Low Back Pain: What You Should Know
Low back pain afflicts tens of millions of people in the U.S. at any time. A 2010 study estimated that in a one-year period, between 6.3% and 15.4% of the adult population experienced low back pain for the first time. That’s about 36.2 million people, on the high end. 24%-80% of these people will have their pain go away, and then return before the one-year anniversary. Low back pain is the biggest cause of temporary disability in the U.S., costing companies billions of dollars in lost productivity and medical bills.
The amount of space needed to address all aspects of low back pain is immense, as there are tens of thousands of research studies on the causes and nature of low back pain; however, the most important and salient points are provided here.
1. For cases of diffuse low back pain, it is difficult to ascertain the specific structure(s) that are generating the pain. Possibilities include bone, cartilage, ligament, disc, nerve root, other nearby nerves, muscle and joint capsule. This makes rehabilitation a challenge. You may need to test out different exercises and therapies to see which one gives you positive results.
2. In many cases, low back pain self-resolves, given enough time. This means if you don’t do anything, it will go away by itself (however, most people do not want to wait that long, and get treatment in some form).
3. If your low back pain is accompanied by any type of radiating pain (pain, numbness or tingling going down buttock(s) and/or leg(s)) it usually has a worse prognosis than if it was just localized.
4. Some cases of low back pain develop gradually from a biomechanical problem elsewhere in the body, such as pelvic, hip, or foot misalignment. This is where corrective action should be focused; otherwise the pain will always come back.
5. Degenerative disc disease is a common finding in chronic low back pain in people over 50 years old. Some cases will always be chronic while others can still be resolved with treatment/ rehabilitation. It depends on what’s going on inside.
6. Congenital malformations are at the root of some cases of low back pain (congenital means formed during fetal development). You need an x-ray to determine this. Examples include scoliosis (excessive curvature of spine), retro and anterolisthesis with ligament laxity (excessive slippage/movement of a lumbar vertebrae); a narrow central canal (where nerve tissue resides); and fused/abnormally developed vertebrae or sacral segment (impedes proper spinal movement). These are generally not correctable and are a limiting/complicating factor to rehabilitation efforts.
7. Long periods of sitting in a chair and sedentary lifestyle (insufficient physical activity) are perhaps the worst thing for your low back, as it weakens the muscles of the spine while placing excessive, prolonged pressure to your discs and joints. Regular physical activity that does not involve repetitive pounding forces to the low back is the first line of defense against low back pain.
8. Red flag cases of low back pain (emergency) are those that involve numbness in the buttocks and back of thighs, which could mean damage to a nerve that controls your bladder; insidious, lasting pain that does not change with rest or treatment (a sign of metastatic cancer); loss of strength in the lower extremity, and pain accompanied by fever. These are very rare; about 1% of all cases.
9. The nature of your low back pain will dictate the most appropriate action to take. If you recently injured your low back or had a sudden onset of acute pain, ice, heat and rest are indicated the first few days. Once the pain level is about 50% improved, you can begin rehabilitation to: (1) speed up recovery; and (2) ensure optimal healing of tissues. If your pain is chronic, then you can try a variety of therapies and rehabilitation. As mentioned in #1 above, due to the enigmatic nature of low back pain you may need to try different approaches to see what works.
10. Surgery for low back pain has mixed results. Most doctors agree that it is best avoided when possible and reserved for the most severe cases that require immediate intervention. Surgery requires damaging and disrupting several layers of precisely situated, fine-tuned spinal muscles and ligaments via incision. Sometimes small motor and sensory nerves are permanently damaged as well from the surgery. This often makes matters worse.
11. Studies show that spinal manipulation and mobilization techniques can benefit low back pain and complement exercise rehab efforts.
12. Researchers have found that psychosomatic factors play a significant role in the perception (resported severity) of low back pain and the odds of overcoming it. Simply put, one’s mindset/attitude surrounding his/her pain is a major determinant of treatment outcome. They found that those who believe their pain to be catastrophic tend to report longer lasting pain that is more debilitating in nature, compared to those who strived to continue on with their regular life activities and work through/move into the pain.
