Pain in Lower Back

Today we’re talking about lower back pain.

         A problem that people often take care of themselves but even then it's still one of the top two reasons people visit doctors and responsible for up to 40% of all missed work days.

 Okay let me begin by giving you a bit of a mixed message. for most of us back pain is actually nota quote disease. it's more part of the normal experience since we've walked onto legs spinal structures such as bones ligaments discs joints and nerves interacted marvelous ways to support us to do the million things we do with our backs . Occasionally this backfires and gives us what we call mechanical back pain. The severity of this pain can be extreme. But always reflect the seriousness of the underlying problem. The vast majority gets better by itself without medical intervention.

 

Why pain in lower back?

On the other hand we know that while it does get better thirty percent of you have a recurrence in six months and forty percent within a year. If this sounds familiar it may be helpful to stop seeing your recurrent back pain is discrete event and mores a chronic vulnerability. that you need to create what I call a back resilience plan. Maybe learn some lessons from people who manage their chronic diseases well .they build a support team and reach out early when there's a problem .they make small changes and they focus on basics like managing stress getting quality sleep and keeping up.

 

So let’s start with the pain itself let's keep it simple and talk about two patterns.

First is what we call back dominant pain. Most commonly this pain radiates down the back to our butt and or around the hips .some patients just have pain in the backend. Others can sometimes feel the pain all the way down the leg but it's a back pain that is dominant .most of these patients get relief or aggravation of pain with particular movements or positions. For example when they arch backwards or bend forwards .typically this kind of back pain comes and goes or it comes in spasms as you move. In fact back dominant pain is a good pain because there's no damage to the nerves or spinal cord and no surgery are needed.

What are the causes of Lowe back pain?

            The second pattern is leg dominant pain and there are two common presentations the first typically comes from a disc problem that puts pressure on the nerves in your back .it travels down the legs this is often referred to as sciatica. When this nervous compressed or irritated we get pain down the leg anywhere from below. The buttock to the foot there may be pain in the back as well but this time the leg pain is dominant. Its a constant pain but tends to feel better when we lie down. Sciatica often gets better by itself but we may need to give you special advice there or medications .sometimes imaging especially if there are thoughts of surgery. So it's a good idea to talk to your care team if you have sciatica.

the second presentation is a leg pain that predictably comes only when you stand or walk or run and is relieved when you bend forward .

Lower left and right pain

When you sit the pain can be anywhere in the leg and patients describe a gradual worsening or heaviness in the legs as they walk which causes them to stop. The medical term for this leg pain is neurogenic claudicating. It typically happens to people over 60 and is caused by significant narrowing or what we call Stenosis. Stenosis is of the spinal tunnel containing. The nerve when this gets severe makes it hard for your nerves to keep up with your activity.

 Now pain predominantly in the back especially if it is intermittent or short lasting is almost always benign, but it's good to quickly review what we call red flags science that you may need more investigation.

 

The first red flag is a sudden change in your normal bowel or bladder control or numbness around the groin and rectal area. Which makes us think something might be pressing on the spinal nerves there.

 

The second red flag wonders whether infection is the source of your back pain .so for example if you have a sustained fever if you're an IV drug user if you have a weakened immune system or at high risk for urinary or other infections.

 

The third red flag is about your risk for fracture in your back so if your pain started with a big fall or a car accident or perhaps your bones are brittle because of osteoporosis.

 

The fourth red flag is wondering whether cancer might be involved. So if you have a history of cancer particularly in the prostate breast or lung and your pain is constant lasting weeks even when lying down or at night or you have other insidious symptoms such as unexplained weight loss. You need to follow this up.

 Finally there’s back pain that comes from diseases that cause lots of information such as ankylosing spondylitis. Now this is rare but when we look at people with chronic back pain it can be seen in as many as one in20. It tends to start when people are younger say ages 15 to 35 they have night pain and lots of morning stiffness lasting over an hour but this gets better with movement.

 

The next question I have an x-ray or a CT scan or MRI. so if you have a red flag or considering surgery for constant leg pain imaging may be an excellent idea but less than five and a hundred patients will actually have a red flags does having an x-ray help for the other 95?  The answer is no.

 

Professor Richard Deo and his group calculated that only one and 2500 back x-rays shown important finding, okay you say so not too helpful but what's the harm well there’s a radiation there's wasted time and money but it's more than, one famous study Mr. IED 98 people with healthy backs and no back pain and found disc problems and two-thirds of them .the problem with this is that it turns out your outlook or your attitude is actually very important to outcomes and low back pain .what we don't want is people saying to themselves oh I have back disease so I better stop exercising or every time they feel a twinge. They feel they have a quote illness.

 

This brings us to the next type of flags what we call yellow flags these four flags predict an increase risks is somebody’s acute low back pain will become chronic. Number one is the belief that back pains harmful or potentially severely disabling. Secondly is fear and avoidance of activity or movement because of back pain. When I think of these two risk factors actually think of a trial done with baggage handlers and maintenance worker sat an airport we're in bad shape from back pain and have been off work for a month.

I hope this article will help you understand in different lower back pain.

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