Lower Back Pain; Causes and Treatment Options

By Kenneth C. Spengler, Jr., MD

Back pain is one of the most common complaints from people who are seen at my office. Although there are several serious causes of back pain, such as arthritis or a pinched nerve, the majority of back pain is classified as mechanical low back pain.

Mechanical low back pain is muscular or soft tissue related, hurts when you move and may be accompanied by spasms in your back. There is not a test that will show a specific soft tissue injury that may be causing this pain. Mechanical low back pain in many cases is caused by overuse related to activities such as yard work, lifting and even vacuuming. In some cases, these activities can injure the muscles, tendons and ligaments of your back with the pain developing several days after the activity.

There was a time when doctors might have recommended a period of prolonged rest to alleviate symptoms. However, studies have shown that your recovery time actually decreases if you return to light exercise sooner. If your pain involves a spasm in the back, you might need to have a day of rest or wear a back brace for a short period of time. In most other cases, it is a good idea to start walking and moving even while your back still hurts. Not every type of exercise works for every person, but people who return to some form of light exercise soon typically have a faster recovery and less chance of relapsing. Most cases of mechanical back pain improve within three weeks with exercise, over-the-counter anti-inflammatory medications, ice, using caution with activities that involve bending or twisting your back and in some cases physical therapy. Physical therapy and other exercises should focus on strengthening the core muscles of your body.

There is no magic answer to how you can prevent yourself from experiencing mechanical low back pain, but there are ways to minimize your chances of developing back pain of this type, such as participating in a regular aerobic activity that includes a core fitness plan. In addition, you should be conscious of the type of activities you take part in and how they can affect your back. For example, if you know you have a lot of yard work that involves bending, lifting or twisting, spread out the work over the course of several days instead of trying to do all of the work in one day.

Not all back pain improves with this course of action. Some symptoms may signal a more serious condition such as problems with the spine, a degenerative condition or nerve pain, which is most commonly referred to as sciatic nerve pain.

While mechanical low back pain involves spasms of localized pain in the back, individuals with nerve pain may experience pain that extends into one or both legs. Sciatica occurs when a disc pushes out of place and comes in contact with the nerve root. Arthritis can also cause sciatica by narrowing the opening through which the nerve passes. Many of these degenerative conditions are a natural part of aging and may not produce symptoms of a serious spinal condition. For those who do have pain, conservative treatment such as modified activity, physical therapy and exercise are appropriate. The use of epidural steroids (cortisone injections into the spinal cord) can often be effective in diminishing symptoms. Cortisone injections work by decreasing the swelling in an irritated nerve, relieving pressure and thereby decreasing pain.

While most patients with symptoms of a herniated disc improve and recover with conservative care, surgical treatment is considered only as a last option. In certain situations such as when the herniated disc is interfering with bowel or bladder function, producing pain controllable only by IV medication, or causing progressive muscle weakness, surgery may be done on an urgent basis.

A good, general guideline to follow if you are experiencing low back pain is to take an over-the-counter anti-inflammatory medication, ice the area and try some light exercise. If the pain does not improve within three to seven days, you should make an appointment to see your physician. If you have weakness or pain below your knee, you should make an appointment immediately to see your physician. Proactive steps, such as building some aerobic activity into your schedule five days a week and strengthening your core area (abdomen, back and pelvic) can greatly decrease your chance of developing low back pain.

Dr. Kenneth C. Spengler, Jr. has a strong expertise in spine care as well as sports medicine and lower extremity injuries. Dr. Spengler has been a leader in orthopedic care for more than three decades in the Seacoast region. For information, please call his office at 603-778-7975.