Low Back Pain: Causes, Treatment & Prevention
Low Back Pain Caused by Injury, Accident or Age
If you have low back pain, you are not alone. About 80 percent of adults experience low back pain at some point in their lifetimes. It’s the most common job-related injury in West Virginia leading to disability. Back injuries at work is also a leading cause of missed work days. More than a quarter of adults reported low back pain during the past 3 months, according to the National Institute of Health.
How to Treat Back Pain
As injury attorneys, we work with clients everyday who suffer from low back pain caused by traumatic injury. We have observed that there is no one size fits all treatment that works best for everyone all the time. In other words, some people might respond better to a chiropractor, others might respond better to physical therapy, while others might need more aggressive treatment like epidural steroid injections, selective nerve root block (SNRB), facet joint block or a sacroiliac joint block. Then still others may respond best to alternative forms of treatment. Below are some of the treatments available for low back pain:
Hot or cold packs may help ease pain and reduce inflammation for people with acute, subacute, or chronic pain, allowing for greater mobility among some individuals. As stated below, movement is an important part of recovery. Therefore any treatment that allows a low back pain sufferer to move sooner, should be considered.
Movement & Activity: the latest research shows bed rest should be limited. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain. Strong evidence shows that persons who continue their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs.
Strengthening exercises, beyond general daily activities, are not advised for someone suffering acute low back pain, which resolves in a few days to at most a few weeks. However, strengthening exercises may be an effective way to speed recovery from chronic or subacute low back pain. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Evidence supports short- and long-term benefits of yoga to ease chronic low back pain.
Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.
Medications: A wide range of medications are used to treat acute and chronic low back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:
- Analgesic medications are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDS) relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
- Anticonvulsants—drugs primarily used to treat seizures—may be useful in treating people with radiculopathy and radicular pain.
- Antidepressants such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain, but their benefit for nonspecific low back pain is unproven, according to a review of studies assessing their benefit.
- Counter-irritants such as creams or sprays applied topically stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics reduce inflammation and stimulate blood flow.
Spinal manipulation and spinal mobilization (chiropractic care) are approaches in which professionally licensed specialists, doctors of chiropractic, use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain. According to the National Institute of Health, neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.
Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any long term benefits for people with low back pain.
Acupuncture is moderately effective for chronic low back pain. It involves the insertion of thin needles into precise points throughout the body. Some practitioners believe this process helps clear away blockages in the body’s life force known as Qi (pronounced chee). Others who may not believe in the concept of Qi theorize that when the needles are inserted and then stimulated (by twisting or passing a low-voltage electrical current through them) naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine are released.
Biofeedback is used to treat many acute pain problems, most notably back pain and headache. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and selfregulate their breathing, muscle tension, heart rate, and skin temperature. People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Evidence is lacking that biofeedback provides a clear benefit for low back pain.
Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.
Epidural steroid injections are a commonly used short-term option for treating low back pain and sciatica associated with inflammation. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.
Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device consisting of electrodes placed on the skin over the painful area that generate electrical impulses designed to block incoming pain signals from the peripheral nerves. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested that it elevated levels of endorphins, the body’s natural pain-numbing chemicals. More recent studies, however, have produced mixed results on its effectiveness for providing relief from low back pain.
When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.
Surgical procedures are not always successful, and there is little evidence to show which procedures work best for their particular indications. Patients considering surgical approaches should be fully informed of all related risks.
Types of Low Back Pain
Low back pain can range in intensity from a dull, constant ache to a sudden, sharp sensation that incapacitates the person. Pain can begin abruptly as a result of a car accident or by lifting something heavy. Or low back pain can develop over time due to age-related changes of the spine and/or lifestyle changes like becoming more sedentary.
Short Term, or Acute Low Back Pain
For many people, low back pain is acute, which is a technical word for short term. Acute back pain by definition lasts a few days to a few weeks, and there is no long term loss of function. If your pain is not better within 72 hours, you should consult a doctor, according to medical experts.
Symptoms that Require Urgent Care
If you suffer back pain after a traumatic injury like from a fall or automobile crash, you should be checked out as soon as possible by a healthcare professional, according to Webmd.com. They warn to pay particular attention to loss of bowel or bladder control, leg weakness, fever, and pain when coughing or urinating. Another alarming symptom is when pain radiates into your legs and/or buttocks. If you suspect a head injury, that’s another reason you should seek medical care immediately.
