Pain that occurs below the ribcage, in the lumbar region of the spine, is called “low back pain.” About 80 percent of adults, typically 30- to 60-years-old, will experience low back pain at some point in their life. The pain can range in intensity from a constant, dull ache to a sudden, sharp sensation. If the pain does not subside after a few days, it may require specialized pain management.
What causes low back pain?
Back muscles are commonly injured when lifting an object, especially a heavy object, when reaching for an object or twisting, and when falling. Sports activities can also injure back muscles.
The most common causes of low back pain include:
- Overuse, strain, or injury.
- A physically demanding job.
- Sitting at a desk, slouching.
- Compression fractures.
- A spine problem at birth.
- An overstuffed bag carried over your shoulder, or a heavy briefcase, especially if you carry it day after day.
- Poor posture.
- Herniated disc that puts pressure on the spinal nerve roots.
- Chronic physical conditions or illness.
- Spinal stenosis – a narrowing of the space around the spinal cord, which places pressure on the nerves.
- Spondylitis – pain and stiffness due to severe inflammation of the spinal joints.
What are the Symptoms of Low Back Pain?
The most common symptom of low back pain is a sudden onset of the pain. The pain is generally localized and does not radiate into the leg. There is also tenderness in the lower back. Sometimes, a muscle strain is accompanied by spasms, whereby the muscle will twitch and pulse as the body tries to stabilize the injury.
The acute, stabbing pain from of low back pain can resolve in a short amount of time. However, continued pain or flare-ups may continue for weeks or months after the initial injury.
How is Low Back Pain Diagnosed?
A complete medical history and physical exam will usually identify any serious conditions that may be causing your back pain. Also, a complete back examination and neurologic tests are conducted to determine the source of the pain. It is important to note that the diagnosis of low back pain can be difficult to determine.
The pain management experts at Novus Spine & Pain Center may order radiological imaging, such as an X-ray, CT scan, MRI, myelogram, or bone scan, depending upon the results of the physical exam.
How is Low Back Pain Treated?
Treatment for lower back pain depends on the patient’s history, the type of pain, and the severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and exercise is almost always part of a treatment plan.
An important part of low back pain treatment is exercise. Depending on the injury, exercise usually begins two weeks after the injury, because back muscles can become atrophied with the lack of use, resulting in even more pain.
Options available for treating low back pain include:
Nutrition and exercise. Exercise improves lower back pain and the pain of sciatica by increasing flexibility and the range of motion. Exercise also releases endorphins, the body’s natural pain relievers. Nutrition and healthy eating will help combat any nutritional deficits in the body.
Yoga. In one study, participants who took 12 weeks of yoga classes had fewer symptoms of low back pain, compared with those who didn’t participate in yoga. Additionally, the benefits of yoga lasted several months after completion of the class. The same study suggests conventional stretching also works just as well as yoga. If your physician recommends yoga as a treatment, make sure your yoga instructor has experience working with back pain patients.
Biofeedback. The process of biofeedback helps a patient become aware of normally involuntary processes inside the body (such as blood pressure, temperature, and heart rate control). Biofeedback helps you gain some conscious control of these processes which can influence and improve your level of pain. This awareness of the body helps the patient to relax which can help relieve the pain.
Massage Therapy. Gentle focused rubbing of the affected area can help relieve muscle spasms and contractions as well as improve discomfort. Massage may help relieve chronic low back pain, especially when combined with exercise and stretching. Researchers found that patients using a combination of massage, exercise and stretching were able to move about more easily, and had less short and long-term pain. Massage can also help with relaxation which decreases stress and tension.
Physical Therapy. If back pain has kept you inactive for a long period of time, a rehabilitation program can help. This therapy strengthens your muscles and gets you back to your daily activities. A qualified physical therapist can help you with stretches, strength exercises, and low-impact cardio without straining your back.
Chiropractic manipulations. Targeted adjustments when combined with other treatments, may significantly reduce low back pain. Manipulations can help correct nerve transmission.
Acupuncture. There is mixed evidence that acupuncture is effective. A German study with over a thousand participants found effective relief of lower back pain with acupuncture. However, those who had simulated acupuncture (involving toothpicks tapping the skin) reported the same relief as those who had real acupuncture with needles. After eight weeks, both groups reported greater relief than a control group that did not have any acupuncture.
Medications. Mild, lower back pain often feels better with over-the-counter pain relievers. NSAIDs (ibuprofen-like drugs), acetaminophen (such as Tylenol), muscle relaxants, and membrane-stabilizing medications are often effective in treating low back pain. In some cases, pain-relieving creams can be helpful for muscle aches. In cases of severe or chronic pain, prescription medication may be necessary.
Regenerative Injection Therapy (Prolotherapy). A technique of injecting irritating substances into painful ligaments and tendons. We use this to initiate the body’s healing of a damaged ligament or tendon.
Peripheral nerve blocks and ablation. Nerves leading away from the spinal cord (peripheral nerves) can often be a source of pain. We block these nerves with a local anesthetic and then destroy the nerves (ablation).
