Which Lifestyle Factors Contribute To Lower Back Pain
There are three major lifestyle factors that may affect your chances of developing lower back pain:
- Multiple studies have established a link between smoking and lower back pain. Smoking raises inflammation inside the body and hinders the body from healing itself.
- Obesity is also associated with several types of chronic pain, including lower back pain. In people with high body mass index , the stress on the spine increases, contributing to even more wear and tear.
- Your level of physical activity can also play a role in your lower back health. While a sedentary lifestyle could increase your risk of developing lower back pain, so can excessive or strenuous physical activity. Check with your doctor if you are unsure about your ideal level of physical activity.
Back Pain Treatment At Home
The good news is that, given time, most back pain gets better on its own. Over-the-counter pain medication may help ease your symptoms. You can also try applying hot or cold packs to reduce your back pain. Both heat and cold stimulate the nerves so use whichever you prefer and see what works best for you. Doctors more commonly recommend heat to relax tight muscles, but you may find ice reduces swelling. Use your heat or cold pack for about 15 to 20 minutes at a time. Dont apply the heat or cold treatment directly to skin. Rest and avoiding activities that especially put strain on your back may also help while you heal. However, doctors dont generally recommend bed rest when your back hurts.
Less Common Causes Of Low Back Pain
Inflammation of the joints of the spine sometimes causes back pain. Osteoarthritis is the common form of arthritis and usually occurs in older people. Ankylosing spondylitis is another form of arthritis that can occur in young adults and which causes pain and stiffness in the lower back. Rheumatoid arthritis may affect the spine but you are likely to have other joints affected too.
Various uncommon bone disorders, tumours, infection and pressure from structures near to the spine occasionally cause low back pain .
The rest of this leaflet is mainly about nonspecific low back pain – the common type of low back pain.
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Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
Key Points About Low Back Pain
- Specific treatment for low back pain depends on the cause of the pain and the severity. But it often includes pain medicines and muscle relaxers, physical therapy, and assistive devices such as a back support. It also may include lifestyle changes such as stress reduction, weight loss, and increased physical activity.
- A back rehab program may be used as part of the treatment for low back pain.
- Measures to prevent back pain include using safe lifting techniques, maintaining correct posture, staying at a healthy weight, not smoking, and reducing stress.
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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.
Persistent Low Back Pain
Nonspecific low back pain is classed as chronic if it lasts for longer than six weeks. In some people it lasts for months, or even years. Symptoms may be constant. However, the more usual pattern is one in which symptoms follow an irregular course. That is, reasonably long periods of mild or moderate pain may be interrupted by bouts of more severe pain.
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How Is Low Back Pain Diagnosed
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Tests include:
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
Why Does My Back Hurt
There are various causes of back pain, including muscle pain with or without muscles spasms, disc pain, joint pain, or nerve pain. In most cases, these are not harmful or dangerous.
Muscle pain is the most common acute back pain. The period of acute pain is usually limited and may be treated at home or by primary care doctors. Sometimes, these patients may be referred to doctors who specialize in back pain. Some back pain can be a symptom of a more serious problem, like a fracture, infection, or cancer in the spine, said H. Michael Guo, MD, a Duke physiatrist who specializes in spine care. These patients should be seen by spine doctors. Fortunately, spine infections and cancer are very rare and usually only affect people with special risk factors. Spine fractures are also rare and may be associated with thinned spine bones or injuries.
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When Surgery Is Necessary
When conservative treatment for low back pain does not provide relief or neurologic symptoms are worsening or severe, surgery may be needed. Candidates for surgery present any of the following:
- Reasonably good health
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurologic deficits develop, such as leg weakness, numbness or both
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If several nerve roots and discs are causing the pain or if degeneration and instability exist in the spinal column, the neurosurgeon may choose: a minimally invasive approach a more open decompression or fusing the vertebrae together with bone grafts and stabilizing them with instrumentation, including metal plates, screws, rods and cages, depending on the extent of disease. After such surgery, patients may gain restored mobility in the back, including the ability to bend over. In addition, patients may require postoperative physical therapy.
The benefits of surgery should always be weighed carefully against the risks. Although a large percentage of patients with low back pain report significant pain relief after surgery, it is not guaranteed that surgery will help.
Did Larry Need Radiographic Ct Or Mri Imaging
Dr. Malanga: Many people believe that imaging tests are essential to the diagnostic process, but I disagree. In some cases, imaging tests do more harm than good. In Larrys case, I dont believe his pain and symptoms warrant imaging tests. He has mechanical symptoms with a normal neurologic examination. Imaging at this point, would not affect the treatment plan.
The problem with indiscriminately ordering an is that we might find a lot of things in his age group or older that have nothing to do with his complaints. If you ordered an imaging test for a 56-year-old man with no pain, you will likely find abnormalities. This often leads to unnecessary treatment.
My goal for Larry is to get him pain free and functionalI would not want him to worry about what an imaging test might show.
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What Can I Do For Low Back Pain At Home
If your lower back pain has just started, the best thing you can do is start a log. Record your symptoms, times, dates and which activities trigger the pain or make it worse or better. Take this information to your family physician if the pain doesnt resolve on its own. It will make diagnosing the cause much easier.
Once you know which motion or position causes your lower back pain, try to avoid it and see if you get better. Icing the painful spot can also help. And so can over-the-counter pain relievers that help reduce inflammation. Just remember that pain killers treat only the symptom pain and not its cause.
