For those 85% of us who have at some point or another suffered from low back pain, this video is on the “mandatory watch list”. Dr. Mike Evans explains the major causes of low back pain and what types of therapies and treatments are effective.
If you don’t have 11 minutes to spare to watch this video, allow me summarize it for you!
Back pain usually resolves on its own. However, it’s the 2nd most common reason to visit your family doctor, and the number 1 reason for going to the E.R. We also know that 30% of you who have experienced low back pain will have a occurrence within 6 months, and 40% within 1 year. These re-occurrences should not be considered isolated events, but more of a chronic vulnerability causing mechanical low back pain.
Mechanical low back pain can have two different patterns, and this helps to determine the cause of the low back pain.
Low Back Pain Dominance
The majority of the pain is in the low back, but may extend into the buttocks and thighs.
The pain is aggravated by certain movements, and relieved by others
The pain comes and goes in spasms
This type of low back pain indicates that there is no pressure on the nerves or spinal cord, and is most likely a mechanical disruption of a muscle, joint, or ligament.
Leg Pain Dominance
The bulk of the pain is in the legs, and can extend right down to the feet.
The pain is usually be sharp during any movement and relieved by resting
This type of low back pain indicates that there may be pressure on the nerve or the spinal cord, usually referred to as “Sciatica”. This can be caused by compression of a disc onto the nerves, narrowing of the spinal canal, or a nerve entrapment in muscle tissue.
Now, pain in the low back is almost always benign, meaning it’s not serious and will resolve. However, if you have the presence of any of the following “Red Flags” it may be a sign that you need more investigation.
- Sudden change in the bowel or bladder control, or numbness around the groin or rectal area.
- Recent infection, high fever, vomiting, or if you have a weakened immune system
- High risk for urinary or kidney infections
- Risk for fracture in your back – recent trauma, accident, or if you have brittle bones from osteoporosis
- History of cancer, specifically lung, breast, or prostate
- Pain is constant, lasting weeks, even at night
- Unexplained weight loss
Do I need an X-Ray, CT scan or MRI?
Not likely. Major studies have shown that only 1/2500 low back x-rays show anything serious. Other than being time consuming, costly on the health care system, and exposing you to ionizing radiation; a famous study found that peoples’ attitudes change if they have an image that shows even a mild injury in the low back. It also seems that a negative attitude towards the pain, really contributes to making us avoid movement or exercising. Why is that such a big deal? Because motion is lotion!
So what works in treating low back pain?
- Movement! Until the late 90’s, we were prescribing bed rest to low back pain patients. This made them even worse. Sometimes people with back pain do need to rest, like with severe sciatica. Best evidence is showing that a brisk walk which causes your arms to swing is one of the best ways to get rid of low back pain on your own.
- Over the counter medications can help in the short term, especially with helping us keep moving.
- Spinal manipulations, Acupuncture, and soft tissue therapies such as Massage have also proven effective. These therapies are not to be used indefinitely. For the most part, resolution should occur between 8-10 treatments, or about 1-2 months.
- Pilates, Yoga, or core strengthening exercises like planks are effective once the bout of low back pain has been resolved to prevent re-occurrrences. (NB: Do NOT do sit-ups! Sit ups can increase the pressure on our vertebral discs and cause more injuries.)
- Cognitive Behavioral Therapies (CBT)
- Multidisciplinary approaches – seeing a team of doctors or therapists with different skill-sets, who will communicate and work together.
Acknowledgements: A very special thank-you to Doctor Mike Evans for creating the most up to date and comprehensive video on low back pain.