Low back pain has many causes including acute sprains of muscles or ligaments, a sudden increase in the load that your low back is unaccustomed to, unfavorable postures and activities, and a combination of some or all of the above. These activities may create an imbalance in muscle loading patterns and ultimately pain. Pain experience is a complex mix of tissue damaging beliefs, social practices, personal and psychological ingredients. The actual cause of back pain may not be determined and is referred to as non-specific low back pain. 90-95 percent of individuals who experience low back pain will not have a specific diagnosis of their low back condition, and will be told that they have simple back pain. This means that similar symptoms may present in different individuals, but the causes and structures involved may be different (Lederman, 2010). Overall, the disability incurred through pain is mainly psychosocial, this means emotionally and socially related. The person’s attitude about his or her condition and the expected degree of disability will be the best predictor as to when the individual will return to their normal tasks and everyday activities.
An estimated 84 percent of people may experience low back pain. It comes in many levels, from slight pain or soreness to an extreme pain, which makes physical activity uncomfortable. Acute low back pain is defined as a problem that occurs in that lasts less than 3 months; chronic low back pain is pain that lasts more than 3 months (Lederman, 2010). There are many factors that can contribute to back pain such as disability, which limits one’s ability to engage in normal work and leisure activities, a decrease in the quality of sleep and an increase in the frequency of sleep disturbances, interrupted work and an increase in sick days or a decrease in productivity, and certain syndromes, which may affect an individual at various times. These symptoms can vary from urinary and bowel movements to changes in mood.
Non-Surgical Treatment Options
Physical therapy is an exercise program that gradually increases in difficulty in order to improve posture, body mechanics, and flexibility. It strengthens the muscles that support the back and helps to take the pressure off the spine. There are two types of physical therapy programs that are beneficial: passive and active programs. Passive programs mainly consist of methods to reduce pain such as heat/ice packs, TENS units, Iontophoresis, and Ultrasound. The active program consists of methods that help to improve physical capabilities such as flexibility, strength, endurance, and coordination. This is accomplished through regular aerobic exercise and conditioning to prevent reinjury. These methods are aimed to avoid pain in the injured area and regain normal functioning. This includes pool walking, stationary cycling, and exercises to improve muscle strength and endurance. There are even specific exercises for lower back ache treatment. Medications are often used in the treatment of acute and chronic lower back pain. There are many different types of medications that are used to treat lower back pain. They range from over-the-counter analgesics to prescription strength narcotics. With any type of medications, there are a vast array of side effects and possible adverse reactions. It is important to consult with a physician when taking medications in an attempt to fully understand the implication of the prescribed medications. The most common side effect of many pain-relieving medications is drowsiness and the possibility of dependency due to the relief that the medication provides. It is important to use caution and understand the full scope of the effects and adverse reactions of medications for lower back pain.
Physical Therapy
Active physical therapy, which focuses on the patient’s involvement, is more effective at relieving chronic low back pain. Carefully planned exercise is utilised to reverse the deconditioning and to increase strength in the weakened musculature. A study conducted by Rainville et al. had compared the differences in the success of pain relief using strengthening and flexibility exercises on 123 patients with chronic non-specific LBP. These patients were randomly assigned to 8 week programs of either strength or flexibility. The results showed that “rotational exercise strength programmes appear to be more effective than flexibility exercise strength programmes in decreasing pain and improving dynamic function in patients with chronic non-specific LBP.” This study brings to light that the type of exercise is an important factor when considering that not all exercise will provide the same benefits.
Passive physical therapy (modalities) is often used to decrease the patient’s pain to a more manageable level. Modalities include ultrasound, electrical stimulation, traction, short-wave diathermy and heat/ice packs. If it is applied with other techniques, there is not strong evidence that it is beneficial to the patient. This is why it is recommend that you do not use passive therapy as a sole treatment technique. A study was performed that surveyed 100 physical therapists that are members of the Orthopedic Section of the American Physical Therapy Association. The therapists noted that the most commonly used electrophysical agents are: ultrasound, electrical stimulation and heat/ice packs. This survey noted that therapeutic ultrasound is used to increase tissue extensibility, treat trigger points and scar tissue, and decrease pain.
The goal of physical therapy is to improve the mechanical function of the spine, which includes increasing the range of motion of the lumbar spine and its surrounding musculature. This will give the patient the power and endurance to avert a recurrence in the future. Home programs are designed to teach patients the right postures that will protect the spine during activities of daily living. Duration of physical therapy is highly variable, based on the patient’s symptoms and functionality. For acute LBP, it is recommended 1-2 times a week for 2-4 weeks. For chronic LBP, it is recommended 1-2 times a week for 4-6 weeks. Patients with chronic symptoms or debilitating pain are encouraged to continue physical therapy to maintain spinal health and check in with their therapist 1-2 times per month.
