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- A thorough review of possible causes for this frustrating symptom!
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Misinformation provided by such practitioners may contribute to disability by allowing progression of disease or by exaggerating the seriousness of the problem in the mind of the patient. Thus, while back pain is rarely serious, it should always be carefully evaluated to reach an accurate diagnosis and to determine if specialized care is needed.
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Almost everyone will experience acute low back pain at least once during a lifetime. Much of what must be done to care for a bad back must be done by you. It would certainly help to be well informed about the causes of back pain when seeking appropriate treatment. It goes without saying that when incapacitating back pain occurs as a result of a serious accident or injury, you should seek emergency medical care. When back pain grows progressively worse, persists unrelieved for longer than a week, or is worsened by rest, you may need the services of a specialist.
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Back pain that occurs for no apparent reason and does not affect movement may be a symptom referred from an internal organ. Once a diagnosis has ruled out a serious problem and it has been established that you have nonspecific or uncomplicated mechanical-type back pain, self-help measures designed to relieve your symptoms and to protect and strengthen your back may be the only treatment needed.
Time is the most important part of treatment for uncomplicated back pain caused by injury. In the absence of red flags, imaging studies or special testing might not be indicated during the first four weeks of low back symptoms.
Low back pain myths debunked and all your treatment options reviewed
When a red flag is present, you should not delay in reporting your symptoms to your family physician. Here are some red flags that should be considered when back pain is severe, persistent, or associated with other symptoms.
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Although an x-ray exam is not often indicated depending upon your medical history when acute back pain occurs, your doctor might order an imaging study if symptoms persist longer than a month. A plain x-ray image can be helpful in finding a structural problem, such as spondylolisthesis, that might be causing back pain; it might also detect bone disease, an abdominal aneurysm, or some other problem that might be causing non-musculoskeletal back pain.
When there is a red flag involving spinal nerves, an MRI study might be needed to look for nerve root impingement or disc herniation. CT-myelography might be ordered in the case of spinal stenosis or cauda equina syndrome, and so on. An appropriate specialist will order an appropriate testing procedure. In most cases, a good physical exam and a detailed case history by an astute clinician will provide a diagnosis that will often be confirmed by special studies. Generally, non-musculoskeletal back pain referred from an internal organ is characterized by pain that is not affected by movement, percussion, and other mechanical testing procedures.
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Back pain complicated by neurological symptoms, such as loss of reflexes, localized muscle weakness, muscle atrophy, and other signs of progressive nerve damage, may be an indication of massive herniation of an intervertebral disk. Barring the medical emergency of a cauda equina syndrome, any recommendation for surgical excision of a herniated disk would warrant taking time for a second and third opinion. Surgery can often be avoided when time is combined with periodic evaluation by a physician who can watch for progressive neurological signs that indicate an unquestionable need for surgery.
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As an option, patients may be taught self-application of heat or cold to the back at home. Here are some basic self-help measures that anyone can use safely and effectively to relieve symptoms and to buy the time needed for recovery. Cold constricts blood vessels and reduces swelling. When an injury is severe enough to cause swelling in deep tissues, early application of heat might increase pain and swelling by dilating blood vessels and drawing blood into the injured tissues.
When back pain is not severe, it probably makes little difference whether you use heat or cold; you may try using brief applications of each and then use whichever feels best. Heat applied for 20 or 30 minutes will often provide soothing relief by relaxing spastic muscles.
Complete Guide to Low Back Pain ()
If heat seems to increase pain or cause a throbbing sensation, you should discontinue use of heat and use cold applications for at least two days before trying heat again. A gel pack that can be cooled in a freezer or heated in a microwave oven can provide a convenient source of heat or cold. Just when you least feel like it, and it hurts the most, is when experts say you have to get moving. It is hard to know.
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The diagnosis implies that underlying serious disease pressure on the spinal cord, vertebral fracture or collapse, infection, cancer, inflammatory arthritis and pain from other organs has been ruled out. The problem may lie in the discs, joints, ligaments or muscles of the lower back. Chiropractor Shanthini Fonseka explains: Lots of abdominal problems can cause back pain, including kidney stones and infection, pancreatitis, duodenal ulcers and aortic aneurysms widening of the aorta — but in these cases, you are likely to have additional symptoms that suggest the underlying cause.
In rare cases, back pain can be due to dangerous pressure on the spinal cord cauda equina , cancer in the spine or infection. But Australian academic Dr Christopher Williams warns against over-reliance on the red-flag symptoms and says you need to trust your own judgment, too. If people are concerned about the nature of their back pain, I would always recommend that they consult an appropriately trained health professional for assessment. Experts agree that imaging x-rays and scans are not needed for LBP that has lasted for fewer than four weeks, when there are is no concern about serious underlying disease.
Lesley Colvin, a pain medicine specialist in Edinburgh, says the best evidence is for exercise. There is some evidence that simple pain medications are helpful to relieve pain. But their effectiveness is minimal and has large variation between individuals. There is some evidence that heat packs are beneficial. For most people, the pain will subside quickly and they can be reassured that there is no serious injury or lasting damage.
Manual therapies seem much of a muchness, though practitioners may disagree. Physio, osteopathy and chiropractic are all approved by the National Institute for Health and Care Excellence and use a mix of spinal manipulation, spinal mobilisation and massage. Consultant physiotherapist Chris Mercer does not think there is much to choose between them.
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They use similar techniques and feel similar to patients, but their philosophy differs. Being in pain for that long takes its toll. The advice is to have an assessment that takes into account the physical, psychological and social impact of the pain.