Low Back Pain

INTRODUCTION:-

Low back pain is extremely common. Almost every person will have at least one episode of low back pain at some time in his or her life. The pain can vary from severe and long term to mild and short lived. It will resolve within a few weeks for most people.

CAUSES

 Low back pain may be related to aging of the disk. As a result of wear and tear on the spine, ligaments, and disks, a disk may begin to protrude or collapse and put pressure on the nerve root leading to a leg or foot, causing pain in those areas (sciatica).

The problem can be aggravated by associated conditions, such as narrowing (stenosis) of the canal or shifting of the vertebra (spondylolisthesis) , one upon the other.

Low back pain is sometimes caused by:

  • Excessive stress to the back, such as lifting something heavy
  • Minimal movement, such as bending or reaching for something
  • Arthritis of the spine
  • Problems with tendons or ligaments in and around the spine
  • Malpositioning of vertebrae

SYMPTOMS

  • Most people find that reclining or lying down will improve their pain and after their initial severe episode, many will be able to rest at night without severe pain. Most people experience more severe pain when they bend over to pick something up. Some get relief from arching backward (extending the back).
  • Leg pain also can be part of the problem. The pain is most common in the back or outer side of the thigh, and can go all the way to the foot. Pain that goes to the foot is called sciatica because it is pain that follows the course of the sciatic nerve. Sciatica is often made worse by coughing or sneezing
  • With an acute episode, back pain can be very severe for a few days or a week and then will often improve. By 2 weeks to 4 weeks, most people are much better. The length of time between episodes varies greatly from person to person, as does the length of each episode, the intensity of each episode, and how well each individual copes with the pain.

DIAGNOSIS

X-rays

X-rays and other imaging studies are typically not used in determining the cause of short-term (acute) back pain. When X-rays are obtained, they are often normal or they show an abnormality that may not be related to the pain. For instance, it is very common to see some disk degeneration in X-rays of people with back pain. But it is also very common to see it in people who do not have back pain. It is difficult to tell whether the degeneration is actually the cause of the pain. The same is true for magnetic resonance imaging (MRI) and computed tomography (CT) scans.
MRI (Magnetic Resonance Imaging)

MRI is often the next imaging test ordered if the physician feels it is indicated. With MRI, the doctor can see the disks and the nerves. He or she can see the level of degeneration of the disks and whether there is any material that has gone outside of the normal confines of the disk (herniation). MRI is also very good at showing infections, tumors, and fractures.

Physioline Management

Treatment

Treatments for low back pain are multiple and varied.
Counseling and Education

At times, counseling and education about the problem to ease a person’s anxiety is enough to make it tolerable until the episode resolves.
Rest

A few days of rest can often calm the pain down as well. Prolonged bed rest (more than 2 days to 3 days) is no longer generally recommended for people with low back pain.
Medication

Medications such as nonsteroidal anti inflammatory drugs (NSAIDS) or acetaminophen can be helpful. Occasionally, stronger medications such as muscle relaxants and narcotics are used for a short period.
Braces

Although there is minimal scientific evidence of their effectiveness in treating low back pain, back braces are commonly used. Most common is a corset type brace that can be wrapped around the back and abdomen. People who use corset type braces sometimes report feeling better supported and more comfortable.
Passive Modalities

Passive modalities include the application of heat or cold, massage, ultrasound, electrical stimulation, traction, and acupuncture. How long the benefit will last or what the chances are of receiving benefit from any of these treatments is not completely known.
Spinal Manipulation

Another form of passive treatment is spinal manipulation. There are many different practitioners of spinal manipulation, each with their own style of manipulation. This has also at times improved symptoms of low back pain.
Injections

The most commonly used injections are local anesthetic and/or steroids. They are usually given either in the area that is believed to be the source of the pain, such as into a muscle or facet joint, or around the nerves of the spine (an epidural or nerve root injection). Injections are occasionally placed into the disk, but this is done far less frequently.
Exercise and Stretching

Exercising to restore motion and strength to a painful lumbar spine can be very helpful in relieving pain. Although there is controversy as to which are the most effective spine exercises, it is generally agreed that exercise should be both aerobic (aimed at improving heart and lung function) and specific to the spine. Aerobic exercises include walking, jogging, swimming, and bicycling.
Proper Lifting Technique

Instruction in lifting techniques can be helpful as well. Improperly bending over to lift can cause a large increase in strain on the low back. Proper lifting keeps the back straight while you bend with the knees.

Prevention
Illustration of proper lifting.

Low back pain caused by lifting can be prevented by using proper lifting techniques and by exercising regularly to improve muscle strength and overall physical condition.

The normal effects of aging that result in loss of bone mass and decreased strength and elasticity of muscles and ligaments can’t be avoided. However, the effects can be slowed by:

  • Exercising regularly to keep the muscles of the back strong and flexible
  • Using the correct lifting and moving techniques
  • Maintaining a proper body weight; being overweight puts a strain on the back muscles
  • Avoiding smoking
  • Maintaining a proper posture when standing and sitting; don’t slouch

 

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