Subacute low back pain
Subacute low back pain is defined as pain that lasts between 4 and 12 weeks.
Chronic Back Pain
Chronic back pain is pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by low back pain develop chronic low back pain with persistent symptoms at one year. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain persists despite medical and surgical treatment. According to a study from the University of North Carolina school of medicine, more than 70% of people who visit the emergency room after a car crash still suffer from pain six weeks later.
What causes lower back pain?
Degenerative, age-related changes to the spine, automobile accidents, and work injuries are among the leading causes of back and spinal injuries. Car crashes cause more than 40% of back injuries every year, according to the Mayo Clinic. Some people feel fine immediately after a crash, but then develop neck and back pain several days later as inflammation sets in, according to Dr. Wojenewik, M.D., a spine surgeon with the Loyola Diversity Medical Center.
Below are the most common conditions and causes of low back pain:
- Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from motor vehicle crashes, twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
- Intervertebral disc degeneration is a common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
- Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
- Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
- Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
- Spondylolisthesis is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
- A traumatic injury, such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord, which can lead to a spinal cord injury. When spinal nerves become compressed and irritated, back pain and sciatica may result.
- Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
- Skeletal irregularities include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
- Inflammatory diseases of the joints such as arthritis, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae, can also cause low back pain. Spondylitis is also called spondyloarthritis or spondyloarthropathy.
- Osteoporosis is a metabolic bone disease marked by a progressive decrease in bone density and strength, which can lead to painful fractures of the vertebrae.
- Endometriosis is the buildup of uterine tissue in places outside the uterus.
- Fibromyalgia, a chronic pain syndrome involving widespread muscle pain and fatigue.
Other Serious Causes of Low Back Pain Requiring Immediate Medical Attention
Low back pain is rarely related to serious underlying conditions, but when these conditions do occur, they require immediate medical attention. Serious underlying conditions include:
- Infections are not a common cause of back pain. However, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis.
- Tumors are a relatively rare cause of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
- Cauda equina syndrome is a serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.
- Abdominal aortic aneurysms occur when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can be a sign that the aneurysm is becoming larger and that the risk of rupture should be assessed.
- Kidney stones can cause sharp pain in the lower back, usually on one side.
How to Prevent Back Injury and Back Pain
Many back injuries can be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly, according to the National Institute of Health. For example, many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture.
Ergonomic Furniture and Protective Equipment: Using ergonomically designed furniture and safety protective equipment to protect the body from injury at home and in the workplace may reduce the risk of back injury as well as seeking help from a coworker when lifting heavy objects. Lifting heavy patients is a leading cause of injury to nursing home workers. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in a chair with inadequate back support. So, standing and walking occasionally, as well as using a sit stand desk and/or lumbar cushion in your chair may help prevent low back pain and injury.
Exercise helps keep muscles, tendons, ligaments and bones strong and flexible and, therefore, resistant to injury. Following any period of prolonged inactivity, a regimen of low-impact exercises is advised by most doctors. Speed walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility. Yoga also helps stretch and strengthen muscles and improve posture. Below are some additional strategies that may help prevent low back pain and injury.
- Always stretch before exercise or other strenuous physical activity.
- Don’t slouch when standing or sitting. The lower back can support a person’s weight most easily when the curvature is reduced. When standing, keep your weight balanced on your feet.
- At home or work, make sure work surfaces are at a comfortable height.
- Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
- Wear comfortable, low-heeled shoes.
Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.
- Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body.
- Do not twist when lifting.
- Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
- Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.
Reduce backpack overload in children: Low back pain unrelated to injury or other known cause is unusual in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue. The American Academy of Orthopaedic Surgeons recommends that a child’s backpack should weigh no more than 15 to 20 percent of the child’s body weight.
Ask an Experienced West Virginia Injury Attorney
If you or a loved one has been injured in an accident, at work, or because of another’s negligence, we invite you to call West Law Firm for a Free Consultation to help protect your rights and learn about your options. Our toll free number is 1-877-943-9378. West Law Firm is located in S. Charleston, West Virginia and we serve clients throughout the state.
Brooks West is a personal injury lawyer, founder, and President of West Law Firm. He has been helping those wrongfully injured in West Virginia for almost two decades. The results and service he provides his clients have earned him membership in the Multi-Million Dollar Advocates Forum and the AV Preeminent Rating from Martindale-Hubbell. Brooks is most proud of the many 5-star reviews he has received from satisfied clients.