and pain in the buttock . Pain may also be caused by tendinitis of the hip abductor muscles. Symptoms of greater trochanteric pain syndrome include hip pain at night lying on side, dislocated hip symptoms, and hip muscle weakness. Hip pain relief can be sought through anti-inflammatory medications, physical therapy, and stretches for hip pain.
When Should I See A Doctor For Back Pain
When your back first starts to hurt, try taking an over-the-counter pain reliever and applying ice in the first 48 hours. You may apply heat after 48 hours. You may need to take it easy for a while, but its best to stay as active as tolerated, and to avoid absolute bed rest, said Dr. Guo.
If your back pain lasts more than two weeks and keeps you from participating in normal, daily activities, see your family doctor. If your pain is severe, you should see a doctor sooner. You should seek urgent medical care if you have:
- Fever associated with back pain
- Back pain after trauma
- Loss of bladder or bowel control
- Loss of strength in your arms and legs
- Unexplained weight loss associated with back pain
Also, always be more cautious if you have special risk factors for cancer, infection, or fractures that may affect the spine.
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How To Relieve 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.
How Is Lower Back Pain Diagnosed
Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.
Your provider may order:
- Spine X-ray, which uses radiation to produce images of bones.
- MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
- CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
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Electromyography to test nerves and muscles and check for neuropathy , which can cause tingling or numbness in your legs.
Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain . Urine tests check for kidney stones, which cause pain in the flank .
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How Your Back Works
The spine, which is also called the backbone or spinal column, is one of the strongest parts of the body and gives us a great deal of flexibility and strength.
Its made up of 24 bones, known as vertebrae, one sitting on top of the other. These bones have discs in between and lots of strong ligaments and muscles around them for support. There are also the bones in the tailbone at the bottom of the back, which are fused together and have no discs in between.
On either side of the spine, running from top to bottom, are many small joints called the facet joints.
The spinal cord passes inside the vertebrae, which protect it.
The spinal cord connects to the brain through the base of the skull and to the rest of the body by nerves that pass through spaces between the bones of the spine. These nerves are also known as nerve roots.
As you grow older, the structures of your spine, such as the joints, discs and ligaments, age as well. The structures remain strong but its usual for your back to get stiffer as you get older.
How Does Inflammation Correlate With Pain
Inflammation, the bodys response to injury, naturally waxes and wanes throughout the day. As your activity level changes, so does the inflammation of the damaged structures. For example, bed rest is often prescribed for individuals experiencing pain because it allows your body to rest and heal without the risk of overdoing it. Bed rest isnt practical for many people, however, so a full day of working or running kids from one activity to the next may cause inflammation to flare up. The surrounding muscles of the injured structure may attempt to work overtime to shield the injured areas and heal the inflamed area, but this can only last for so long before those same muscles are worn out and the pain returns.
Though very irritating, this oscillating pain journey is very common. By consulting a spine surgeon like myself the goal is to decrease your pain flare-ups and get you back to your normal life, through non-operative and, when necessary, operative means.
Through my years of practice, and even with my friends and family members, I have found most people tend to ignore these flare ups or adapt to a new normal with pain. If something doesnt feel right, it may not be right. Be sure to get it checked out. People often put themselves at a disadvantage by procrastinating to the point that the pain has done more damage than they ever believed it would.
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Can Lower Back Pain Be A Sign Of Something Serious Like Cancer
Lower back pain can be related to cancer. In fact, it is one of the first symptoms of prostate cancer when it metastasizes and creates lesions. Almost any cancer can spread to the back and some, like sarcoma, can originate in the back. Be cautious, especially if you are experiencing other symptoms besides lower back pain. Talk to your doctor if you have additional symptoms or concerns.
For Your Convenience We’ve Divided These Causes Into Five Categories As Follows
- Low risk: This can be easily managed with over-the-counter medications or by avoiding the movement/stressor causing your pain.
- Low-medium risk: Usually managed as an outpatient by your doctor with prescription medication.
- Medium risk: May require a visit to your doctor or hospitalization. Prescription medication may be necessary.
- Medium-high risk: Hospitalization or urgent intervention. Although not life-threatening get help immediately of some kind.
- High risk: Serious and potentially lethal complications possible emergent intervention needed Intensive Care Unit care often needed.
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What Are The Most Common Lower Back Surgery Procedures
Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:
Spinal Fusion. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.
Laminectomy and laminotomy. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.
What Happens When I Visit A Back Doctor
We gather a full medical history of your back problems and perform detailed physical examinations, said Dr. Guo. That includes checking for tenderness, spine range of motion, strength, sensation, and reflexes. Depending on your symptoms, we may perform provocative tests to find out what triggers your pain. We may order imaging studies, such as X-rays, MRIs, or CT scans. We may order electromyography and a nerve conduction study, which assess whether you have muscle and/or nerve problems that may cause your symptoms. We use all the information to help identify the cause of your back pain and associated symptoms, and provide the most appropriate treatments for you.
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Symptoms Of Low Back Pain
These might range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Pain that comes on suddenly is âacute.â It might happen during sports or heavy lifting. Pain that lasts more than 3 months is considered âchronic.â If your pain is not better within 72 hours, you should consult a doctor.
