Back Pain

Back pain can come on suddenly and last less than six weeks (acute), which may be caused by exertion, a fall or heavy lifting. Back pain that lasts more than three months (chronic) is less common than acute pain.

One of the most common reasons people go to the doctor or miss work, back pain is a leading cause of disability worldwide. In fact, about 80 percent of adults experience low back pain at some point in their lifetimes.

What are the risk factors associated with back pain?

Beyond underlying diseases and genetics, certain other risk factors may increase the likelihood for low back pain, namely:

Age: As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. Likewise, the intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

Fitness level: Back pain is more common among people who are not physically fit. Weak back and core abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise is beneficial for maintaining the integrity of intervertebral discs.

Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

Occupational: Repeated heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in a chair with inadequate back support.

Backpack overload in children: Low back pain unrelated to injury is unusual in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue. The American Academy of Orthopaedic Surgeons recommends that a child’s backpack should weigh no more than 15 to 20 percent of the child’s body weight.

ABOUT THE SPINE:

The first step to understanding back pain is understanding how the spine and muscles relate. First, there are three distinct regions of the back:

• Cervical or neck
• Thoracic or mid-level
• Lumbar or lower back

The thoracic spine (mid-back) region is much less frequently injured than the lumbar and cervical spine because it is much more rigid than the other two areas. The lumbar and cervical regions are most susceptible to injury and pain because of their weight-bearing function and involvement in moving, twisting and bending.

The lumbar (lower) region is the most prevalent source of back pain. The Lumbar region or lower back includes the five vertebrae (referred to as L1-L5) between the ribs and the pelvis which supports much of the weight of the upper body.

The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. These discs are round and flat, with a tough, outer layer that surrounds a jellylike material called the nucleus.

Thick bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted in the spinal cord and they control body movements and transmit signals from the body to the brain.

Most low back pain is:

• Acute, or short term, and lasts a few days to a few weeks
• Resolved on its own with self-care and without residual loss of function
• Related to the mechanics of the spine, meaning that something has caused a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit and work together.

Lumbar muscle strains and sprains are the most common causes of lower back pain. Both can result from a sudden injury or from gradual overuse that causes muscle fibers and ligaments to be abnormally stretched or torn.

Signs and symptoms of back pain may include:

• Muscle ache
• Shooting or stabbing pain
• Pain that radiates down your leg
• Limited flexibility or range of motion of the back

Most back pain gradually improves with home treatment and self-care, usually within two weeks. If not, see your doctor.

Contact a doctor if your pain:

• Is severe and doesn't improve with rest
• Persists for a maximum of 10-14 days
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness or tingling in one or both legs
• Is accompanied by unexplained weight loss
• Is accompanied by headaches or fever
• Includes stiffness in the lower back area that restricts range of motion
• Leaves you unable to maintain normal posture due to stiffness and/or pain
• Causes muscle spasms either with activity, or at rest

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

The vast majority of lumbar (low back) pain is mechanical in nature, and due to the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.

Low back pain is rarely related to serious underlying conditions, but when these conditions do occur, they require immediate medical attention. Serious underlying conditions include infections, tumors, Fibromyalgia and kidney stones.

Some examples of mechanical causes of back pain include:

Muscle or ligament strain: Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful. If you're in poor physical condition, constant strain on your back may cause painful muscle spasms.

Bulging, herniated or ruptured discs: Discs act as cushions between the bones (vertebrae) in your spine. The soft material inside a disc can bulge or rupture and press on a nerve, or become compressed and bulge outward (herniation), causing low back pain.

Arthritis: Osteoarthritis can affect the back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis, which puts pressure on the spinal cord and nerves and causes pain or numbness with walking and over time leads to leg weakness and sensory loss.

Skeletal irregularities: Back pain can occur if your spine curves abnormally. Scoliosis, a condition in which your spine curves to the side, lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine may lead to back pain, but generally only if severe.

Osteoporosis: A metabolic bone disease marked by a progressive decrease in bone density and strength, Osteoporosis can lead to painful fractures of the vertebrae if your bones become porous and brittle.

Intervertebral disc degeneration: One of the most common mechanical causes of cervical or lumbar pain, disc degeneration occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.

Radiculopathy: Caused by compression, inflammation and/or injury to a spinal nerve root, this pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.

Sciatica: A form of radiculopathy, Sciatica is caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.

Traumatic injury: Sports, car accidents, or a fall can injure tendons, ligaments or muscles resulting in low back pain or whiplash in the upper back and neck area. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted in the spinal cord.

