Low Back Pain
The lower back, or lumbar spine, functions in structural support, movement, and protection of body tissues. It is a complex structure of vertebrae, disks, spinal cord, and nerves, and includes:
five bones, called lumbar vertebrae, stacked one upon the other that connect the upper spine to the pelvis
six shock absorbers, called disks, which act both as cushions and stabilizers to protect the lumbar vertebrae
spinal cord and nerves, which act as "electric cables" and travel through a central canal in the lumbar vertebrae, connecting your brain to the muscles of the legs
small joints, which provide stability and allow for functional movement
muscles and ligaments, which provide strength, power, support and stability
Functions of the Lower Back
Protects the soft tissues of the nervous system and spinal cord, as well as adjacent organs of the pelvis and abdomen.
When standing, the lower back holds most of the weight of the body.
When bending, extending or rotating at the waist the lower back is involved in the movement.
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 one of the most significant health problems. Consider these statistics from the National Institutes of Health (NIH):
- Seventy to 85 percent of all people have back pain at some time in their life.
- Back pain is a common cause of activity limitation in young adults.
Even with today's technology, the exact cause of low back pain can be found in very few cases. In most cases, back pain may be a symptom of many different causes, including any/several of the following:
- overuse, strenuous activity, or improper use (i.e., repetitive or heavy lifting, exposure to vibration for prolonged periods of time)
- 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 (causes increased weight on the spine and pressure on the discs often causes back pain)
- poor muscle tone in the back
- muscle tension or spasm
- sprain or strain
- ligament or muscle tears
- joint problems (e.g., spinal stenosis)
- protruding or herniated (slipped) disk
- disease (e.g., osteoarthritis, spondylitis, 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)
- avoiding smoking
- 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 which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs 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 cross-sectional images (often called slices), both horizontally and vertically, 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, radiofrequencies, 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 physician 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:
- activity modification
- physical rehabilitation and/or therapy
- occupational therapy
- weight loss (if overweight)
- no smoking
- following a prevention program (as directed by your physician)
- assistive devices (e.g., mechanical back supports)
Generally, there are three 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/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 two-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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