Causes and Treatment of Low Back Pain

The main causes of low back pain include muscle strain, herniated disks, arthritis, and more.  You can treat low back pain with ice/heat, stretching, a back brace, and more. Keep reading to hear the main causes and treatments.

Last episode, we tagged along with Lori, a 46-year-old bakery owner who went to see her doctor for three days of low back pain. We learned what types of questions doctors want to know when evaluating low back pain, we reviewed the anatomy of the lower back spine, and the more worrisome signs/symptoms that require immediate attention. We will now review the causes of low back pain, explain how sciatica can play a role, discuss imaging considerations, and finally the treatment grand finale.

Causes of Low Back Pain

Muscle strain:  This is by far the most common cause of acute low back pain. We see this in those who bend or lift, carry heavy loads (carrying children is a common culprit), prolonged sitting or driving long distances, improper posture, or improper ergonomics at the work station or while working at home. The muscle gets pulled, overstretched, or stiffened, and subsequently becomes inflamed. This can take weeks to resolve, but should improve through time. It can be repetitive or chronic, however, if the improper activity triggering it also persists.

Herniated disk: The words “herniated disk” can sound a little intimidating and scary. Bending over or lifting heavy objects can cause strain on the back that causes the disk inside the spine to “pop out” (hence, “herniate”). But truthfully, it is typically a benign and self-resolving pain. In fact, if you MRI a sample of the population randomly, many of us may have a herniated disk.  But we don’t all have pain. The treatment is similar to muscle strains.

Arthritis: “Degenerative” changes in the spine are a finding that is often reported on a low back x-ray and reflects arthritis. Like herniated disks, many of us may have these changes and it’s not always the cause of the pain. If the changes are significant enough, however, it can irritate the structures of the lower back.

Spinal Stenosis:  This is also another finding that is reported on imaging. The spine has a central canal (think of it like a hose) that houses the nerves that run down the spine (like water in a hose). If this canal is “stenotic,” or tightened, then it can impinge on the nerves and cause sciatica, tingling, numbness, or weakness in the legs. Mild and Moderate stenosis is not always of concern, but if it’s severe and/or the symptoms become chronic then it’s something that may require further evaluation.

Weight gain:  There’s no doubt, as Lori has realized, that the more weight you carry on your joints and muscles the more likely to injure those structures. The same goes for the lower back. Weight loss is key.

Spine compression fracture:  Compression fractures are fractures of the spine that cause it to compress, sometimes losing height if severe enough.  They are more of a concern in the elderly population, those with osteoporosis (bone loss) or risk factors for osteoporosis, and those with trauma.

Other less common causes: Cuada equine syndrome, spinal infections, epidural abscesses, vertebral osteomyelitis, and transverse myelitis are much, much less common causes of low back pain. But are often an emergency. Make sure to review the previous low back “red flags” discussed in the previous episode that can be caused by these serious low back conditions.

What Is Sciatica?

You may have heard this term that refers to the sciatic nerve that leaves the lower spine and travels down the back of the leg. If that region around the spine is inflamed from a muscle strain, or if a herniated disk is impinging on the sciatic nerve, then this nerve can also become inflamed. This will cause radiation of the pain from the lower back down to the back of the leg. As the inflammation in the lower spine diminishes, the sciatica resolves as well. 

Unfortunately, Lori’s left muscle strain has aggravated her sciatic nerve and that is the reason for the radiating pain down the left leg.

Diagnostic Testing for Low Back Pain

Most patients with acute low back pain do not require imaging. Studies show that imaging the low back, via X-rays or MRI, do not typically change the ultimate treatment or outcome of acute low back pain. Most low back pain is short-term and treated in the same way conservatively – no matter what imaging shows. Imaging is recommended, however, if there are severe or progressive neurologic symptoms, if there are “red flags” that may indicate more serious roots of the pain, or if surgical treatment or epidural injections are being considered.

Studies show that total health care expenditures over 100 billion dollars annually in the U.S. Unnecessary MRI’s contribute to the skyrocketing health care costs of this country, and ultimately places the financial burden on all of us.

Treatment of Low Back Pain

Low back pain is typically treated conservatively. What does this actually entail? Well, if you know how doctors typically treat non-concerning low back pain, you can use the following tips to treat it on your own at home (but, of course, check with your doctor first):

Ice and/or Heat: Ice aids with acute inflammation and heat loosens the muscles. Rotating each for 20 minutes also can help. But in general, use whatever improves your symptoms.

Stretching:  The last thing you want is to remain inactive. Bed rest does not help low back pain. Continuing with your daily routine activities is vital, and stretching exercises on a daily basis can keep the muscles from stiffening.

Back brace:  A structural support for the back can help take some of the pressure off the inflamed muscles.

Pain relievers:  Over-the-counter (OTC) anti-inflammatories, like ibuprofen, are one of the mainstays of treatment. Not only do they help relieve pain, but they also fight the inflammation. A common regimen is ibuprofen 600mg (always with food) three times a day for a time period (like one week), and then as needed. Not everyone can take them, however, so please ask your doctor first. Otherwise, acetaminophen is another OTC option but lacks anti-inflammatory property.

Muscle relaxants:  These can help loosen up the muscles for some, but does not attack the underlying problem – which is the inflammation. They tend to be sedating, therefore must be taken at bedtime.

Corticosteroids:  With sciatica, doctors may consider a short course of prescription steroids to quickly calm down the nerve.

Activity modification:  Use common sense – if you are weight lifting 100 pounds at the gym, lay off that machine until your pain is resolved. Perhaps you can refrain from carrying your 5 year old for some time. If you drive long distances, stop to take a stretch frequently. Proper posture and work ergonomics are also important to address, because they are common causes of low back pain. Ask your employer for an ergonomic evaluation of your work station, a place you spend hours each day. 

Physical therapy:  Physical therapy can aid in strengthening your lower back muscles and improving your range of motion and functioning.

For Lori’s 3 days of low back pain, I prescribed her one week of ibuprofen around the clock (and then as needed), asked her to use a heating pad and rotate it with ice every 20 minutes several times a day, gave her a handout on low back stretching exercises, and asked her to return in 1 month if not improved. We also discussed the need for weight loss to help prevent future flare ups. Lori came back to see me in 1 month, but this time for a pap smear. Her low back pain resolved after 2-3 weeks and she’s now back to her normal activity.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.