The Differences In Treatment With Orthopedic Doctors Vs Neurologists
There are a few prominent procedures only each specialty doctor is trained to perform. For instance, only a neurologist is trained to perform surgery inside the dura, the lining of the spinal canal.
For this reason, a neurologist is the best option for treating conditions such as a tethered spinal cord or spinal cord tumor. Conditions such as syringomyelia and Chiari malformation also still fall under the neurologist specialty. On the other hand, such conditions like pediatric and adult scoliosis, spinal deformities, or kyphosis still fall under the realm of an orthopedic doctor.
Today, both types of doctors have developed a friendly working relationship and can work together to provide comprehensive care. Together, they want you to receive treatment for the best end results. But if there are subtle differences in your injuries such as the ones listed above, they would be better addressed by either a neurologist or an orthopedic doctor to achieve the desired outcome and recovery.
AICA Orthopedics employs highly trained, skilled neurologists and orthopedic doctors. Our team strives to provide accurate diagnoses and quality treatment for the source of your injuries or pain.
With knowledge, expertise, and experience, our specialists place patient needs at the top of the priority list in order to provide you specific and individualized care. To learn more about our neurologists and orthopedic doctors, please dont hesitate to .
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Learn About The Different Back Pain Specialists
When a back problem occurs, it’s typically a good idea to first consult with a primary care physician. This doctor will conduct an initial exam and, depending on the findings, he or she may refer you to a spine specialist.
If you are referred to a specialist for chronic back pain, it will likely be to one of the following:
How Orthopedic Treatment Can Help
Orthopedic spine specialists who don’t have a specialty in orthopedic surgery use non-surgical methods to treat patients who suffer from lower back pain. They specialize in musculoskeletal disorders that affect the lower back in people with sports injuries and other traumatic injuries, as well as disorders and diseases of the spine. They may work with other spine specialists mentioned above to manage the lower back pain and restore movement.
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Who To See For Lower Back Pain: Doctors And Specialists That Can Help
Back pain is one of the most common ailments for adults in the United States, with 8% of the population suffering from chronic back pain.¹ Not only does it affect your quality of life, but it can also be concerning when you dont know whats causing it.
There are doctors and other healthcare professionals who specialize in treating lower back pain. Their expertise can help you deal with this condition so you can improve your quality of life.
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Injections And Other Procedures
If you have severe sciatica, your doctor may suggest an epidural injection. Epidural injections contain a local anaesthetic and steroid to relieve pain and reduce inflammation. Theyre only recommended for sciatica and not non-specific lower back pain.
If your back pain is chronic and other treatments havent helped, your doctor may suggest a procedure called radiofrequency denervation. Its only suitable for certain types of back pain. Your doctor will refer you to a specialist to assess whether it would help you.
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Why Did Larrys Primary Care Physician Refer Him To You
Dr. Malanga: Larrys primary care physician referred him to me as opposed to a spine surgeon because my specialty in pain and sports medicine approaches care by maximizing conservative, non-operative techniques. The United States has 4 to 6 times the surgical rate of most other countries, so referring to a non-operative spine specialist is the best initial approach for Larry.
Golfers of all ages and physical activity levels can experience bouts of low back pain. Photo Source: 123RF.com.
Which Doctor Should You See For Back Pain
Back pain is so common, experts say, that approximately 80 percent of adults will have an aching back at some point in their lives. Truthfully, its probably closer to 100 percent, says , a spine surgeon at HSS.
If youre in this group and youve been avoiding seeking relief , Dr. Dowdell would like to put your mind at ease. Not only is spine surgery not always necessary for treating back pain, sometimes its not even helpful.
There are so many variables when it comes to back pain, he says. How it can be treated depends on whats causing it. Ultimately, some types of back pain can be helped with surgery, and some cant.
For example, a may be helped with surgery, while is often managed with physical therapy, exercise and anti-inflammatory medications. If you wind up , you may be able to with rest, stretching, ice or heat, and anti-inflammatories.
The one thing thats the same for nearly everyone, says Dr. Dowdell, is which type of doctor to approach first.
Heres where he suggests you start, what to expect…and what may happen next if your pain doesnt go away.
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Please Describe Your Thought Process As You Developed Larrys Treatment Plan
Dr. Malanga: My treatment plan is initially focused on controlling pain and inflammation. I first recommended judicious use of anti-inflammatory medication and heat compresses. I prescribed a short course of anti-inflammatory medication for Larry, as using these drugs for too long increases the risk for cardiovascular problems. After completing the course of , I suggested Larry take naturally derived supplements, such as , bromelain, and high-dose omega 3s, to reduce inflammation. These have been proven to be effective without the potential serious side effects from both over-the-counter and prescription medications, such as non-steroidal anti-inflammatory medications.
Larry and I also discussed his diet. I recommended reducing his carbohydrate and processed sugar intake to curb inflammation, while upping his consumption of healthy fats and sugars like those found in nuts and berries.
I would teach Larry some simple movement strategies, including how to position himself at work and stretches he can do throughout the day. While those small adjustments can reduce pain in the short term, I suggested that Larry work with a physical therapist to build sustained strength and flexibility, which should start taking shape in 4 to 6 weeks. After a few sessions with a physical therapist, the goal is for Larry to be able to do those exercises on his own.
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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