Lower Back Pain
Eighty percent of adults will experience significant lower back pain sometime during their lifetime. lower back pain usually involves muscle spasm of the supportive muscles along the spine. Also, pain, numbness and tingling in the buttocks or lower extremity can be related to the back. There are multiple causes of lower back pain. Prevention of lower back pain is extremely important, as symptoms can recur on more than one occasion.
Causes
Muscle Strain: The muscles of the lower back provide the strength and mobility for all activities of daily living. Strains occur when a muscle is overworked or weak. Ligament Sprain: Ligaments connect the spinal vertebre and provide stability for the lower back. They can be injured with a sudden, forceful movement or prolonged stress. Poor Posture: Poor postural alignment (such as slouching in front of the TV or sitting hunched over a desk) creates muscular fatigue, joint compression, and stresses the discs that cushion your vertebre. Years of abuse can cause muscular imbalances such as tightness and weakness, which also cause pain. Age: "Wear and tear" and inherited factors may cause degenerative changes in the discs (called degenerative disc disease), and joint degeneration of the facet joints of the spine (called degenerative joint disease). Normal aging causes decreased bone density, strength and elasticity of muscles and ligaments. These effects can be minimized by regular exercise, proper lifting and moving techniques, proper nutrition and body composition, and avoidance of smoking. Disc Bulge: Disc bulgeor herniation, can cause pressure on a nerve, which can radiate pain down the leg. This generally responds well to a strengthening and stretching program and rarely requires surgery. Other causes of lower back pain include bladder/kidney infection, endometriosis, cancer or ovarian problems.
Diagnosis
MR has displaced CT and myelography as the initial imaging modality of choice in complicated LBP
, with contrast useful for neoplasia, infection and postoperative evaluation.
CT is useful in patients with surgical fusion/instrumentation or bone structural abnormalities,
and in patients with MRI contraindications.
Myelography/CT, discography/CT, and radioisotope bone scans are useful in selected patients for problem solving.
OA can cause a crackling noise when the affected joint is moved or touched and Advanced imaging
techniques such as SPECT/CT and PET/CT have value in selected patients but are not considered routine
clinical practice at this time.
Treatment
There is no treatment that helps everyone. Most people benefit from using several approaches. Research has shown that the following 'self-management' approaches can help:
Learn and use pain coping skills, relaxation and stress management.
Participate in active rehabilitation and multidisciplinary pain programs.
Rest from aggravating activity. Avoid prolonged sitting, driving, bending, heavy lifting and twisting.
Ice applied to the lower back for 15 minutes every 1–2 hours is helpful in reducing pain and spasm.
Avoid using heat for the first 48 hours of an acute injury.
Modifying your sleeping position can help ease strain to your lower back.
The following treatments have been studied and shown to help:
Massage may be helpful if combined with activity and exercise therapy.
A personalized exercise and active rehabilitation program designed for you by a spine care professional. These medications have been studied and can be helpful:
Lower dose tricyclic antidepressants (such as amitriptyline or nortriptyline).
Short courses of muscle relaxants for pain flair-ups with muscle spasms.
Narcotic medications for severe pain under close medical supervision.