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Guide to Low Back Pain

What Is Low Back Pain?

Low back pain is a universal human experience — almost everyone has it at some point. The lower back, which starts below the ribcage, is called the lumbar region. Pain here can be intense and is one of the top causes of missed work. Fortunately, low back pain often gets better on its own. When it doesn’t, there are effective treatments.

Symptoms of Low Back Pain

Symptoms range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. Pain that lasts more than three months is considered chronic. If your pain is not better within 72 hours, you should consult a doctor.

Symptoms That Require Urgent Care

Severe back pain after a fall or injury should be checked out by a health care professional. Other warning signs include a loss of bowel or bladder control, leg weakness, fever, and pain when coughing or urinating. If you have any of these symptoms along with your back pain, contact your doctor.

Muscle Strain or Sciatica?

The kind of back pain that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes back pain can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, pain may run from the buttock down one leg. This is called sciatica.

Back Pain Culprit: Your Job

If your job involves lifting, pulling, or anything that twists the spine, it may contribute to back pain. However, sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or you tend to slouch.

Back Pain Culprit: Your Bag

Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.

Back Pain Culprit: Your Workout

Overdoing it at the gym or golf course is one of the most common causes of overextended muscles leading to low back pain. You’re especially vulnerable if you tend to be inactive during the work week and then spend hours at the gym or softball field on the weekend.

Back Pain Culprit: Your Posture

Mom was right when she said, “Stand up straight!” Your back supports weight best when you don’t slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.

Back Pain Culprit: Herniated Disc

The spine’s vertebrae are cushioned by gel-like discs that are prone to wear and tear from aging or injuries. A weakened disc may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disc and can cause intense pain.

Back Pain Culprit: Chronic Conditions

Several chronic conditions can lead to low back pain.

  • Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.
  • Spondylitis refers to chronic back pain and stiffness due to severe inflammation of the spinal joints.
  • Fibromyalgia causes widespread muscle aches, including back pain.

Who’s at Risk for Low Back Pain?

Most people get their first taste of low back pain in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

  • Being overweight
  • Inactive lifestyle
  • Jobs that require heavy lifting

Diagnosing Low Back Pain

To help your doctor diagnose the source of low back pain, be specific in describing the type of pain, when it started, related symptoms, and any history of chronic conditions. Your doctor may order X-rays, CT or MRI scans to look for damaged bones or discs, or other injuries to the spine.

Home Care for Low Back Pain

Back pain due to muscle strain will usually get better on its own, but you can take steps to make yourself more comfortable. A heating pad or warm baths may provide temporary pain relief.

The Bed Rest Debate

When your back hurts, you may not feel like getting out of bed. But if the problem is muscle strain, doctors recommend returning to your normal activities as soon as possible. Studies suggest that any more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility.

Yoga

If back pain doesn’t go away in three months, there’s evidence that yoga can help. In one recent study, people who took 12 weeks of yoga classes had fewer symptoms of low back pain than people who were given a book about care for back pain. The benefits lasted several months after the classes were finished. The study suggests conventional stretching also works just as well. Make sure your instructor is experienced at teaching people with back pain and will modify postures for you as needed.

Medications

Mild back pain often feels better with over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen. Pain-relieving creams may be helpful for muscle aches. For severe pain or chronic pain, your doctor may recommend prescription medication.

Injections

If simpler therapies and medications aren’t helping, your doctor may recommend injections to the back. One procedure, called a nerve root block, targets irritated nerves. Injections for back pain usually contain steroid medication.

Surgery

If long-lasting back pain is interfering with your daily life, and other treatments have not provided relief, you may be a candidate for surgery. Depending on the cause of your pain, a surgeon may remove a herniated disc, widen the space around the spinal cord, and/or fuse two spinal vertebrae together.

Physical Therapy

If back pain has left you inactive for a long time, a rehabilitation program can help you strengthen your muscles and get back to your daily activities. A physical therapist can guide you through stretches, strength exercises, and low-impact cardio that will help you be fitter without straining your back.

Strengthening the Back

Two types of strength-training moves that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.

Preventing Low Back Pain

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

  • Stay at a healthy weight.
  • Exercise regularly.
  • Lift with your legs, not your back.
  • Make sure your work station position isn’t contributing to your pain.

