Back Pain

 

Overview
Most people will suffer from an attack of back pain at some point in their life. An attack of back pain can last for a period of days, weeks, or even longer. It typically resolves with time, but rest, exercise, and other self-care measures help. Some people can suffer from chronic pain that continues despite treatment.  You play an important role in the prevention and healing process of back pain. Strong, flexible muscles help to promote a healthy back that maintains good alignment, allows movement, and provides structural support. 

Anatomy 
The low back region of the spinal column is called the lumbar spine. Protected within the bones of the lumbar spine are the spinal cord, nerves, and blood vessels. The five lumbar bones are called vertebrae and are numbered L1 to L5. Each bone is separated and cushioned by shock-absorbing discs.  Each disc contains a fibrous outer layer called the annulus that surrounds a gel-filled inner layer called the nucleus. The vertebrae are held in place by muscles and ligaments that provide support and enable movement of your body. The spinal nerves exit from the spinal column through holes called foraminae on both sides of the vertebra. The lumbar spine supports the weight of your body and can be a prime location for injury and pain.

 

Types of back pain
Back pain ranges from mild to severe, and is classified as either acute or chronic.  Acute low back pain often relates to soft tissue injury (e.g., sprains of muscles, tendons, or ligaments) or disc herniation. Acute pain occurs suddenly and usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves with over time.  The source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues.  Chronic back pain persists and may be present all the time, or worsen with certain activities, poor posture, and improper body mechanics. In some cases, the complexity of chronic symptoms requires consultation with pain management specialists. 

 

What are the symptoms?
Signs and symptoms of back pain may be stiffness, tightness, aching, burning or stabbing or shooting pains, pressure, or tingling. Most people experience pain primarily in their low back area. The pain may spread to the buttocks, thighs, or knees. Many people may also experience muscle spasms. The symptoms are generally more noticeable when bending or arching the back, when lifting heavy objects, or when sitting or standing for long periods of time.  If you experience extreme leg weakness and/or difficulty controlling bladder or bowel function, a condition called cauda equina syndrome, you should seek medical help immediately. 

What are the causes?
Back pain can result from:

• Injury or trauma: A significant force can stress the structures of the spine, for example, sports injury, or fall. A fracture including vertebral compression fractures, can result, including a tear in the muscles and ligaments of the back. In addition, the discs may bulge or herniate.

• Bulging and herniated disk: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain and swelling occur when this material squeezes out and comes in contact with a spinal nerve.

• Pinched nerve: When a spinal nerve is compressed, pain may run down your leg into your feet, called radiculopathy.  This is also called sciatica.

• Osteoarthritis (degenerative disk disease): As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes can lead to stenosis or disc herniation.

• Stenosis: Narrowing of the spinal canal occurs as discs bulge or protrude, facet joints enlarge, and ligaments stiffen over time. As the spinal canal narrows, it compresses the cord and nerves, causing them to swell and inflame.

• Spondylolysis: A weakness or stress fracture develops in one of the bony bridges that connect the upper and lower facet joints.

• Spondylolisthesis: A weakness in the muscles and ligaments predisposes the vertebra to slip out of normal position.

 

Other rare causes include cancer, infection, or congenital anomalies.

 

How is a diagnosis made?
A careful medical examination will help determine the type of back problem and its cause, and the best treatment options. Diagnosis requires evaluation that includes a medical history, physical exam, and possibly a diagnostic test such as an MRI scan or CT myelogram.

 

Treatment Options

 

Medical Therapy: 
Most patients will improve with medical management, typically within the first 6 weeks after the onset of symptoms.

Step 1: Pain relievers, muscle relaxers, and possibly oral steroids (Medrol Dosepak) coupled with bed rest or reduced level of activity. 

Step 2: Physical therapy which includes stretching exercises, heat, massage, and ultrasound. Patients need to determine the modality that works best for them. Each session provides short term benefit and ultimately should also be done at home.

Step 3: Pain management including epidural steroid injections (ESI). ESI is an injection of medication directly into the spinal canal. An ESI typically provides benefit lasting one month and can give lasting relief for those patients who are not surgical candidates.

Surgical Therapy: 
Indicated for patients who do not respond to medical management, have large disk herniations, severe symptoms, are unlikely to respond to further non-surgical treatment, and/or have neurologic loss of function.

 

Recovery and prevention
Most people with acute low back pain respond rapidly to treatment.  Recurrences of back pain are common. The key to avoiding recurrence is prevention.  Try the following:

• Proper lifting techniques

• Good posture during sitting, standing, moving, and sleeping

• Appropriate exercise program

• An ergonomic work area

• Healthy weight and lean body mass

• No smoking

• Avoid stress or strain on the spine

 

If you have back pain, come see us for consultation.  We take an aggressive approach to the treatment of back pain.  We have the clinical and research experience for great outcomes with a personal touch.