Evaluating and Treating Lower Back Pain

One of the chief reasons people visit any doctor is low back pain. It is estimated that four out of five people will experience low back pain at some point in their life. It is a major contributor to health care dollars spent and in money lost in time off of work. As Jack Nicklaus, Lee Trevino, Joe Montana, Larry Byrd, Troy Aikman, Nolan Ryan and others can attest, low back pain can dramatically affect an athlete’s career as well.

Low back pain can be grossly divided into two types. The first type and subject of discussion today is mechanical low back pain. Disk disorders of the spine are also an important cause of back pain but will be discussed in a later column.

Mechanical back pain is directly related to the function of the spine and is caused by overload. The structures affected may be the soft tissues that surround the spinal column or may involve a specific joint. Neurological symptoms may also be present. There are limits to the amount of stress that any joint can handle at one time and over time. Sometimes, people can attribute their back pain to a single traumatic event. More commonly, patients complain that they began to notice back pain during day-to-day activities. Some authors have pointed out that this phenomenon is similar to how chronic tendonitis can eventually lead to tendon rupture.

Along with pain, there may be stiffness and soreness associated with an injured low back. Also, in certain cases there may be neurological symptoms. This is usually characterized as a burning or tingling sensation that proceeds from the low back down the buttocks and back of the leg. It may also continue into the lower leg or into the foot.

Although all patients with significant low back pain should be examined by physician, it is especially important in patients with the neurological complaints described above. Patients with low back pain and new bowel or bladder problems should see their doctor immediately. These symptoms may indicate a serious injury to the spinal cord that needs prompt evaluation.

When evaluating low back pain, your doctor will do a physical examination to try to localize the area of pain. Often it is possible to determine that pain is related to a specific muscle, joint or ligament. In other cases, the pain may be more diffuse or may radiate to other areas such as the legs. In certain populations, X-rays are indicated in the workup for low back pain. There are also some situations that may prompt your doctor to order a CT scan or MRI of your back. All three of these imaging modalities look for specific disorders within the spine and all have advantages and disadvantages.

The good news is that though very painful and bothersome, most low back pain can be treated without surgery. Initially, ice should be applied to the back for 20 to 30 minutes every four to six hours for the first two to three days. After the first few days it is reasonable to apply moist heat to the painful area. There is certainly a role for non-steroidal, anti-inflammatory medicines, muscle relaxors and sometimes pain medicine. Also rehabilitation with a physical therapist or chiropractor may be appropriate in a variety of situations.

The decision to return to work or play is a highly individualized decision made between patient and doctor. Some people who injure their back are ready to return in only a few days while others take significantly longer. After the back has had time to heal, it is important to take steps to prevent re-injury. Strengthening of the lower back muscle and abdominal muscles under the direction of a therapist or chiropractor can be very helpful. Exercises to increase abdominal muscle strength help to add balance to the musculoskeletal system. Routine stretching exercises, especially before heavy lifting, may help prevent recurrence.

If you injure your back, it is important to have a prompt evaluation by your doctor, trainer or chiropractor. Indeed, some back injuries are more serious than others and many can be helped with a few simple treatment and therapy modalities.

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