There are numerous
structures of the spine that can generate pain, often making diagnoses and
treatment challenging. Such structures include the large nerve roots that supply
strength, sensation and function to the arms and legs. Muscles, tendons, ligaments, discs, joints,
and bones are also potential pain generating structures. 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 may or may not correlate to a specific
injury. It's source can be genetic or due to repetitive stress to the spine, 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.
Common spine conditions that may cause both back and leg pain and/or
possible numbness include degenerative disc disease, herniated or bulging
discs, facet joint arthritis, bone spurs, spinal stenosis, and
spondylolisthesis (slipped spinal bone).
In rare circumstances, spinal cysts and tumors are also a source of
pain.
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 function.
There are many medical
providers that evaluate and treat back disorders. A physiatrist is one such
provider specializing not only in back disorders, but also has a comprehensive
understanding of a wide variety of diagnostic and treatment options for the
musculoskeletal system (muscles, bones, associated nerves, ligaments, and
tendons). The goals of such treatment
are to reduce pain and restore function and quality of life.
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 pelvic and hip musculature 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. A physiatrist can
be your
"gate keeper" to achieving pain relief by non-surgical means. They are an excellent resource to assist you
in maintaining a healthy and pain free quality of life. Learn more about the Physiatrists at Resurgens Spine
Center to see how they can help you get back to doing what you love.