Lower Back Pain: Diagnosis and Treatment
Lower back pain can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:
The large nerve roots in the low back that go to the legs may be irritated
The smaller nerves that supply the low back may be irritated
The large paired lower back muscles (erector spinae) may be strained
The bones, ligaments or joints may be damaged
An intervertebral disc may be degenerating
Certain causes of lower back pain have a tendency to occur more often in younger individuals versus older adults:
Younger adults (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease) or from a back muscle strain or other soft tissue strain.
Older adults (over 60) are more likely to suffer from pain related to joint degeneration (such as osteoarthritis or spinal stenosis) or from a compression fracture.
Lower Back Pain Treatment Options
Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.
Rest. Ceasing activity for a few days allows injured tissue and even nerve roots to begin to heal, which in turn will help relieve lower back pain. However, more than a few days of rest can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the spine. Patients who do not regularly exercise to build strength and flexibility are more likely to experience recurrent or prolonged lower back pain.
Heat and Ice Packs. Heat and/or cold therapy helps relieve most types of low back pain by reducing inflammation. Often patients use ice, but some prefer heat. Both may be used alternately.
Medications. A wide variety of over-the-counter and prescription medications is available to help reduce lower back pain. Many medications reduce inflammation, which is often a cause of pain, while others work to inhibit the transmission of pain signals from reaching the brain. Each medication has multiple unique risks, possible side effects and drug (or food or supplement) interactions, which need to be evaluated by a physician.
Exercise. Exercise is a key element of almost any lower back pain treatment plan. Typically an exercise program will be developed and taught by a spine health professional, such as a physical therapist, chiropractor, or physiatrist, and will include three components: aerobic conditioning, stretching, and strengthening. The exercises are best done through a controlled, progressive program, with the goal of building toward a stronger, more flexible spine.
Surgery is almost always the patient’s decision, and a qualified spine surgeon will be able to explain the pros and cons of each procedure. Laminectomy and microdiscectomy have been shown to significantly reduce pain symptoms by relieving the pressure on compressed nerve roots. Fusion surgery, which is used to stop the motion at a motion segment, is a more extensive surgery but can be effective at relieving pain due to a painful motion segment.