Back Pain

WHAT’S THE CAUSE?

Back pain often develops without a specific cause that’s easy to identify with a test or imaging study. Conditions or causes commonly linked to back pain include:

• Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms.
• Bulging or ruptured disks. Disks act as cushions between the individual bones (vertebrae) in your spine.
• Compressed nerve. A herniated disk or a bone spur presses on a spinal nerve, causing pain in the lower back. The compression may also cause numbness in the affected leg.
• Arthritis. Osteoarthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
• Osteoporosis. Porous and brittle bones in your spine (vertebrae) can cause compression fractures, resulting in back pain.

SYMPTOMS

• Muscle ache
• Shooting or stabbing pain
• Pain that radiates down your leg
• Pain accompanied by numbness or tingling in a leg
• Limited flexibility or range of motion of the back
• Inability to stand up straight

WHAT TESTS TO EXPECT

Diagnostic tests aren’t always needed. If there’s reason to suspect a specific condition may be at fault, a doctor may order one or more tests.

Tests used to diagnose back pain include:

• X-ray. An X-ray shows the alignment of your bones and whether you have arthritis or broken bones.
• Magnetic resonance imaging (MRI) and computerized tomography (CT) scan. They can reveal herniated disks or problems with bones, muscles, tissue, tendons, and nerves.
• Bone scan. In rare cases, a doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
• Nerve studies. An electromyography (EMG) test measures the electrical impulses produced by nerves and the responses of your muscles. It can confirm nerve injury caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
• Myelogram. A dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.

TREATMENT

• Medications

 If mild to moderate back pain doesn’t get better with over-the-counter pain relievers, your doctor may prescribe a muscle relaxant. Be aware that muscle relaxants can cause dizziness and may make you sleepy. Narcotics may be used for a short period of time with close supervision by a doctor.

• Physical therapy

Treatments such as heat, ultrasound, electrical stimulation and muscle-release techniques applied to your back muscles and soft tissues may reduce pain. A physical therapist also can provide instruction on specific exercises that may increase flexibility, strengthen back and abdominal muscles, and improve posture. The exercises can help prevent pain from returning.

• Injections

If other measures don’t relieve your pain and if the pain radiates down your leg, your doctor may inject an anti-inflammatory medication such as cortisone into space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, reducing pain. The relief may be temporary.

• Surgery
  

If you have unrelenting pain or progressive muscle weakness from nerve compression, you may benefit from surgery. 

LIFESTYLE

A short period of bed rest is OK, but more than a couple of days may do more harm than good. Continue your daily activities as much as you can tolerate.

Light activity, such as walking and daily activities of living, is usually OK.
If activity increases your pain, stop doing that activity.

It’s also important to maintain a healthy weight because extra weight strains your back muscles.

Try and lift smartly, letting your legs do most of the work.

Excerpt From: The Mayo Clinic. “Mayo Clinic A to Z Health Guide”.