Back Pain

Most episodes of back pain are caused by mechanical disorders associated with overuse of the back and spine, or the gradual changes associated with aging. In about 10% of the cases, back pain is caused by a systemic illness.

The disorders affecting the lower back can be divided into mechanical and systemic disorders. Mechanical disorders that can result in back pain include:

• Muscle strains usually related to sustained physical activity such as shoveling snow, gardening or prolonged driving. Acute strain may also occur when completing a common task from a twisted or rotational posture.
• Osteoarthritis resulting from the narrowing of the intervertebral discs located between the vertebrae of the spine. This narrowing is a common occurrence as a result of aging. The adjacent vertebrae grow spinal joint spurs in response to the increasing pressure placed on them. The bony growths can cause localized pain in the back or leg pain if they are related to nerve impingement.
• A herniated intervertebral disc may cause back pain associated with muscle spasms, as well as severe leg pain as the disc presses on a nerve in the low back. The pain radiating down the leg is called sciatica. Disc herniation may cause a loss of function of the nerve that may include a loss of reflex, sensation, or muscle strength.
• Spinal stenosis is a narrowing of the canal that the spinal cord occupies. This narrowing has many causes including bone spurs growing around the spinal joints, thickening of spinal ligaments, or bulging of a disc. The narrowed canal squeezes the nerve roots causing leg pain, numbness, or weakness. The pain is increased by standing, walking and sitting, and may be relieved with laying down.
• Diffuse Idiopathic Skeletal Hyperostosis (DISH), resulting from excessive bone growth can affect the vertebra from the neck to the lower back causing pain and stiffness.

Systemic disorders that can lead to back pain include ankylosing spondylitis, osteoporosis, tumors and spinal infections.

Typically, only a medical history and physical examination are required to diagnose low back pain. In some cases, individuals who do not respond to initial physical therapy may undergo specialized radiographic tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT) to screen for additional involvement of soft tissues, ruptured discs, spinal stenosis, tumors or nerve injuries.

When treating back pain bed rest should be kept to a minimum. Instead, patients should continue their activities of daily living, as tolerated. Referral to a physical therapist to develop an individualized exercise program and receive low back education will be beneficial for patients with back pain.

While excessive exercise should be discontinued until the pain is relieved, there are exercises that can help reduce pain. Pain management exercises may include flexion exercises (bending forward) and extension exercises (bending backwards), stretching, and strengthening.

Five to ten-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain.  Heat may help to relax the muscles. Heat should also be used to treat back pains that last longer than 48 hours. Over-the-counter pain relievers such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) are frequently adequate to control episodes of back pain, and muscle relaxants may help those with limited motion secondary to muscle tightness.

Massage therapy has proven helpful for those with chronic muscular pain, and some patients with mechanical back pain of the cervical, thoracic and/or lumbar spine have been known to benefit from manipulation of the spine.

A small minority of low back pain patients, particularly those with leg pain due to a herniated intervertebral disc, spinal stenosis, or tumors affecting structures in the spine will require surgery.

In most instances, individuals with low back pain will improve over a two- to six-week period. The goal is to minimize recurrences and, while being in good physical condition does not prevent all back pain episodes, it will make the resolution of those episodes easier. Lifestyle changes may be necessary. Be sure to pay attention to your body, exercise, eat right and maintain a healthy lifestyle. If you smoke, stop. Smoking is a predisposing factor for back pain. Obesity does not cause back pain, but it does make it more difficult to heal. If you are overweight, try to increase your activity level and eat healthier to get into shape. No particular diet is known to prevent episodes of low back pain.