Medications
Analgesic medications are drugs specifically used to relieve pain. They include over-the-counter acetaminophen and aspirin, as well as prescription opiates. Some opiate drugs are natural forms of the opium plant, while others are synthetically made to mimic the effects of these. Opiates are often used for severe acute pain, but also have a wide use in chronic pain patients. Opiates can be very addictive. Addiction is a state of dependence on a medication or drug manifested by continued use, a loss of control, and preoccupation with the drug and its effects. It has a number of adverse psychological, physical, and social effects. It also can increase the sensitivity to pain and cause pain to last longer. This is known as opiate-induced hyperalgesia and can be mistaken for the worsening of the original condition. Because of the risks involved with opiate use, use of these drugs should be carefully considered with your doctor. Opiates should not be used for pain lasting longer than 4-6 weeks. If a decision is made to use opiates, the lowest possible effective dose should be used. Regular use of opiates can lead to tolerance, where the drug will have a decreasing ability to relieve pain, and also physical dependence, where sudden stopping of the medication will result in a withdrawal syndrome. The dependency is due to adaptation of the nervous system to the chronic presence of the drug. Symptoms of opiate withdrawal may include restlessness, lacrimation (excessive secretion of tears), rhinorrhea (runny nose), yawning, perspiration, chills, myalgia (muscle pain), arthralgia (joint pain), anorexia, nausea, vomiting, and abdominal cramps and diarrhea. Opiates are also known to constipate and can cause or worsen hemorrhoids. If pain persists despite use of a high dose of opiates, it’s likely that the original painful condition may have worsened. Do not increase the dose of the opiate without consulting your doctor. If the opiate is no longer effective, despite an increase in dose, a change to a different medication may be needed and it’s possible that the pain is no longer due to the same condition. It’s important to note that long-term opiate use can cause hormonal imbalance in both men and women and suppression of the immune system.
Taking medications is the most common treatment patients use when their back pain is not severe enough to be referred to a surgeon. These can be used in conjunction with brief periods of bedrest or activity modification. The goal is to reduce pain and allow for increased mobility. Patients should be sure to understand the potential risks and effects of the drugs they’re taking.
Exercise and Stretching
Exercise and stretching is a more recent component of the treatment regimen for back pain. The traditional view was that bed rest and avoidance of physical activity were essential to recovery. Patients with pain were often told to stay in bed and avoid all activities. However, it is now known that too much rest can be harmful. Substantial scientific evidence now shows that an increased level of activity will speed recovery. There is no specific amount of rest that is good for recovery. In general, it is advisable for patients to start their usual activities as soon as possible. Stretching and activities which strengthen the muscles are the primary exercises recommended for low back pain. These types of exercises can be carried out on one’s own, or with assistance from a professional. A physical therapist is a good resource to learn which exercises are most appropriate for an individual. An understanding of specific exercises for muscle strengthening as well as stretching can help patients prevent back pain and speed recovery. These exercises are most helpful if the pain is chronic. Even if the pain is not chronic, an exercise program can prevent the pain from returning. The exercises may be learned from neurosurgeons, orthopaedists, or physiatrists. In the past, patients were often told they had weak abdominal muscles and this was the cause of the low back pain. It is true that the abdominal muscles are critical to the support of the lower back and a regular strengthening program is very helpful. A well-designed program will typically include specific exercises for these muscles. In general, exercise for low back pain should be done carefully and minimally in the beginning. If the exercises cause an increase in pain, they should be stopped immediately.
Surgical Treatment Options
Minimally invasive procedures. Surgery is rarely necessary, but when a patient’s leg pain is caused by a herniated disk and is not relieved by other treatments, discectomy may be recommended. This procedure involves removing the bulging of a herniated disk. This can be performed using the traditional approach, utilizing a small incision, or by using a minimally invasive microscopic or endoscopic method with a smaller incision and a quicker recovery time. Another minimally invasive procedure is percutaneous lumbar laminotomy (also known as nucleoplasty). This procedure involves inserting a special needle into the disk guided by an X-ray, followed by passing a plasma laser or radiofrequency probe through the needle to the nucleus pulposus, where heat is administered to shrink the disk tissue, thus reducing the volume of the disk and ultimately relieving pressure on the spinal nerves. These methods do not require a hospital stay and can be performed as outpatient surgery. They also have quicker recovery times than the traditional surgery they are an alternative to. However, they are relatively new procedures and some studies have reported the effects of these treatments to be short-lived. Spinal fusion surgery. This procedure involves connecting two vertebrae together by using a bone graft, either from the patient or a donor, and then is followed by using rods and screws to fixate the two vertebrae so that the bone can grow together. This stops the painful motion at that segment of the spine. This is a major operation and can be described as a “solid state” operation, leaving the patient with a loss of flexibility at the fused segment but pain relief if it is successful. This procedure is often employed for various causes of spinal pain such as spondylolisthesis, spinal stenosis, and disk degeneration. It is usually effective if the painful spondylolisthesis has not been relieved by other treatments and for spinal stenosis when there is associated instability of the spine. However, there is much controversy over employing this as a treatment for lower back pain caused by disk degeneration because success varies and it is difficult to determine precisely which patients will benefit from this.
