Doctor’s Tip: The lowdown on back pain
Low back pain is one of the most common complaints for which patients see primary care doctors. To understand low back pain, it is necessary to understand the anatomy of the back.
The lumbar spine consists of 5 vertebrae, L1 through L5, stacked on top of each other, with the sacrum and coccyx (“tailbone”) located below L5. The vertebrae articulate (join) with each other via the facet joints, located in the back of each vertebra. The spinal cord runs through a vertical hole behind the round body of the vertebrae. Between the bodies of each set of vertebrae are pads called disks, which consist of a fibrous band around the outside called the annulus fibrosis, and a soft, jelly-like center. There are nerve fibers in the annulus fibrosis. Nerves to the legs and elsewhere exit between the vertebrae.
Many muscles attach to the vertebrae, and the most common back injury is a simple muscle strain, often from lifting improperly such as twisting while lifting, or using your back rather than your legs to lift. Strains are more apt to occur in people who are poorly conditioned and therefore weak, particularly when the supporting core muscles of the abdomen are weak.
People with low back strain typically have pain in the area of the strained muscle, made worse with forward or backward or sideways bending. Treatment is intermittent ice for up to 48 hours, then heat. The safest analgesic is acetaminophen, with aspirin and anti-inflammatories such as ibuprofen or naproxen having more side effects. Symptoms usually resolve within several days. Although people with back strain should avoid activities that cause increased pain, bed rest is counterproductive and “active recovery” such as walking is best. X-rays are not necessary. If the symptoms persist, physical therapy and chiropractic manipulation can be helpful.
Facet joint arthritis can cause back pain, and usually occurs in middle-aged or older people. The pain is usually located deep in the back, just to one side of the midline, and often radiates into the buttock. Another cause of back pain is a strain of the SI joint (sacroiliac, the immovable joint where the pelvis bone joins the tailbone in back), which causes pain to one side of the sacrum, often radiating down to the thigh. People with this often complain of pain in their hip.
Another cause of back pain is an injury to a disk, again often caused by improper lifting. A disk can develop a bulge, like a weak spot in a tire or a balloon, and when the annulus fibrosis bulges the stretched nerve fibers cause pain, usually in the center and to one side of the back.
If the bulging disk touches one of the nerve fibers exiting the spinal cord, pain or numbness and tingling can occur down the leg, sometimes to the foot. Disk injuries often heal with time, and again active recovery is best. X-rays are usually not helpful at least initially, although if symptoms persist an MRI can help delineate what is going on. If weakness in a leg occurs, by all means seek medical attention; sometimes surgery is indicated. If problems with bowels or bladder occur, this could mean nerves going to these structures are injured, and surgical treatment is urgent.
Back fusions are major operations with long recoveries, and are controversial except in cases of back instability caused by injuries or certain degenerative conditions of the spine. “Failed back syndrome” is when a person has had one or more operations and their pain is no better or even worse.
Finally, some serious, even life-threatening conditions such as tumors and abdominal aneurysms can cause low back pain. So if you have significant back pain with no obvious injury and it is not made worse by bending, seek medical attention right away so that a serious condition can be ruled out or treated.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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