Low Back Pain-
is very common in the population and is estimated that 90% of people will have
it sometime during their life. The following are some of the common types of
lower back pain:
Lumbar Strain - this is very common in active people. Small tears in
the muscles and ligaments cause local pain.
Facet Joint Syndrome - Facet joints are the small articulations between
vertebraes. They may be injured with trauma or repetitive activity. Pain is
worse with overextension or twisting.
Herniated Disc - this is a disease of the intervertebral disc, which
is a shock absorbing spacer between vertebraes. It is a gelatinous disc that
can weaken with repetitive stress or injury, causing the jelly-like center (nucleus
pulposa) to herniate through a crack in the disc's "shell" - the tough annulars
This disc herniation can be caused locally in the back or affect one of the
existing nerves, causing sciatica pain (a radiation of pain into the hip or
leg). Disc herniation can cause severe pain but usually improves without surgery.
Degenerated Discs - as people age discs will dry and become more brittle
causing loss of shock absorbency with pain. Other causes of back pain must be
suspected in people with unusual back pain or pain that does not improve. Fractures
can occur in anyone but people with undiagnosed Osteoporosis (bone loss) like
post menopausal women or young gymnast with repetitive forces on their spines,
are particularly at risk for Spondylolysis, (a type of stress fracture) with
or without Spondylolithiasis (forward slipping of the vertebrae after Spondylolithiasis
causes of bone pain can include tumors or bad kidney infections that can present
also as back pain so back pain that is unusual should be checked closely.
Rest - relative rest is important. We only reserve strict bed rest for
the most painful episodes. It is important not to be too rested, as the body
will lose significant muscle mass if immobilized too long. Sleeping with a pillow
under the knees (on your back), or between your knees (on your side) helps.
Ice - is recommended 15-20 minutes (with a 15min break) to control pain.
We recommend ice always for the first 72 hours.
Heat - is given similarly for 15-20 minutes with breaks. This will reduce
spasm and pain but can make swelling worse. We recommend heat only after 72
hours. Heat and ice may both be used, heat first to 'warm up the joints' and
ice after to 'cool it down'.
Medication- an anti-inflammatory, if no allergies exist, is the drug
of choice. Other drugs include: muscle relaxants, codeine, narcotics, or sedatives,
these will sedate people but do nothing for the inflammation. These drugs are
particularly addictive when given for back pain.
Other drugs belonging to the anti-depressant class are particularly useful in
decreasing pain in long-term injuries, yet are not addictive (amitryptline).
Physiotherapy and Athletic Therapy - are useful to reduce inflammation
and later control the gradual return to function. A rehabilitative program should
be tailored for each person, with a staged exercise plan.
Chiropractor Manipulations - manipulations (or adjustments) can be effective
in dealing with acute pain if delivered by skilled Chiropractors, Osteopathic
doctors, or Physiotherapists.
The medical explanation for the success of manipulations is that endogenous
opiates in the spine are released and the adjustment facilitates better movement
of a stiff joint. We do not support the theory of subluxation or joints being
out of alignment. There is no scientific justification for these theories despite
their wide spread popularity.
We do not support the use of x-rays to show a joint out of alignment but believe
they should be used to determine the presence of tumors, fractures, or other
bony diseases. Spinal manipulations are usually considered safe but neck manipulations
have been associated with strokes in younger adults. Spinal manipulations may
be effective for controlling back pain but at our clinic we do not support their
continued use. A strong back achieved through rehabilitation, is our goal. "Exercise
is the best medicine".
Brace/Supports - these may be used in some conditions in conjunction
with a back strength program. Only using a brace may cause a reliance on the
brace causing weaker back muscles.
Ergonomics - better posture in the work place will help prevent aggravation
Weight Reduction - of even 10lbs will significantly unload pressure on
Activities - certain activities should be started slowly after recovering
from back pain. The simplest activities to start include: walking, swimming,
cycling, and skating. Next in complexity are: skiing, hockey, and running (which
in some people, aggravates back pain, but in others improves it). The worst
activities are those that involve twisting and pivoting, like racquet sports,
football, and basketball.
Other Tips - when suffering intense back pain, move purposefully and carefully
so you don't twist excessively. Vary positions at home. Avoid prolonged sitting,
as this causes more pressure on the spine than standing or lying.
Lift properly with the knees, not the back, keeping objects close to you.
Exercise - it is essential to have a graduated back strengthening program.
This should be done with a skilled therapist that pushes you enough (neither
too little nor too much).
It is essential to continue your back program even after you return to work
or sports to ensure your back does not get aggravated again.
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