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Tips to Manage Low Back Pain at Home

Perhaps you bent the wrong way while lifting something heavy. Or you’re dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four say they’ve had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.

Sometimes it’s clearly serious: You were injured, or you feel numbness, weakness, or tingling in the legs. Call the doctor, of course. But for routine and mild low back pain, here are a few simple tips to try at home.

Spinal Stenosis

Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation. “Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes,” she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice — take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.

Keep moving. “Our spines are like the rest of our body — they’re meant to move. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you’re feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you — and your back — more mobile. Just don’t overdo it. There’s no need to run a marathon when your back is sore.

Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. “They help you maintain the proper posture and alignment of your spine. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.

Stretch. Don’t sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. Because most of us spend a lot of time bending forward in our jobs, it’s important to stand up and stretch backward throughout the day. Don’t forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.

Think ergonomically. Design your workspace so you don’t have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.

Watch your posture. Slumping makes it harder for your back to support your weight. Be especially careful of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.

Wear low heels. Exchange your four-inch pumps for flats or low heels (less than 1 inch). High heels create a more unstable posture, and increase pressure on your lower spine. According to research, nearly 60% of women who consistently wear high-heeled shoes complain of low back pain.

Kick the habit. Smoking can increase your risk for osteoporosis of the spine and other bone problems. Osteoporosis can lead to compression fractures of the spine. One study found that smokers are about a third more likely to have low back pain compared with nonsmokers.

Watch your weight. Use diet and exercise to keep your weight within a healthy range for your height. Being overweight puts excess stress on your spine.

Try an over-the-counter pain reliever. Anti-inflammatory drugs can help reduce back pain. Be sure to check with your doctor or pharmacist about any interactions over-the-counter pain relievers may have with other medications you are taking. People with a history of certain medical conditions (such as ulcers, kidney disease, and liver disease) should avoid some medicines.

Call your doctor if:

  • Your low back pain doesn’t go away after a few days, and it hurts even when you’re at rest or lying down.
  • You have weakness or numbness in your legs, or you have trouble standing or walking
  • You lose control over your bowels or bladder

These could be signs that you have a nerve problem or another underlying medical condition that needs to be treated.

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Common Cycling Injuries

Since the 1800s when bicycles first made their appearance, cycling has become popular for commuting, recreation, exercise, and sport. Studies estimate that large numbers of these cyclists experience physical problems: 48 percent in their necks, 42 percent in their knees, 36 percent in the groin and buttocks, 31 percent in their hands, and 30 percent in the back. No matter why they use a bicycle, young people can follow some basic safety principles to avoid common cycling injuries.

WHAT ARE THE MOST COMMON CYCLING INJURIES AND HOW CAN THEY BE PREVENTED?

Knee Pain

The knee is the most common site for overuse injuries in cycling. Patellofemoral syndrome (cyclist’s knee), patella and quandriceps tendinitis, medial plica syndrome, and iliotibial band friction syndrome are a few of the more common knee overuse injuries. The first four injuries mentioned involve pain around the kneecap, while the last condition results in outer knee pain. Shoe implants, wedges beneath the shoes, and cleat positions may help prevent some overuse injuries.

Head Injuries

One of the most common injuries suffered by cyclists is a head injury, which can be anything from a cut on the cheek to traumatic brain injury. Wearing a helmet may reduce the risk for head injury by 85 percent. The majority of states have no laws governing the use of helmets while riding a bicycle, but helmets are readily available for purchase and typically low in cost.

Neck/Back Pain

Cyclists most likely experience pain in the neck when they stay in one riding position for too long. An easy way to avoid this pain is by doing shoulder shrugs and neck stretches that help relieve neck tension. Improper form also leads to injuries. If the handlebars are too low, cyclists may have to round their backs, thus putting strain on the neck and back. Tight hamstrings and/or hip flexor muscles can also cause cyclists to round or arch the back, which causes the neck to hyperextend. Stretching these muscles on a regular basis will create flexibility and make it easier to maintain proper form. Changing the grip on the handlebars takes the stress off of over-used muscles and redistributes pressure to different nerves.