Fevers Chills And Weight
Patients with a spinal infection usually have localized pain, worse when they are bearing weight or engaged in activity. Pain can be intense, and may be relieved only by laying down. Fever, chills, headache and generalized illness are usually present, but even with advanced infection these symptoms may be subtle or overlooked for some time. If, however, you’ve noticed that you are losing weight, experiencing fatigue and have had fevers, chills or night sweats in addition to your back pain, you should bring this to the attention of your doctor. Severe pain may be caused by simply sitting up or changing positions. If the vertebra is weakened by infection it may collapse, and a deformity may be detected.
Spinal infections usually start somewhere else, and the most frequent causes are urinary tract infections, dental abscesses, pneumonia or any chronic wound. Back pain that starts up while you are being treated for one of these problems deserves a careful look.
Neurological signs should be carefully sought. Patients who initially complain of focal spine pain, followed by progressive radicular pain, weakness and incipient paralysis may have infection within the canal, with development of an epidural abscess.
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Pain Locator: Where Does It Hurt
Abdominal pain can have a wide range of causes. Understanding the nine regions and four quadrants of your abdomen can help pinpoint possible origins and identify associated ailments. Here’s a helpful guide.
Abdominal pain could be indicative of many ailments, ranging from gas and constipation to gallstones or pancreatitis. Understanding the type of pain you’re experiencing, where it’s originating from, and the severity of your ailment, could help you get the correct treatment before symptoms worsen.
It’s important to become acquainted with the nine regions of the abdomen, so you can better understand how your digestive organs function and are susceptible to a variety of medical issues.
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.
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When Should I See My Healthcare Provider About Lower Back Pain
Lower back pain usually gets better with rest and pain relievers. Back pain that doesnt go away may be a sign of a more serious condition.
See your provider if you have:
- Pain that doesnt get better after about a week of at-home care.
- Tingling, numbness, weakness or pain in your buttocks or legs.
- Severe pain or muscle spasms that interfere with your normal activities.
- Fever, weight loss, bowel or bladder problems or other unexplained symptoms.
A note from Cleveland Clinic
Millions of people live with low back pain. Stiffness, pain and limited movement can have a major impact on quality of life. But you may be able to avoid lower back pain by maintaining a healthy weight and staying active. Talk to your provider if back pain doesnt go away or if youre unable to do the activities you enjoy. Several treatments can relieve pain, help you move better and get more out of life.
Last reviewed by a Cleveland Clinic medical professional on 01/18/2021.
References
The Underlying Cause Of Pain May Be Hard To Identify
It is usually difficult for the brain to distinguish between injury to one spinal structure versus another nearby. For example, a torn or herniated disc may feel similar to an arthritic facet joint due to their close proximity. In some cases, the same nerve root can be compressed or irritated by different structures, such as a disc or bone spur.
See Spinal Cord and Spinal Nerve Roots
Your physician will take a thorough medical history, discuss your symptoms, and conduct a physical exam in order to accurately diagnose the cause of back pain. Sometimes diagnostic testssuch as X-rays, MRI scans, or diagnostic injectionsare needed when trying to locate or confirm the underlying cause of pain.
Once your doctor reaches an accurate diagnosis for your back pain, an effective treatment plan can begin.
Radicular pain follows the path of the nerve into the arm or leg and may be accompanied by numbness or weakness.
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What Exactly Is The Lower Back Anyway
Your lower back is known as the lumbar region of the spine. It has a lot of heavy lifting to do: The lumbar spine carries the weight of your entire upper body, plus biomechanical stresses that occur with movement.
The lumbar spine has five vertebraebackbones. Each vertebra has a large disc cushiony gel wrapped in a tough membrane on its front side that acts as a shock absorber. Each vertebra also has two cartilage-lined facet joints on its back side. Working together, discs and facet joints allow the spine to safely bend and twist.
Your lower back also includes ligaments, tendons, and muscles. Ligaments are strong bands that hold the vertebrae and discs together. Tendons attach muscles to the vertebrae. These structures help limit excessive movement that could harm the spinal cord.
Signs That Your Hip Is The Source Of Your Pain
One of the biggest signs that your pain is caused by a problem in your hip is the presence of groin pain. Your hip joint is located behind the groin, thats why groin pain usually means the hip is the root cause of pain. In some cases, this groin pain will radiate downward toward your knee.
Another obvious sign that your hip is the source of your pain is pain around or over the hip joint. However, hip problems can also refer pain to your low back, contributing to the confusion over where the true source of the pain is located.
Hip-related pain is most often caused by osteoarthritis in the hip. In addition to groin pain, people who have osteoarthritis in their hip joint often report pain in their buttock, front of thighs, and knees. They may also limp when they walk and report reduced range of motion in their hips, pain that worsens with activity and improves with rest, and discomfort that begins as occasional but becomes more regular.
While osteoarthritis is the most common cause, hip pain may also derive from piriformis syndrome, avascular necrosis in the hip, and/or sacroiliac joint dysfunction.
- Piriformis syndrome causes dull, mild pain in the low back and buttocks and can cause pain radiating down the legor sciatica.
- On the other hand, the hip pain associated with avascular necrosis is severe and constant.
- Sacroiliac joint pain might be attributed to both the hip and the low back, as the sacroiliac joints connect the sacrum in spine to the hip bones.
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