Dealing with Low Back Pain

Back pain, particularly low back pain (LBP), is estimated to affect 80% of the population at one point or another during any individual’s lifetime.  At any given point in time, 20 to 30% of Americans may be experiencing low back pain.  The symptoms of lower back disorders range from mild and generally tolerable, to severe and disabling.  This article will help provide an understanding of the causes of LBP and the treatment options available.

In order to understand the causes of LBP it is important to have a basic understanding of the anatomy of the lower back, otherwise known as the lumbosacral spine.  The lumbosacral spine consists of five lumbar and five sacral vertebrae.  These are the bones that comprise the rigid structural components of the lower back.  In between the vertebrae are discs that consist of a gelatinous material in the center called the nucleus which is surrounded by a tough fibrous tissue called the annulus that keeps the gel in place.  The vertebrae and discs are surrounded and supported by various different groups of muscles and ligaments that provide support and stability while allowing the motion necessary for bending and twisting activities.

Low back pain can result from muscular/ligamentous strains in which case it is often classified as mechanical or myofacial LBP.  When there is a disruption of the disc it may protrude or “herniate” beyond its normal confines causing pressure upon neurologic structures which can produce severe pain.   Arthritic disorders may also be a cause of LBP.  In any of these situations, pain may be localized to the lower back region or it may radiate into the lower extremities.   Severe pain may result in marked limitation of motion and impairment of normal activities of daily living, as well as work capabilities. 

Up to 95% of cases of LBP will respond to conservative or “non-operative” treatment within six weeks.  Activities should be limited to tasks that can be accomplished without significant pain.  It is best to avoid total inactivity as this can lead to rapid deconditioning of the muscles that support the lumbar spine and result in an unnecessarily protracted recovery.  Moist heat applied to the lower back helps relax and relieve stiffness and muscle tightness.  Anti-inflammatory medication can be used to help decrease pain.  Additional prescription pain medication and muscle relaxant medications are employed when pain is severe and persistent.

Physical therapy consisting of modalities and an exercise program to restore flexibility and strength of the spinal musculature is an effective means of expediting recovery.   Therapy need only continue until a patient is feeling improved and is independent in a home exercise program. 

 When LBP does not respond to “conservative” measures, further diagnostic testing is often needed.  X-Ray studies as well as MRI and CT scans may be ordered depending on which test will best be able to provide the information needed to decide on future treatment alternatives.  These studies will at times demonstrate conditions that require surgical treatment.

At TOG, every possible effort is made to resolve a patient’s discomfort in the least invasive and most expeditious manner.