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Low Back Pain
Why Does My Back Hurt So Much?
Studies have shown that 50-80% of adults will have Low back pain at some point in their lives. Diagnosis and treatment of Low back pain is recommended as soon as possible to prevent further deterioration and to guide treatment. There are many causes of Low back pain: it is commonly caused by tendon/ligament/soft tissue injury when muscles are overused especially when performing activities you are not used to as in lifting and moving heavy furniture, doing yard work, repetitive type of work ;Muscles may experience Strain and Ligaments of the Spine may be sprained when over worked . You may have Myofascial pain which is generally an "achy" type pain that comes from poor posture such as sitting at a computer for long periods of time; the muscle tend to fonn "knots" also known as trigger points. Spinal stenosis which is a narrowing of the spinal cord may cause pain and cramps in the legs , numbness and tingling and difficulty walking, people with this problem usually get relief by walking in a stooped posture in lumbar flexion because this is the position of comfort. Disc herniations also known as "slipped discs" can cause Low back pain with radiation of pain down one or both legs also known as Sciatica because the pain follows the path of the Sciatic Nerve. Discs are gelatinous structures in between each vertebrae which act as "shock absorbers" in the spine and when they extend beyond their normal boundaries they can cause compression and irritation of the adjacent nerve roots resulting in a burning sensation in the back muscles along with spasm, shooting pain in the legs and numbness and tingling. If this compression is severe it may result in permanent neurological damage such as foot drop.Non-spinal causes of Low back pain have to be ruled out prior to starting treatment ,a few examples are spinal tumors, uterine fibroids, kidney and pancreatic disease, discitis,Multiple myeloma, abdominal aneurysms and primary cancers that may have metastatized (spread) to the bone.
Diagnosis of Low back pain may entail Xrays, CT Scans, MRI, Nerve Conduction Studies and EMG and if non-spinal etiology is suspected then your doctor may order blood test, Ultrasound, Bone Scans. Once the diagnosis has been established you should start an intensive rehabilitation program. In the Specialty of Physical Medicine and Rehab which is a branch of Medicine specializing in the Musculoskeletal system, this occurs in 3 phases. A general outline has been given here however a more specific treatment plan will be needed depending on the diagnosis.
In the Acute Phase: Your physician will recommend 1-2 days of rest from physical activity, treat the pain and inflammation, this may include the use of anti-inflammatory medication and other pain medication, injections may also be used to alleviate muscle spasm; Acupuncture which is a complementary treatment may be used for pain management. The physician will develop an individualized treatment plan to help you recuperate.
Second Phase: In this phase of recovery your doctor will recommend a skilled physical therapy program x3/week to increase the strength and flexibility of the spinal, abdominal and lower leg muscles that support the spine. Modalities such as moist heat, ultrasound, electrical stimulation will be sued during your treatment. Manipulation of the spine may also be beneficial as well as Spinal Decompression therapy.
Third Phase: This is maintenance phase to minimize recurrence of the problem and to prevent further injury, your rehabilitation team including the physician and physical therapist will teach you correct posture and lifting techniques and will teach you a home exercise program to maintain the gains you have made.
Of note spinal decompression which is a form of mechanical traction is very beneficial to patients suffering from low back pain relation to disc herniations and sciatica and is also helpful to those of us who have degenerative disc disease. This treatment is pain free and has shown in studies to have a very high success rate. However there is a small percentage of people who do not respond to conservative treatment. If this is the case your physician may refer you for spinal injections known as Epidurals, which are usually given in a series of 3, patients generally have good results in alleviating sciatic symptoms and the effects may last from one month to one year depending on patient response. These injections are fluoroscopically guided and are generally safe. Other minimally invasive procedures include Percutaneous Laser Disc Decompression in which heat energy from the laser is used to shrink the disk in order to relieve nerve root irritation and compression. The recovery period is short of 2 weeks; there is no scar and no structures are removed from the spine. This procedure is less expensive, less invasive than conventional spine surgery and are done in office on an outpatient basis. If you are considering spine surgery you may want to review medical literature in the New England Journal of Medicine, May 2007, which compared early surgery to conservative treatment for sciatica. The study showed that although early spine surgery gave the patient faster relief of leg pain and there was a faster rate of perceived recovery, follow up after one year found that both groups had similar outcomes. Other studies have shown that there is a risk of recurrent lumbar disc herniation and the rate of subsequent surgery is high.