What is Lower Back Pain?
Low back pain (LBP) is often described as sudden, sharp, persistent, or dull pain felt below the waist. LBP is very common and affects the majority of people at some point during their life.
Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder.
Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).
Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting less than 3 months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain.
Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s). Sometimes pain is accompanied by neurologic symptoms such as numbness, tingling, or weakness.
Neurologic symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities.
Diagnosis
Pain felt in the low back (lumbar spine) is not always indicative of a spinal problem. A thorough physical and neurologic assessment may reveal the cause of the low back pain. The physical examination begins with the patient's current condition and medical history.
Range of Motion
The patient's range of spinal motion is evaluated while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas).
Neurologic Assessment
The neurologic assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement. In some cases electrodiagnostic studies such as electromyography (EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury.
Lab Tests
If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis.
Imaging Studies
Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurologic dysfunction is suspected. An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back.
The results of the physical and neurologic examinations combined with test results are carefully evaluated to confirm a diagnosis.
Non-Surgical Treatment
Most patients with low back pain (lumbar spine) are treated without surgery. A conventional treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient's medical condition, age, other drugs the patient currently takes, and safety.
Medication
The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase.
Physical Therapy
Physical therapy (PT) is started as soon as the patient can tolerate activity. A managed PT program can help build muscle strength, flexibility, improve mobility, coordination, stability, balance, and promotes relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist.
PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise.
Spine Surgery
Seldom is surgery required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain.
Recovery
First and foremost, follow the treatment plan outlined by the physician and physical therapist. To enhance recovery from surgery, an episode of low back pain, or to help prevent future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.
Professor of Neurological Surgery
Northwestern University
Chicago, IL
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