Worried about low back pain? It’s more common than you’d think
Valley View Hospital
Most of us have been through it — a throbbing ache in the lower back that lingers, making us feel miserable through long car rides and hours at our desks. More than 80 percent of Americans experience low back pain within their lifetimes, and sometimes the cause of low back pain is quite serious. But for the majority of us, mild low back pain goes away on its own.
So how do you know when you should see a doctor or treat the pain on your own? Dr. David Miller, neurosurgeon at the High Mountain Brain and Spinal Surgery Center at Valley View and former staff neurosurgeon at the Cleveland Clinic Foundation, said that he advises patients start with their primary care provider when experiencing back pain as well as the following symptoms and/or medical history:
• numbness or weakness in your legs,
• problems with bladder or bowel control,
• patients who take a steroid medicine like prednisone regularly,
• those with a history of osteoporosis or cancer,
• or those with a fever or who feel ill in other ways.
“Back pain is rarely an emergent problem; however, if you experience weakness or loss of bowel or bladder control call your doctor immediately. In the absence of the above issues, conservative treatment will usually be all that is needed for most episodes of low back pain,” said Dr. Wade Ceola, who is joining Dr. Miller in January 2015 from the Springfield Neurological and Spine Institute in Missouri. He offered the following advice:
Remain active: We know from clinical studies that people with low back pain should not take more than 24 hours of bed rest, and remaining active generally hastens recovery. Prolonged bed rest can actually make the pain worse as light activity and movement helps relieve muscle spasms and prevents loss of muscle strength.
Work: For most patients, we usually recommend that you continue to work if you can avoid prolonged standing or sitting. You should also be careful to avoid heavy lifting and twisting.
Pain medications: If you need over-the-counter pain medication, aspirin, acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) are all good choices. It’s usually more effective to take regular, timed doses of these medicines over a period of three to five days than to only take them when pain feels unbearable. Your primary care provider may prescribe a short course of oral steroids or a mild muscle relaxer in rare cases.
Exercise: immediately after a new episode of low back pain begins, back exercise or stretching routines aren’t a great idea as they could make the pain worse or make it last longer. But as the pain begins to subside, it’s a good idea to start some exercises to strengthen the muscles that support your core muscles and increase your back’s flexibility. Swimming or even walking in water is an excellent way to gently condition your core. Walking, stationary bikes, and low-impact aerobics all can help with strengthening and stretching the back. Avoid activities that include twisting, bending, heavy lifting or are high-impact, as these could increase your back pain.
Physical therapy: if your back pain persists for more than a few weeks, your primary care provider may recommend that you work with a physical therapist to develop a formal exercise program.
Other conservative treatments: Chiropractors, physical therapists, and massage therapists use manipulation to treat acute and chronic low back pain. Clinical trials using two treatments a week for two to three weeks show that manipulation can be safe and effective for people who’ve had back pain for more than four weeks.
“Your primary care provider may also recommend injections for certain types of low back pain. Injections are usually a local anesthetic, steroid or a combination of the two, and may be injected into the muscle, joint or epidural space around the nerves for pain relief depending on the cause of the pain,” said Dr. Ceola.
“Of course, conservative treatment doesn’t work for every patient. Your primary care provider may order an imaging study such as an X-ray, MRI or CT scan if low back pain persists for more than four to six weeks,” he said. “If conservative measures fail to improve your pain or you have a structural abnormality, a consultation with neurosurgery is necessary to see if there are any surgical treatment options.”
LOW BACK PAIN: WHEN TO SEE A SPECIALIST
Your primary care doctor may refer you to a specialist if:
• you have back and leg pain that limits your normal activity or impairs your quality of life
• you develop leg weakness and/or numbness
• you experience loss of normal bowel and bladder functions
• you have trouble standing or walking.
A neurosurgeon or other spine specialist will review your imaging and your low back pain symptoms with you and will also evaluate you for neurological deficits. If surgery is recommended, be sure to ask your surgeon about the risks and benefits of surgery, your expected course of care, and your anticipated health outcomes. It’s important to be well-informed about your condition and the different treatment options available to you.
For more information, contact the High Mountain Brain and Spinal Surgery Center at Valley View at 970-384-6770.
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