Lower Back Pain

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 vertebrates. 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 vertebrates. It is a gelatinous disc that can weaken with repetitive stress or injury, causing the jelly-like centre (nucleus pulposa) to herniate through a crack in the disc's “shell”-the tough annular cartilage. The disc herniated can cause pain 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 has occurred).

Other causes of bone pain can include tumors or bad kidney infections that may present also as back pain so back pain that is unusual should be checked closely.

Treatment

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 15 min 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 like amitryptiline belonging to the anti-depressant class are particularly useful in decreasing pain in long-term injuries yet are not addictive.

Physiotherapy and Athletic Therapy

Are useful to reduce inflammations and later control 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, Physiotherapists, or Osteopathic doctors. 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 use x-rays to determine the presence of tumors, fractures, or other bony diseases. Back manipulations are usually considered safe but neck manipulations have been associated with strokes in younger adults. Spinal manipulations may be effective for controlling acute back pain but at our clinic we do not support their continued use. A strong back achieved through rehabilitation, is our goal since:

“Exercise is the best medicine”.

Brace/Supports- these may be used in some conditions in conjunctions 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 of injury.

Weight Reduction- of even 10lbs will significantly unload pressure on the back.

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.

The Skylark Clinic specializes in Sports Medicine and Travel Medicine, which is a branch of medicine preventing illness in travelers.

Figure 1 example of good posture

Skylark Medical Clinic

264 Tache Avenue

Winnipeg, MB R2H 1Z9

Ph: 453-9107 Fax: 453-9115