Low Back Pain

What is it?

Most back pain is caused by muscle strain, trauma, spinal deformity and poor posture and body mechanics. Only about 10 percent of back pain is caused by a systemic illness. Back pain can develop anywhere from the neck to the lower spine. The pain can be localized or spread across a wide area and radiate from a central point.

What causes it?

Back pain has many causes, including overuse, trauma, degeneration of vertebrae, infection, or tumor. The exact cause of pain may be difficult to identify, since it can come from soft tissue, bone, disc or nerves. Risk factors for low back pain include cigarette smoking, jobs that require repetitive or heavy lifting, and exposure to vibration produced by vehicles or industrial machinery. Certain sports, such as cross-country skiing, and prolonged vehicle driving are also associated with back pain. Diseases such as spinal osteoarthritis, spondylitis and compression fractures can also cause pain. Some of these diseases are more prevalent in the elderly; consequently older people are at higher risk for back pain. Biomechanical causes are related muscle imbalances. Some muscles are too tight (e.g., hamstrings) and some muscles are too weak (e.g., abdominals). This becomes more complicated when someone uses poor body mechanics and lifts things improperly when bending at the waist or twisting the spine.

Who gets it?

  • Back pain is the most prevalent medical disorder in industrialized societies.
  • Low back pain disables 5.4 million Americans and costs at least $16 billion each year.
  • Two-thirds of all adults will experience at least one episode of back pain in their lifetime.
  • Seventy percent of people with back pain recover within a month.
  • Symptoms persist for more than six months in only 4 percent of the cases, but this group accounts for 85 percent of the money spent on treatment and compensation for low back pain.
  • About half of the people with chronic back pain return to work.

How is it diagnosed?

Physicians should determine whether pain is musculoskeletal, neurological or from one of the internal organs. This diagnosis is based on a careful history and physical examination. Injection of a local anesthetic and/or steroid into soft tissue or joint spaces can be helpful in diagnosing and treating back pain. Imaging procedures that assist in identifying the pain source include the x-ray, bone scan, computerized tomography (CAT scan) and magnetic resonance imaging (MRI). Expensive imaging procedures are generally reserved for patients whose diagnosis is not apparent with more conventional diagnostic techniques.

How is it treated?

Over-the-counter pain relievers, such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs, are often the only treatment necessary for back pain. Patients should avoid any activity that increases the pain. For persistent pain, assistance from a rheumatologist should be obtained. Treatment should be directed at the specific cause of pain. Management techniques include analgesics, anti-inflammatories, antidepressants, muscle relaxants and rehabilitation exercises. Mechanical back supports are usually recommended for limited periods of time in certain situations, such as post-operative patients. If these techniques fail within a reasonable time, injections with local anesthetics and steroids can be helpful. Surgery can be very helpful when comprehensive non-operative therapy fails.

Physical and occupational therapy are important forms of treatment since they focus on instruction in strengthening, postural re-education, proper body mechanics, and ergonomic assessments to help to prevent re-injury. The biggest component of rehabilitation treatment should be on instruction in an independent home exercise program so you do not become dependent on the health care system. The use of modalities (e.g., heat, cold, ultrasound and massage) provides temporary relief and should only be used as an adjunct to treatment to increase your activity level, strength and endurance to maintain your function.

For More Information

If you want more information on this or any other form of arthritis, visit the Arthritis Foundation Web site at www.arthritis.org


Musings

Back Pain

Of Soreness & Stretches