LOW BACK PAIN
The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet. Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.
There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. This course of pain and timing also helps determine the cause.
Causes of Lower Back Pain
Lower back pain is often caused by a torn or pulled muscle or ligament. This can occur after lifting a heavy object, a sudden movement, poor back posture, or a sports injury. A low back sprain or strain can happen suddenly, or can develop slowly over time from repetitive movements. While sprains and strains do not sound serious and do not typically cause long-lasting pain, the acute pain can be severe.
The single most common cause of lower back pain is a torn or pulled muscle and/or ligament.
Common Symptoms of Lower Back Problems
Specifically identifying and describing symptoms can help lead to a more accurate diagnosis and effective treatment plan.
Low back pain is typically characterized by a combination of the following symptoms:
- Dull, Aching Pain. Pain that remains within the low back is usually described as dull and aching rather than burning, stinging, or sharp. This kind of pain can be accompanied by mild or severe muscle spasms, limited mobility, and aches in the hips and pelvis.
- Pain that travels to the Buttocks, Legs, and Feet. Sometimes low back pain includes a sharp, stinging, tingling or numb sensation that moves down the thighs and into the low legs and feet, also called sciatica. Sciatica is caused by irritation of the sciatic nerve, and is usually only felt on one side of the body.
- Pain that is worse after prolonged sitting. Sitting puts pressure on the discs, causing low back pain to worsen after sitting for long periods of time. Walking and stretching can alleviate low back pain quickly, but returning to a sitting position may cause symptoms to return.
- Pain that feels better when changing positions. Depending on the underlying cause of pain, some positions will be more comfortable than others. For example, with spinal stenosis walking normally may be difficult and painful, but leaning forward onto something, such as a shopping cart, may reduce pain. How symptoms change with shifting positions can help identify the source of pain.
- Pain that is worse after waking up and better after moving around. Many who experience low back pain report symptoms that are worse first thing in the morning. After getting up and moving around, however, symptoms are relieved. Pain in the morning is due to stiffness caused by long periods of rest, decreased blood flow with sleep, and possibly the quality of mattress and pillows used.
Of course, there are other ways people experience low back pain. Low back pain varies on an individual level, and many factors influence the pain experience, including mental and emotional health, financial stress, or exercise and activity level.
Self-Care for Low Back Pain
Basic remedies applied at home can be effective for treating mild or acute pain from muscle strain, as well as reducing the effects of chronic, severe pain. Self-care is administered by the individual and can easily be adjusted. These methods include:
- Short rest period. Many episodes of lower back pain can be improved by briefly avoiding strenuous activity. It is not advised to rest for more than a few days, as too much inactivity can make healing more difficult.
- Activity modification. One variant of resting is to stay active but avoid activities and positions that aggravate the pain. For example, if long periods of sitting in a car or at a desk make the pain worse, then set a timer to get up every 20 minutes and walk around or gently stretch. If standing makes the pain worse, avoid chores that require standing such as washing dishes at the sink. Avoiding, or minimizing, activities and positions that worsen the pain will help prevent or reduce painful back spasms and allow for a better healing environment.
- Heat/Ice therapy. Heat from a warm bath, hot water bottle, electric heating pad, or chemical or adhesive heat wraps can relax tense muscles and improve blood flow. Increased blood flow brings nutrients and oxygen that muscles need to heal and stay healthy. If the low back is painful due to inflammation, ice or cold packs can be used to reduce swelling. It’s important to protect the skin while applying heat and ice to prevent tissue damage.
Alternating heat and ice can be especially helpful when returning to activity: applying heat before activities helps relax muscles, allowing for better flexibility and mobility; applying ice after activity reduces the chances of an area becoming irritated and swollen from exercise.
- Over-the-counter Pain Medications. The most common over-the-counter (OTC) medications are aspirin (e.g. Bayer), ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and acetaminophen (e.g. Tylenol). Aspirin, ibuprofen, and naproxen are anti-inflammatory medicines, which alleviate low back pain caused by a swollen nerves or muscles. Acetaminophen works by interfering with pain signals sent to the brain.
Self-care treatments generally do not need guidance from a doctor, but should be used carefully and attentively. Any type of medication carries possible risks and side effects. If a patient is unsure which kinds of self-care would work best, talking to a doctor is advised.
Common Medical Treatments include
- Muscle Relaxants. This medication acts as a depressant of the central nervous system and increases mobility of tense muscles, relieving pain from muscle tightness or spasms. Muscle relaxants have no role in chronic pain management.
- Back Braces. Some patients find that a back brace can be used to provide comfort and possibly reduce pain. There is some evidence that use of an inelastic corset-style brace, worn daily, in combination with a physical therapy exercise program, can speed healing and reduce pain. A back brace may also be helpful after back surgery.
- Narcotic Pain Medications. Narcotic medications, also called opioids or painkillers, alter one’s perception of pain by weakening signals sent to the brain. Narcotic medications are most often used for treating intense, short-term pain, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can easily become addictive.
- Epidural Steroid Injections. This injection involves a steroid administered directly into the outer part of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy, is used to guide the needle to the correct area. The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.
Medical treatments are often used in combination with other methods. For example, an epidural steroid injection may provide enough short term pain relief to allow progress in physical therapy.
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