Wrist/Forearm Pain or Numbness

Cyclists should ride with their elbows slightly bent (never with their arms locked or straight). When they hit bumps in the road, bent elbows will act as shock absorbers. This is also where changing hand positions will help reduce pain or numbness. Two common wrist overuse injuries, Cyclist’s Palsy and Carpal Tunnel Syndrome, can be prevented by alternating the pressure from the inside to the outsides of the palms and making sure wrists do not drop below the handlebars. In addition, padded gloves and stretching the hands and wrists before riding will help.

Urogenital Problems

One common complaint from male riders who spend a lot of time riding is pudendal neuropathy, a numbness or pain in the genital or rectal area. It is typically caused by compression of the blood supply to the genital region. A wider seat, one with padding, a seat with part of the seat removed, changing the tilt of the seat, or using padded cycling shorts will all help relieve pressure.

Foot Numbness and Tingling

Foot numbness and tingling are common complaints, and shoes that are too tight or narrow are often the cause. In addition, foot numbness can be due to exertional compartment syndrome. This arises from increased pressure in the lower leg and resulting compression of nerves. The diagnosis is made by pressure measurements and is treated with surgical release.

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Prevention of Lower Back Pain

The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

    • Specific exercises: Talk to your doctor about how to perform these exercises.
      • Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease the tendency to suffer back pain.
      • Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles.
      • The pelvic tilt also helps alleviate tight back muscles.
    • Lumbar support belts: Workers who frequently perform heavy lifting are often required to wear these belts. There is no proof that these belts prevent back injury. One study even indicated that these belts increased the likelihood of injury.
    • Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.
    • Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.
    • Sleeping: Individual needs vary. If the mattress is too soft, many people will experience backaches. The same is true for sleeping on a hard mattress. Trial and error may be required. A piece of plywood between the box spring and mattress will stiffen a soft bed. A thick mattress pad will help soften a mattress that is too hard.
  • Lifting: Don’t lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to you, don’t stoop over to lift. Tighten your stomach muscles to keep your back in balance.

Microdiscectomy or microdecompression Spine Surgery

In a microdiscectomy or microdecompression spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.

A microdiscectomy is typically performed for a herniated lumbar disc and is actually more effective for treating leg pain (also known as radiculopathy) than lower back pain.

Impingement on the nerve root (compression) can cause substantial leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from leg pain almost immediately after a microdiscectomy spine surgery.

Microdiscectomy

Microdiscectomy

In general, if a patient’s leg pain due to a disc herniation is going to get better, it will do so in about six to twelve weeks. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone back surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone.

If the leg pain does not get better with nonsurgical treatments, then a microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence (cauda equina syndrome) or progressive neurological deficits. It may also be reasonable to consider back surgery acutely if the leg pain is severe.

A microdiscectomy is typically recommended for patients who have:

  • Experienced leg pain for at least six weeks
  • Not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID’s, and physical therapy).

However, after three to six months, the results of the spine surgery are not quite as favorable, so it is not generally advisable to postpone microdiscectomy surgery for a prolonged period of time (more than three to six months).

Microdiscectomy Success Rates

The success rate for microdiscectomy spine surgery is approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future.

A recurrent disc herniation may occur directly after back surgery or many years later, although they are most common in the first three months after surgery. If the disc does herniate again, generally a revision microdiscectomy will be just as successful as the first operation. However, after a recurrence, the patient is at higher risk of further recurrences (15% to 20% chance).

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Epidural Injection

Epidural injections are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Most practitioners will agree that, while the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program.

Lower Back Pain Treatment

Lower Back Pain

How Epidural Injection Work?

An epidural injection delivers medicine directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ inflammatory mediators from around the area that may be a source of pain.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Several common conditions that cause severe acute or chronic low back pain and/or leg pain (sciatica) from nerve irritation can be treated by injections. These conditions include:

  • A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves. Read Lumbar Herniated Disc for more information on diagnosis and treatments.
  • Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back.
  • Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain.
  • Compression fractures in a vertebra.
  • Cysts which are in the facet joint or the nerve root and can expand to squeeze spine structures.

The epidural injection procedure takes place in a surgery center, hospital, or a physician’s clinic.

Epidural Injection Pain Relief Success Rate

Patients will find that the benefits of an epidural steroid injection include a reduction in pain, primarily in leg pain (also called sciatica or radicular pain). Patients seem to have a better response when the epidural injections are coupled with an organized therapeutic exercise program.

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