Low back pain and what you can do about it


It has been reported that low back pain is the most common complaint prompting a visit to the primary care physician. In addition, most people will experience low back pain at some point during their lifetime. Therefore, it is something that most of us can relate to. Some factors which may result in back pain include sore, weak back muscles, excessive load on weak muscles, poor posture, knee and/or hip pain affecting gait (walking), degeneration of inter-vertebral discs, degenerative joint disease (osteoarthritis) of the spine, spinal stenosis (narrowing of the spinal canal), osteoporotic compression fractures, or rarely, malignancy (cancer).

The majority of low back pain is mechanical (or muscular) in type. In other words, sore sprained back muscles are the cause of the pain. Most of the time, this results from weak over-exerted low back muscles. Some factors that contribute to this are weak low back muscles, poor posture, tight hamstring muscles, excessive abdominal weight, and/or frequent lifting of heavy objects (or even light objects) using poor body mechanics (positioning/technique). Over the counter pain relievers, stretching and strengthening, and weight loss are usually effective in relieving this type of back pain. In select cases, acute back pain is improved by osteopathic manipulation. This treatment is learned by osteopathic physicians (DOs) in medical school. It consists of manual delivery of force used to reestablish proper motion, alignment, range-of-motion, and relieve restriction to muscles, bones, and fascia (connective tissue plane over muscle).

If the pain is chronic (lasting greater than a few months) or recurrent (multiple incidents) of acute low back pain, it is helpful to meet with your doctor. A course of physical therapy and home exercise program for core strengthening maybe prescribed at this time. Core strengthening refers to abdominal and low back muscle strengthening and flexibility which can result in improved posture and improvement (if not resolution) of low back pain. It is extremely important to perform these exercises regularly since most back pain reults from weak core musculature which takes time to reverse. Osteopathic manipulation can be highly affective independently or as an adjunct to physical therapy. A frequently cited New England Journal of Medicine article compared osteopathic manipulation to traditional physical therapy for back pain and found that patients receiving osteopathic manipulation required fewer pain medications compared to those receiving only physical therapy.

If therapy, exercise, and anti-inflammatories have not improved symptoms after 2-4 weeks, then further investigation is warranted. This may consists of x-rays, CT, or MRI. X-ray will show the density and integrity of the vertebral bones (vertebral bodies), the space between vertebrae (an indication of intervertebral disc height), and the relation between vertebral bodies (alignment in multiple planes). CT (“cat scan”) will show X-ray findings in more detail with better contrast resolution. MRI will show all of the above with superior visualization of the spinal cord and nerve roots as they exit the spine.

Contact my office for an appointment to discuss your back pain.