Back Pain: Understanding the Problem
UNDERSTANDING THE PROBLEM
Chances are if you are reading this article you have had an episode of back pain. Statistics from the National Institute of Health report that 8 out of 10 people will experience back pain in their lifetime. Adult women have a higher reported incidence of back pain but men, 31% of men versus 20% of women, report that it affects their ability to perform work activities to a greater degree.
The cost for treating back pain in the United States is staggering. The Center for Disease Control has reported an annual cost of 50 billion dollars to directly treat this problem and an indirect cost of 100 billion dollars. The indirect cost would include lost wages, productivity, legal and insurance overheads.
What causes lower back pain?
The vast majority of low back pain is a mechanical problem. Often, back
pain is associated with spondylosis, which is the general degeneration of the spine associated with aging that occurs in the joints, discs, and bones.
Some examples of mechanical causes of low back pain include:
Sprains and strains account for most acute back pain. Sprains are often caused by over stretching ligaments, and strains are tears in tendon or muscle.
Strains and Sprains can occur from twisting or lifting improperly, lifting an object that is too heavy, or overstretching. These injuries may also trigger spasms in back muscles and this is often an acute symptom.
Intervertebral disc degeneration is one of the most common mechanical causes of low back pain, and it occurs when the discs lose their height and become more compressed. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. This is one reason we tend to get shorter as we age!
Bulging Discs are a very common issue because of the amount of sitting and often prolonged standing that we tend to do. The analogy I use for the disc is a jelly donut. The center of the disc is made of a gelatinous matrix and the outer area of the disc is thick dense fibers. As we sit for long periods of time or we bend and lift something heavy these fibers can become stretched and then jelly like center can push against surrounding nerve tissue, which results in pain. A classic sign is increased stiffness and pain in the morning after sleep. This is because the disc fluid pulls in when non-weight bearing, so the disc is more swollen and compresses the nerves. The good news is this can be corrected by conservative physical therapy!
Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, leaking out against the nerve. In this case the jelly is leaking out of the donut.
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results varying symptoms including pain, numbness, or a tingling sensation. This travels or radiates to other areas of the body that are served by that nerve.
Sciatica is a form of radiculopathy caused by compression of the sciatic nerve. The sciatic nerve is large nerve that travels through the buttocks and extends down the back of the leg.
Scoliosis is a curvature of the spine that can affect both the middle and lower portion of the spine. This curvature often creates not only nerve compression but also muscle imbalance and pain.
Spondylolisthesis is a condition in which a vertebra of the lower spine becomes fractured and slips out of place slightly. This can create pinching the nerves exiting the spinal column. This sounds a lot worse than it generally is. It is graded in four levels of severity. Only the most severe cases require surgery.
Spinal stenosis is a narrowing of the spinal column, which can put pressure on the spinal cord and nerves. This can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
Most back pain resolves within 6 weeks from onset, but what can be done to manage this problem for those who have ongoing back pain and limited function?
Physicians often prescribe medication like an anti-inflammatory, perform X-ray to rule out fracture, degenerative change or cancerous masses. Treatment for most back pain can often be treated by physical therapy or chiropractic.
PHYSICAL THERAPY EVALUATION: During the initial visit we get a history of the most recent complaints as well as a past medical history. This helps determine other factors that could be leading to the pain as well as any red flags of serious illness or disease.
Infections are not a common cause of back pain. However, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis.
Tumors are a relatively rare cause of back pain. Occasionally, tumors begin in the back and the pain would be constant and unchanging.
Abdominal aortic aneurysms occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes enlarged. Again this is rare but back pain can be a sign that the aneurysm is becoming larger.
Kidney stones can cause sharp pain in the lower back. It is generally on one side and is intense usually constant pain.
After we have ruled out any non-mechanical cause of back pain, we go through a thorough evaluation looking at movement, strength, sensation, flexibility, and function. If a patient has referred symptoms, pain/numbness/tingling in an extremity, we perform a specialized evaluation to determine if this pain can be reduced or eliminated thru movement.
During this time we often recommend relative rest, meaning AVOID activities that provoke the symptoms. Studies have shown bed rest of more than 3-5 days is not beneficial in the treatment of back pain. Movement is generally a good idea. Taking medications prescribed by your physician may also reduce some of the symptoms, these could include anti-inflammatory medications and medications to help with nerve pain.
Recommendations for keeping one’s back healthy from the American Physical Therapy Association
Walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility
Always stretch before exercise or other strenuous physical activity.
Maintain good posture. Don’t slouch when standing or sitting. The lower back can support a person’s weight most easily when the curvature is reduced. When standing, keep your weight equally balanced between your feet.
Always stretch before exercise or other strenuous physical activity.
At home or work, make sure work surfaces are at a comfortable height.
Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A rolled-up towel placed behind the small of the back can provide some lumbar support.
Don’t try to lift objects that are too heavy. Lift from the knees, and keep the head up and in line with a straight back. When lifting, keep objects close to the body and avoid twisting when lifting.
Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower back muscles.
This is a two-part article. In our next article we will discuss specific treatments and how this can reduce and eliminate back pain. Much of our treatment model focuses on eliminating pain and teaching the patient how to manage flare-ups independently.
For more information feel free to call our clinic: 865-674-7454
Robb Seahorn PT CSCS