The physicians and pain management team at Semmes Murphey Clinic are dedicated to finding solutions for patients with back pain. Because of the many and varied causes of back pain, the physicians at Semmes Murphey conduct complete diagnostic testing and interviews to narrow the causes and devise a successful treatment plan.

Diagnosis is made by a neurosurgeon based on history, symptom review, a physical examination and, if necessary, the results of diagnostic studies.

During the exam, he or she will ask about the onset, location, and severity of the pain, duration of symptoms and any limitations in movement, as well as any previous episodes or health conditions that might be related to the pain.

The patient’s ability to sit, stand, walk and lift his or her legs will be assessed. The doctor might also ask to rate the pain on a scale of zero to 10 and about normal physical activity levels and how well the patient is functioning with your pain.

Further diagnostic tests may be necessary including:

• X-rays
• Magnetic Resonance Imaging (MRI)
• Computed Tomography Scan (CT or CAT scan)
• Blood tests
• Bone scan
• Nerve studies (electromyography, or EMG)
• Discography
• Myleogram

If lumbar or cervical pain occurs after a recent injury — such as a car accident, a fall or sports injury — call your primary-care physician immediately.

If there are no neurological problems (i.e. numbness, weakness, bowel and bladder dysfunction), the patient may benefit by beginning conservative treatment at home for two to three days. The patient may take anti-inflammatory medications such as aspirin or ibuprofen and restrict strenuous activities for a few days.

If pain gets worse or does not improve after two to three days of home treatment, it’s time to see a doctor.

Once diagnosis is complete, a treatment plan will be developed with the patient and his or her family. Treatment for back pain generally depends on whether the pain is acute or chronic.

There are many treatment options to explore prior to the consideration of surgery. All of these treatment options are aimed at relieving the inflammation in the back and irritation of nerve roots.

Some patients may be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective.

NON-SURGICAL OPTIONS:

The physician can evaluate the patient and perform a neurological exam in the office to determine which nerve root is being irritated, as well as rule out other serious medical conditions.

Depending upon the exam results, a physician can prescribe medications to relieve the pain, swelling and irritation; he or she also may recommend limitation of activities. If these treatment options do not provide relief within two weeks, it may be time to consider other diagnostic studies and possibly surgery.

Strains, sprains and even disc herniations may be treated with simple diminished activity and even bed rest for a short period of time, usually from one to three days to a couple of weeks.

Your doctor may recommend physical therapy. The physical therapist will perform an in-depth evaluation, which combined with the doctor’s diagnosis, will dictate a treatment specifically designed for patients with spinal pain. Therapy may also include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation, and stretching exercises.

More than 90 percent of patients completely recover from an episode of lumbar muscle strain or sprain within one month. Conventional treatments may be used on an "as needed" basis at home to treat sudden flare-ups of lower back pain, along with anti-inflammatory medications. However, lower back strain may develop into a chronic condition unless efforts are made to change habits that contribute to the problem.

There are a variety of non-surgical treatments that can be used in combination with other therapies or alone. The physicians and physical therapists at Semmes Murphey Clinic will recommend and explain all appropriate treatment possibilities so, together, you can come to the decision that is best for you.

Non-surgical options to discuss with your physician include:

• Prescription medication
• Physical therapy
• Exercise – strengthening and aerobic
• Spinal manipulation and massage
• Traction
• Nerve block
• Epidural steroid injections
• Transcutaneous electrical nerve stimulation (TENS)

SURGICAL OPTIONS:

The physicians at Semmes Murphey insist that surgery is not for every patient. They consider each case and patient carefully to determine if surgery is the best route to get the patient’s “normal back.”

In general, surgery is recommended only if there is evidence of worsening nerve damage and when diagnostic tests indicate structural changes for which corrective surgical procedures have been developed.

There are a variety of surgical options to help people suffering from back pain “get their normal back.”

SMC patients can rest assured that they are being treated by nationally and internationally recognized leaders in this field.

Many of today’s modern surgical techniques were invented by physicians at Semmes Murphey Clinic. They were researched, implemented and perfected at SMC and are now taught in U.S. medical schools and used around the world. Semmes Murphey has revolutionized spine surgery and treatments and brought relief to thousands of patients.

According to the American Academy of Neurological Surgeons, you may be able to avoid or lessen back pain or prevent its recurrence by improving your physical condition with exercise and practicing proper body mechanics.

To keep your back healthy and strong:

• Exercise: Regular low-impact aerobics—those that don't strain or jolt your back— can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
• Build muscle strength and flexibility: Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels. Your doctor or physical therapist can tell which exercises are right for you.
• Maintain a healthy weight: Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.

Use proper body mechanics:

• Stand smart: Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.

• Sit smart: Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.

• Lift smart: Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

• Quit smoking: Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.