Diagnosis and Treatment of Low Back Pain: A Physiatrist's Perspective

There are many structures of the spine that can generate pain, often making diagnoses and treatment challenging. Such structures include the large nerve roots that run down the arms and legs, muscles, tendons, ligaments, discs, joints, and bones. Acute back pain starts suddenly and usually heals within a few days to a few weeks with 50% of patients experiencing pain relief within two weeks and 90% within three months. Chronic back pain will last for three months or longer and does not correlate to a specific injury. It consists of a low level stimulation to the nervous system creating an environment in which structures that were previously painless are now sources of pain.

Common Causes of Low Back Pain

Risk factors for back pain include genetics, aging, occupational hazards, sedentary lifestyle, excess weight, smoking, and poor posture. Muscle strain or soft tissue damage is the most common cause of lower back pain. Back sprain/strain symptoms are usually localized to the low back (i.e., do not radiate down the leg) and often start after heavy lifting, twisting while lifting, a sudden movement, or a fall. The pain may include muscle spasms, tenderness to touch, increased pain with activity that decreases with rest. Spine conditions that may cause more leg pain and numbness than back pain include degenerative disc disease, herniated or bulging discs, facet joint arthritis, spinal stenosis, and spondylolisthesis (slipped spinal bone).

Should You See a Doctor for Lower Back Pain?

Regardless of the cause, one should be evaluated by a physician for back pain symptoms that are progressive, that do not improve with rest or over-the-counter (OTC) medications, or involve neurological symptoms such as leg weakness and/or difficulty with bowel or bladder.

There are many medical providers that evaluate and treat back disorders. A physiatrist is one such provider specializing not only in back disorders, but a wide variety of treatment for the musculoskeletal system (muscles, bones, associated nerves, ligaments, and tendons) and disorders that cause pain and/or difficulty with functioning.

What is Physiatry?

The physiatrist is also known as a Physical Medicine and Rehabilitation physician or PM&R physician and is trained in the field of physiatry, also known as Physical Medicine and Rehabilitation. This area of medicine specializes in the diagnosis, treatment, and management of disease primarily using "physical means" such as physical therapy and medications.

What Do Physiatrists Do?

Back conditions commonly treated by physiatrists include sciatica (pain radiating to the leg or foot), muscle and ligament injuries, work injuries, and osteoarthritis. A physiatrist will diagnose injuries and problems of the musculoskeletal system through medical history, physical examination, and diagnostic testing such as x-rays, CT scans, MRI scans, electromyography, and nerve conduction studies (EMG/NCS).

What makes physiatrists different from other healthcare professionals that treat back pain and injuries is that they strive to treat the whole person and not just the specific injury alone. Utilizing a multifaceted approach to include medications, active physical therapy and exercise, assistive devices, back braces, and injections, the goals of treatment are always to restore normal function and improve quality of life.

How Do Physiatrists Treat Back Pain?

Since a physiatrist specializes in improving function, it stands to reason that rehabilitation through physical therapy and exercise are an integral part of most physiatrist's practices. Most physiatrists will use pain treatments such as medications and injections not as the primary treatment, but as an adjunctive means to bring severe pain under control so that one can engage in a beneficial rehabilitation exercise program.

Exercise for Lower Back Pain

Bed rest and inactivity may be necessary as an initial treatment for acute back pain; however, if this is done for more than a couple of days, it can actually prolong healing. Instead, active exercise is a key element for a low back pain treatment plan and should include the following components:

• aerobic conditioning
• stretching
• strengthening

The exercises should be done through a controlled and progressive program under the guidance of a trained specialist with the primary goal of building a stronger more flexible spine.

Low impact aerobic exercise such as walking is ideal in that it increases blood flow, and in turn, oxygen and nutrients, to spine structures which promote healing while decreasing stiffness of the back muscles and joints. Other low impact activities include bicycling, elliptical trainer or step machine, and swimming or water therapy. Additionally, developing strong back and abdominal muscles and increasing flexibility of the hamstrings are also important components of recovery from a back injury and can help heal most types of back pain. Therefore, exercises that promote these activities should be an integral part of a balanced exercise program.

Benefits of Exercise for Lower Back Pain

Studies have proven time and again that Individuals who participate in a regular exercise program for the lower back benefit in several ways, including: maintaining the ability to remain functional both at work and recreationally; increasing weight loss and maintaining weight control, which will decrease the stress placed on spinal structures; an increasing the release of endorphins (our body's natural painkiller and antidepressant) after 30-40 minutes of exercise, which can reduce the need for pain medication and relieve symptoms of depression-- a common condition in those with back pain or a back injury.

Conclusion

Whether you are suffering from the first bout of low back pain or a chronic condition requiring extensive treatments and even surgery, the best way to minimize the severity and frequency of recurrent episodes is to rehabilitate the back through a comprehensive exercise program lead by a trained medical professional. Learn more about the Spine Center at Resurgens Orthopaedics.

Dr. Cottrell is a board-certified Physical Medicine and Rehabilitation physician specializing in the diagnosis and treatment of musculoskeletal disorders at Resurgens Orthopaedics in Covington.