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Low back pain is one of those things that nearly everyone
experiences at least once in their lifetime. It is second only to
the common cold for reasons that people consult their physicians.
Some studies have shown that 80% of all adults, at some time in
their life, have low back pain. Furthermore, of those that do have
low back pain at some time in their life, 60% will have recurrent
episodes. It is safe to say that many of you reading this right now
have some back pain. This week I will discuss some causes/confusion
associated with mechanical musculoskeletal low back pain, that is,
pain not as a result of a serious medical disorder such as cancer,
kidney dysfunction or the like. I will describe some more common
diagnoses and how they typically feel to the individual, I will then
discuss some preventative measures. Any specific questions should be
directed toward your physician or physical therapist.
RADIOLOGIC FINDINGS:
(MRI’S, X-RAYS, CT-SCANS, BONE SCANS)
Despite recent advances in imaging technology (MRI, CT Scan, Bone
Scans, X-ray) that allow medical practitioners to ‘see’ what is
going on in a painful low back, physicians and therapists still have
difficulty identifying and therefore treating low back pain. Some
studies have shown as many as 50% of individuals that have a
positive radiologic finding of a disc problem are asymptomatic, that
is, without pain. So what does that mean? Well, just because you
have a positive finding on a radiologic test does not mean
necessarily that the finding is the source of your pain. It can
cloud the picture in some instances. A thorough clinical exam and
interview is perhaps more valuable in diagnosing the problem than
the radiologic exam. That is one possible reason your physician may
not immediately order these types of tests. These tests should
confirm the findings of your clinical exam. They are very valuable
in this way.
TYPES OF LOW BACK PAIN
There are many types of mechanical low back pain that can be caused
for any number of reasons. Some pain is intermittent (comes and
goes), some is constant (despite bodily positional changes), some is
localized to the low back, some pain ‘radiates’ into the lower
extremity, some pain is acute (high intensity with recent onset) and
some is chronic (lower levels of pain for greater than a few
months). Some causes of low back pain are: muscle imbalance in the
spine and/or lower extremities, arthritis, herniated or bulging
disc, poor postures and body mechanics. Given all of the variables
mentioned above (which are by no means totally inclusive), the
number of different types/causes and combinations of low back pain
are almost countless. Every individual is different. For the sake of
simplicity, here are how some more common types of back pain behave.
Herniated/’slipped’/bulging discs:
There are several levels of severity for bulging or herniated discs.
It is beyond the scope of this article to discuss these but suffice
it to say that a bulging disc in some instances may be asympotmatic
or in some cases require surgery. Statistically speaking, the
typical person suffering from a disc problem is a male in his
thirties or forties. He will have more pain sitting than standing or
walking. He will typically have pain radiating into one lower
extremity. Usually he will respond to anti-inflammatory medication
(steroid dose pack) but can have re-current episodes without
addressing the cause of the herniation in the first place. Factors
such as muscle imbalance, loss of flexibility and/or poor
lifting/postural mechanics affect the disc. These issues are
addressed by a physical therapist. A herniated /bulging disc is an
actual physical deformity of cartilage and/or fluid in your spine,
medication may ease the symptoms but will not address the deformity.
Addressing the physical derangement is a goal of the physical
therapist. Surgery is a last option to correct the physical
deformity of the cartilage if physical therapy does not work. Recent
studies in the New England Journal of Medicine followed two groups
of patients several years after a disc problem. One group had
surgery, the other physical therapy – both groups were fairing the
same several years after their respective treatment. Surgery is
usually a last option. Walking is usually an excellent exercise for
people with disc problems.
Stenosis/degenerated spine: Statistically
speaking this is usually an elderly individual with low back pain
that may or may not radiate into one or both lower extremities. The
pain usually comes and goes; coming with standing and walking,
relieved by sitting. Interestingly they can usually walk long
distances in a grocery store – when leaning on a shopping cart.
Typically they have weak abdominal musculature and tight muscles in
the legs. Unfortunately stenosis and degenerative changes in the
elderly cause them to ‘sit around’ more because it hurts to walk and
they gradually decline in health (cardiovascularly) from a sedentary
lifestyle. They should address their low back pain with a physician
or physical therapist so that their general health does not decline.
I see many people that fit into this category in my clinic and most
of them have significant relief after treatment.
LOW BACK PAIN PREVENTION
TIPS
The following 3 tips are not intended to treat low back pain, merely
try to prevent it. There are many other tips given by medical and
nonmedical personel to individuals but these are the three that I
find that can apply to just about anyone, young or old.
• DO NOT SMOKE ! – If you needed another reason to not smoke, here’s
one. Smoking deprives your back of nutrients needed to maintain
health in your spine. Smoking deprives your spine (and other parts
of your body) of oxygen.
• MOVE ! Again, nutrition to your spine (particularly the discs) is
maintained through movement, i.e. walking, cycling, stretching and
exercise. Sedentary individuals are at higher risk for injury.
• IF IT HURTS DON’T DO IT ! If you have some back pain from sitting
or walking or lifting, your back is telling you that that activity
is not healthy for your back and if you continue to do it
– YOUR BACK IS REALLY GOING TO HURT YOU.
NO PAIN NO GAIN DOES NOT APPLY!
Before I leave this topic for this week I would like to make one
last comment.
If you suffer from low back pain-
you do not have to live with it!
I can not tell you how many people I have run across that have low
back pain saying – ‘everyone has low back pain, it’s just something
you live with’. In most instances you can eliminate or significantly
reduce your low back pain. Consult your physician or physical
therapist if you have pain.
Please feel free to
contact me if you have an area
of interest in health and wellness that I may give some input on.
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