Trigger point injections. This procedure involves injecting a local anesthetic and steroid into a “trigger point.” These are usually effective for treating muscle spasms.
Transcutaneous electrical nerve stimulation (TENS). This technique relieves pain by applying a mild electrical current to the skin at the site of the pain. The electric impulses interfere with normal pain sensations.
Peripheral nerve stimulation. Tiny electrodes placed close to the affected nerves release a small electrical current that inhibits pain transmission and may provide pain relief.
Disc denervation. Electrical stimulation is delivered along the vertebral bodies (the thick oval segment of bone forming the front of the vertebra also called the centrum) near the discs. Once located, the appropriate nerves are anesthetized and destroyed using electricity.
Spinal cord stimulation (SCS). An implanted electrical device decreases the perception of pain by confusing the spinal cord and brain pain processing centers. A small electrical lead is placed in the epidural space next to the spinal cord. Electrical signals replace the pain signals. If you have success during a trial period, you may decide to have a permanent SCS device implanted to help you long-term.
Lysis of adhesions (“Racz Procedure”). This procedure is effective in removing excessive scar tissue in the epidural space when conservative treatment for lower back pain has failed. A 2005 study found that “spinal adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment for a significant number of patients with chronic low back and lower extremity pain without major adverse effects.” We can use this procedure when we find vertebral body compression fractures, post-laminectomy syndrome, radiculopathy, or disc disease.
Infusion techniques. This procedure involves inserting a small catheter into the epidural space or directly next to affected spinal nerves. The catheter delivers a local anesthetic, and other medicines, for extended time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long-lasting.
Kyphoplasty and vertebroplasty. Two minimally invasive procedures for treating osteoporotic fractures. Both stabilize crushed vertebrae by an injection of acrylic cement into the vertebra. Pain is relieved from the added support and stability to the spine.
Intrathecal pump implants. An intrathecal pump works to relieve chronic pain by inserting small amounts of medicine directly into the area surrounding the spinal cord (intrathecal space) to prevent pain signals from reaching the brain.
Percutaneous discectomy. In this procedure, a needle is inserted through the skin into the affected disc to suction out disc material from the bulging disc to relieve pressure within the disc.
Cryotherapy. Electrical stimulation from a probe helps us identify the affected nerves. Once identified, freezing cycles are initiated over the painful nerves.
Surgery. If other treatments have not provided the expected relief, you may be a candidate for surgery. Surgery can remove a herniated disc, widen the space around the spinal cord, or fuse two spinal vertebrae together, depending on your specific situation.
How can I Keep My Back Healthy?
Most people will get their first taste of low back pain in their 30s. The odds of future episodes of low back pain increase with age.
Following any period of prolonged inactivity, a regimen of low-impact exercises is best. Speed walking, swimming, or stationary bike riding for 30 minutes daily can increase muscle strength and flexibility. Yoga also can help stretch and strengthen muscles and improve posture.
While there is no “sure way” to prevent back pain as you age, there are some things you can do to lower your risk of low back pain:
- Maintain a healthy weight. Being overweight increases your chance of back pain.
- Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower back muscles.
- A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
- Exercise regularly.
- Always stretch before exercise or other strenuous physical activity.
- Exercise your core muscles (stomach and back).
- Maintain an active lifestyle (avoid becoming inactive).
- Lift with your legs, not your back.
- Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in and keep the head down and in line with a straight back. When lifting, keep objects close to the body.
- Do not twist when lifting.
- Make sure your workstation position doesn’t contribute to your back pain.
- At home or work, make sure work surfaces are at a comfortable height.
- Don’t slouch when standing or sitting. The lower back can support a person’s weight most easily when the curvature is reduced.
- When standing, keep your weight balanced on your feet.
- Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often, and periodically walk around the office or gently stretch muscles to relieve tension.
- A pillow or rolled-up towel placed behind the small of the back when seated can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
- Wear comfortable, low-heeled shoes.
- Sleeping your side with the knees drawn up in a fetal position. This position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine.
- Sleep on a firm surface.
- Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking may also cause back pain.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating low back pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Low Back Pain Resources
Lower Back Pain Symptoms and Treatment (Spine-Health.com)
Lower Back Pain Symptoms and Causes (Spine-Health.com)
Low Back Pain in Older Adults (Spine-Health.com)
Low Back Pain Overview (WebMD slideshow)
Low Back Pain Fact Sheet (National Institute of Neurological Disorders and Stroke)
Low Back Pain (Wikipedia)
Low Back Pain (Johns Hopkins Medicine)
Low Back Pain (eMedicineHealth.com)
Additional Information and Resources
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at 800-352-9424
Information also is available from the following organizations:
National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
Tel: 877-22-NIAMS (226-4267); 301-565-2966 (TTY)
American Academy of Neurological and Orthopaedic Surgeons
American Academy of Physical Medicine & Rehabilitation