Low Back Pain: Common Causes and Treatments

Low Back Pain (LBP) results from an injury to the lumbar spine and it affects nearly everyone - 80% of population - at some point in their lives, interfering with work, recreation and daily activities. LBP costs the healthcare industry over $50 billion annually and it's the leading cause for missed work. LBP is the second most common neurological condition, first being the headache.

LBP can happen due to an accident or trauma; an exacerbation of an old injury; a chronic condition that never goes away. Fortunately, most LBP goes away without invasive intervention (i.e. drugs or surgery) but only if you know what's causing your LBP and treat it properly. Unfortunately, the most commonly prescribed therapy for LBP is NSAIDS, like Aspirin and Tylenol, or muscle relaxers, which can damage your liver and your gut.

Low Back Pain: Common Causes and Treatments

LBP can be severe to mild, depending on the cause. It can be achy, throbbing, or sharp pain, and sometimes, electric-shock-like pain, shooting down the affected side leg. The type of pain is indicative of what type of structural damage is causing the pain.

• Acute Injury - acute trauma like car accidents or work related accidents causing injury to the low back spine
• Arthritis - lumbago, spondylitis
• Degenerative Disc Disease - Disc bulge or protrusion, Disc herniation, dis degeneration caused by wear and tear, causing inflammation in the spinal joints
• Inactivity - causing muscles to 'give out' upon strenuous activity, as simple as bending down to lift something from the floor
• Fibromyalgia - diffused musculoskeletal pain throughout the body, spine, shoulders, and neck in particular, usually accompanied by sleep disorder
• Mental Stress - mind - body connection is real and it is one of the most common causes for LBP
• Over weight or Obesity - weak core muscles causing stresses in the low back
• Old Unsupportive Mattress - creating stresses in the spine where there are no support during sleep
• Osteoporosis - can cause compression fracture in the vertebrae due to loss of bone mass
• Overuse - constant stress in the lumbar spine
• Poor Posture - not maintaining normal posture in the lumbar spine from poor ergonomics causing chronic stress in the back
• Pregnancy - center of gravity shifts to anterior, causing hyperlordosis or baby's weight pressing on a nerve
• Sciatica - nerve impingement due to protruding disc(s)
• Spinal Stenosis - narrowing of the spinal canal due to bone spurs pressing on nerve(s)
• Structural Abnormalities in the Spine - Spondylosis or Spondylolisthesis
• Tight muscles - in the low back or legs (Hamstrings)
• Unsupported Arches in the Feet - fallen arches or high arches that are not supported with orthotics causing lordosis problems in the low back
• Weak Core Muscles - weak stomach and low back muscles
• Space Occupying Lesion - Cyst, tumor, cancer in the spine
• Referral Pain from Visceral Problems - pain referred from other areas in the body that refer pain to the low back area

Above reasons are just a few causes for LBP. In order to treat LBP properly, though, it's imperative for the doctor to find the CAUSE and not just treat the symptoms. If needed, a doctor may order one or more of the following tests after a thorough exam to determine the cause.

Diagnostic Tests

• X-Ray -  radiological study can determine the skeletal's integrity. No soft tissue injuries can be seen in X-Rays.
• Computerized Tomography Scan (CT Scan) - x-ray scan of the bones in 2 dimensional views, unlike one dimensional view from X-Rays.
• Magnetic Resonance Imaging (MRI) - magnetic polarity stimulates the liquid molecules in the body creating the images of the soft tissues. So the discs, ligaments, tendons, muscles, and space occupying lesions (tumors and cancers) can be seen on MRI scans, determining if there are issues other than bones are involved
• Electromyography (EMG) - electrical activity in a nerve to detect if muscle weakness results from injury or a problem with the nerves that control the muscles.

After a diagnosis has been confirmed by imaging (if it was performed), the doctor will usually start with the most non-invasive treatment protocol, barring any substantiated need for a radical invasive surgery.

Non-Invasive Low Back Pain Treatment Protocol

1. RICE -  acronym is Rest, Ice, Compression, and Elevate. It's the acute injury protocol for most sprains and strains and LBP is no exception. Upon acute (1-3 days from the onset of pain) injury, you should rest and put ice (cryotherapy) on the injured ares to reduce inflammation. Alternate using ice "ON" and "OFF" in 15 minute increments. If ice alone does not change your pain, you can alternate ice and moist heat. NEVER use HEAT alone and never use DRY heat. Use a lumbar support belt to compress the muscles to reduce swelling. Obviously, you can't elevate your low back but position your body so that it's in the most relaxed state so as not to cause the muscles to go into spasm. After the first day of RICE, choose any of the following methods for finding the cause of the LBP and treat it properly.
2. Chiropractic Spinal Manipulation - a specific and gentle spinal manipulation by a licensed Chiropractor can reduce pain in just one visit, depending on the cause. Of course, you need to maintain the short and long term protocol to completely treat the cause but if the pain is caused by spinal joint problems, you can have an immediate pain relief after just one spinal adjustment. Spinal manipulation of the specific misaligned vertebral joint (subluxation) will restore the alignment, alleviating the pain. It's like straightening the kinked garden hose. Taking pain killers or NSAIDS may temporarily reduce the inflammation (is a normal reaction of the body in an attempt to heal) will not make the subluxation to go away. Only an adjustment will. Furthermore, a Chiropractor will approach your healing process wholistically and show you proper ergonomics, give nutritional counseling, show muscle strengthening exercises, and advise preventive techniques.
3. Acupuncture - balancing your 'Chi' and addressing the weaker meridian will make your body's energy flow better. The only licensed acupuncturist will know which meridian and which acu-points will need to be stimulated to balance the Yin and Yang in the injured area. Acupuncture treatment to the injured area will increase the blood flow and promote faster healing, and often, it can cause analgesic effect.
4. Physical Therapy  - oftentimes, your medical doctor will prescribe physical therapy for LBP to address the stiff muscles and soft tissues that are causing the pain. A physical therapists are trained to apply therapeutic modalities such as Ultrasound and Electric Stimulation, along with heat and ice, depending on the injury. They may also stretch your injured muscles and show you how to stretch at home to maintain flexibility. They also mobilize your joints to create more flexibility. However, they do not perform spinal manipulation and they do not diagnose your condition.

There are many more treatment modalities for LBP. But pain does not occur without a real cause. Your pain may resolve after RICE but without knowing what caused the pain, the chances are, the pain will reoccur. Proper diagnosis is a key to a successful treatment so don't 'guess' what it could be. Besides, you can cause more damage by just treating the symptoms and the problem will reoccur. Only a licensed doctor can find the real cause so you can decide which treatment protocol to use.

Finally, the pain will not just 'go away' on its own. I've heard the infamous phrase, 'I thought it'll go away' too many times from patients who hobbled in after taking NSAIDS for days without any improvements. Sooner you get the proper diagnosis, quicker your recovery will be.

Here is a post on how to PREVENT back pain since prevention is the key!

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Image: by b.zyczynski via Depositphoto