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Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning.
Low back pain is 1 of the most significant health problems facing society today. Consider these statistics from the National Institutes of Health:
Eight out of 10 people have back pain at some time in their life.
Back pain is a common cause of activity limitation in children and adults of all ages.
Even with today's technology, the exact cause of low back pain can be difficult to determine. In most cases, back pain may be a symptom of many different causes, including any or several of the following:
Overuse, strenuous activity, or improper use (for example, repetitive or heavy lifting, or exposure to vibration for prolonged periods of time)
Trauma, injury, or fracture
Degeneration of vertebrae (often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)
Abnormal growth (tumor)
Obesity (often caused by increased weight on the spine and pressure on the discs)
Poor muscle tone in the back
Muscle tension or spasm
Sprain or strain
Ligament or muscle tears
Joint problems (such as, spinal stenosis)
Protruding or herniated (slipped) disk
Disease (for example, osteoarthritis, spondylitis, or compression fractures)
The following may help to prevent low back pain:
Practicing correct lifting techniques
Maintaining correct posture while sitting, standing, and sleeping
Exercising regularly (with proper stretching before participation)
Maintaining a healthy weight
Reducing emotional stress which may cause muscle tension
In addition to a complete medical history and physical examination, diagnostic procedures for low back pain may include the following. However, during many initial assessments and examinations, specialized tests are not necessary:
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of bones onto film.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.
Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
Electromyogram (EMG). A test to evaluate nerve and muscle function.
Specific treatment for low back pain will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment may include:
Physical rehabilitation and/or therapy
Weight loss (if overweight)
Following a prevention program (as directed by your doctor)
Assistive devices (for example, mechanical back supports)
Generally, there are 3 phases to low back pain rehabilitation. These include the following:
Phase I: Acute Phase. During this initial phase, the physiatrist and treatment team focus on making a diagnosis, developing an appropriate treatment plan, and implementing the treatment regimen to reduce the initial low back pain and source of inflammation. This may include any or all of the items listed above and/or the utilization of ultrasound, electrical stimulation, or specialized injections.
Phase II: Recovery Phase. Once the initial pain and inflammation are better managed, the rehabilitation team then focuses on helping the patient to restore working function of the body. This includes returning the patient to normal daily activities while implementing a specialized exercise program that is designed to help the individual regain flexibility and strength.
Phase III: Maintenance Phase. The goal of this phase of low back pain rehabilitation is 2-fold — educating the individual on ways to prevent further injury and strain to the back, and helping the individual to maintain an appropriate level of physical fitness to help further increase strength and endurance.
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