- With an annual incidence of 5%, low back pain affects up to 90% of the population at some point in time in their lives.
- Back Pain is the fifth most common cause for physician visits in the country and 7.6% of US adults reported at least one episode of severe acute low back pain within a 1-year period.
- The pain does not always reflect the extent of damage – meaning the severity of pain from low back problems is often unrelated to the extent of physical damage.
- Back pain usually goes away on its own. About 90 percent of patients with low back pain will recover within 6 weeks.
- 30% of people who have experienced low back pain will have a recurrence within 6 months, and 40% within 1 year.
Low back pain can have two different patterns: back-dominant pain and leg pain dominant:
- Back-dominant pain is a mild to severe pain or discomfort in the lower part of the back that sometimes radiates into the buttocks, the back of the thigh or to the groin. This type of low back pain indicates that there is no pressure on the nerves or spinal cord.
- Leg pain greater than back pain (leg pain dominant), usually referred to as “Sciatica”, is mostly disease of spinal nerve root generally presented by radicular pain in the legs, and can extend right down to the feet. The pain is usually be sharp during any movement and relieved by resting.
Low back is almost always benign, meaning it’s not serious and will resolve. However, if you have the presence of any of the following “Red Flags” it may be a sign that you need more investigation:
- Sudden change in the bowel or bladder control, or numbness around the groin or rectal area.
- Recent infection, high fever, vomiting, or if you have a weakened immune system
- High risk for urinary or kidney infections
- Risk for fracture in your back – recent trauma, accident, or if you have brittle bones from osteoporosis
- History of cancer, specifically lung, breast, or prostate
- Pain is constant, lasting weeks, even at night
- Unexplained weight loss
One lesser known cause of back pain is ankylosing spondylitis (AS). AS s not caused by physical trauma to the spine. Rather, it is a chronic spinal arthritis caused by inflammation in the vertebrae. Ankylosing spondylitis is rare. Males are more likely to have ankylosing spondylitis than females. Most people with the disease develop it at age 15-35 years, with an average age of 26 years at onset.
X-Ray, CT scan and MRI
The next question is: should i have an X-Ray, CT scan or MRI?
Not likely. Major studies have shown that only 1/2500 low back x-rays show anything serious. Other than being time consuming, costly on the health care system, and exposing you to ionizing radiation; a famous study found that peoples’ attitudes change if they have an image that shows even a mild injury in the low back, that may have nothing to do with the source of the pain. It also seems that a negative attitude towards the pain, really contributes to making us avoid movement or exercising.
The factors which highlight the patient’s risk of developing CHRONIC back pain can be identified using the ‘yellow flags’ system:
- A negative attitude that back pain is harmful or potentially severely disabling
- The tendency to fear pain, and avoid activities
- The tendency towards low mood and isolation
- Strong expectation that passive rather than active treatments will help
What works in treating low back pain
- Movement! Until the late 90′s, we were prescribing bed rest to low back pain patients. Sometimes people with back pain do need to rest, like with severe sciatica, but people who don’t move at all do worse.
- Over the counter medications can help in the short term
- Spinal manipulations, Acupuncture, and soft tissue therapies such as Massage have also proven effective. These therapies are not to be used indefinitely. For the most part, resolution should occur between 8-10 treatments, or about 1-2 months.
- Pilates, Yoga, or core strengthening exercises like planks are effective once the bout of low back pain has been resolved to prevent recurrences.
- Cognitive Behavioural Therapies (CBT) – CBT is a form of psychological therapy. It usually involves 10 to 20 meetings with a therapist. It is believed that changing your thoughts about pain can change how your body responds to pain.
- Multidisciplinary approaches – The multidisciplinary approach includes treating the physical, psychological, emotional, and socioprofessional aspects of the disorder. A team is therefore needed to address all the extraneous effects that are produced by living with chronic back pain from months to years. Psychologists, physicians, physical therapists and occupational therapists tend to be the professionals involved in multidisciplinary teams.
- Surgery – Surgery for Lower Back Pain is usually considered after pain has not been relieved with nonsurgical methods. For sciatica, laminectomy and microdiscectomy have been shown to significantly reduce pain symptoms by relieving the pressure on compressed nerve roots.
- Spinal fusion – Spinal fusion is surgery to join, or fuse, two or more vertebrae in the low back. It may be done by itself or along with surgery to remove bone and tissue that are narrowing the spinal canal and squeezing the spinal cord and/or the spinal nerves.