What to do if you have lower back pain

Did you know that 85 percent of people will have back pain at some point in their life?  But what should you do if your back hurts?  Should you see your primary care physician, an orthopedist, athletic trainer (AT), physical therapist (PT), chiropractor?  Each of these options can be helpful. Here are some guidelines:

If you have minor pain for a day or two, you likely don't need to see a physician; however if the pain persists or radiates down your leg, call your physician.  If at any point you have bowel or bladder issues with back pain, you should immediately go to the Emergency Room as this constitutes a medical emergency.  Back pain, like most other injuries, can be separated into acute (recent) pain and chronic (long term) pain.  Unfortunately, regular acute back pain often leads to chronic back pain as the person ages.

Back pain is often different for younger people (under 40) compared with those over 50 or 60.  For younger individuals, we often see three types of injuries:

Minor muscle strains that generally create soreness in the low back.  They often limit athletic performance and can make it very difficult to move initially, but will get better in a few days. Having an adjustment for your back is often helpful if done within two weeks and you don't experience any pain past your knee.  Generally seeing a Chiropractor, PT or AT, is helpful for a manipulation (or mobilization).  If you have these injuries yearly (or more than that), this is a warning sign from your body that there is a deeper cause of the injury.  An AT or PT can design a program to help prevent the injury from re-occurring.

When these injuries occur too often, it can lead into the second type of injury: Disc Herniations. The typical presentation for disc herniation is an individual that complains of pain, numbness or tingling down the leg, typically at the back of the thigh, calf or into the toes. This occurs when the herniated disc pinches the sciatic nerve (this is often called Sciatica).  This person often reports a previous history of "throwing their back out" a few times a year.  In this case, seeing a physician — preferably an orthopedist — is helpful.  They can help determine the extent of the injury and prescribe medication to alleviate some of the pain and inflammation.  Following-up with a rehabilitation specialist such as a PT or AT is a great second step.

Individuals with a disc herniation typically have increased pain with flexion (bending over) and that usually makes the sciatica worse, thus it is good to avoid that position initially.  In a more severe herniation, the individual will have weakness in certain muscles of the leg.  Clinicians can often narrow down which low back disc is injured based on what muscles are weak and where you feel numbness or tingling.  Not every disc herniation requires surgery. Conservative care which includes rehabilitation, will resolve most of your symptoms helping you avoid surgery.  If this doesn't work, then a cortisone injection in your back may be indicated.  If you do need surgery, a spine specialist will remove the herniated portion of the disc to alleviate the pressure on the nerve.

An important note on "disc bulge."  Many people have an MRI with a disc bulge at multiple levels. Disc bulges are very common in individuals with and without back pain.  If you have a disc bulge without symptoms associated to that disc, it is not serious.

The last common injury in a young person often involves a fracture of a small portion of their vertebrae and is called a spondylolysis (fracture only) or spondylolisthesis (fracture that slips forward).  We see this most commonly in gymnasts, dancers, offensive lineman and any athlete that overextends their back (picture a gymnast after her landing).  Initially we avoid any extreme extension, especially if it causes pain.

For older individuals (50 and up), we often see these three different types of injuries:

Older individuals often present with stenosis (a narrowing of the canals where the nerves pass through), degenerative disc disease, or degenerative joint disease.  Unlike a disc herniation, those with stenosis typically have pain, numbness, and tingling that radiates into their leg when extending or arching their backs and feel better with some trunk flexion or bending forward.  Seated positions and bending forward to lean on a chair often relieve pain as this essentially "opens up" the tight area and relieves the pressure on impinged nerves.  Initially when beginning rehabilitation, specific treatments will often be reliant on whether the individual has an extension bias (disc issue) or flexion bias (stenosis).   Although many individuals with back pain clearly have symptoms related to an extension or flexion bias, the bias may change especially early in treatment and this may change the direction of your rehabilitation.

Each progression is different based on the extent of the individual's injury, but rehabilitation is a key component of recover.  Stay tuned for a future post that will outline helpful rehabilitation exercises for back injuries.

Read more Sports Doc for Sports Medicine and Fitness.