Minimally Invasive Procedures
A relatively new field, minimally invasive surgical techniques, is evolving and allows a surgeon to use an operation to diagnose and treat back problems with less tissue disruption. The goal of this article is to describe the evolution of conservative spine care to the modern day use of minimally invasive surgical techniques. This article will discuss various techniques in the field of minimally invasive spine surgery and provide an overview of these methods. Many of these procedures are performed by orthopedic surgeons or neurosurgeons, but the field is truly open to appropriately trained surgeons from any specialty. Most often, these procedures are used in treating back pain, leg pain, and sciatica caused by a variety of spinal conditions, and the appropriateness of each of these procedures is based primarily upon the duration and severity of the pain, as well as the presence of correlating diagnostic tests.
Spinal Fusion Surgery
The amount of fusion surgery being performed is rapidly increasing in the US. The vertebrae are modeled after the disc space is prepared and the necessary amount of bone and often artificial bone graft substitute is packed in attempt to eliminate any movement between the vertebrae. Instrumentation placement comes next and final imaging is taken to confirm the smaller than a dime like incision has indeed performed the intended surgery. This process can take as long as 4-8 hours depending on the amount of vertebrae to be fused. Most patients are required to stay in hospital for 2-5 days and a successful fusion generally results in elimination of lower back pain but there is significant recovery and inability to perform heavy physical activity for up to 6 months after the surgery. There are variable success rates and amount of pain relief based on diverse indications and techniques with rates generally being higher for the correctable spondylolisthesis. As fusion technology advances, the trend is toward less invasive methods with smaller incisions and less disruption of the natural tissues.
All surgical treatments have specific indications of when they are appropriate. Fusions are generally indicated for chronic low back pain that is mostly due to degenerative disc and/or unstable spondylolisthesis. The goal of fusion is to create a solid union between two or more vertebrae. The premise is that if the painful motion is eliminated through fusion, the patient will be pain free. The term “fusion” refers to the process of creating a bone solid bridge between two or more vertebrae. Screws are often utilized to hold the vertebrae and bone graft in place until the new bone grows between the vertebrae. The bone graft can be taken from the patient (autograft) from a hip or from allograft bone usually taken from a cadaver. The fusion process can be enhanced with instrumentation that acts as an internal brace to hold the vertebrae and graft in place while the fusion matures. This can include an array of metal rods, plates, and screws. Fusion is generally effective if the main source of pain is localized to the intervertebral disc and if the disc is the cause of abnormal motion between the vertebrae. Fusion is not indicated if there is no abnormal motion between vertebrae or if the pain is coming from the facet joints unless a simultaneous fusion is performed between the vertebrae at these joints.
Prevention and Self-Care Techniques
Maintaining proper posture and body mechanics are the first steps to preventing lower back pain. Whether sitting, standing, or engaging in physical activity, poor posture is a common cause of lower back pain. Bad posture puts added stress and pressure on the spine. For example, slouching forward while sitting in an office chair increases the pressure on the discs in the lower back. The total pressure on the disc is significantly higher when sitting compared to lying down. Repetitive heavy lifting with improper body mechanics can lead to a herniated disc. Maintaining the natural curve of the spine in both sitting and standing positions can help reduce the risk of disc herniation. Specific sitting techniques to support the spine and ways to properly lift and carry objects will be discussed further. Another important factor to preventing lower back pain is achieving and maintaining a healthy body weight. Increased body weight adds stress to the spine and can contribute to the development of low back pain. A high percentage of body fat has been linked to increased low back pain and can add undue stress to the lumbar spine. In addition, body weight and distribution of the weight play a key role in the development of low back pain. People with a greater amount of body fat in the abdominal area are at greater risk for experiencing pain in the lower back. Often times, the weight of the upper body can cause an excessive arch in the lower back and lead to pain. So it is important to identify any specific areas of the body where excess weight is held and distribute it evenly. By taking a walk each day and maintaining a healthy diet, it is possible to achieve and maintain a proper body weight and reduce the risk of developing low back pain.
Proper Posture and Body Mechanics
To minimize the development of back pain, certain measures must be taken to improve posture. This may include having to wear a lumbar roll when sitting, a pillow under the knees when lying, and a neck roll when sleeping to assist in maintaining the normal curves of the spine. Effects may not be noticed instantaneously, but will over time have a profound effect on posture. Avoiding sitting for long periods is also recommended. When seated, feet should be kept flat on the floor, knees and hips should be level, and there should be a small gap between the back of the knees and the edge of the seat. Changing positions and taking short walks around the room every 20-30 minutes will reduce the negative effects of prolonged sitting on the back. When changing from a seated position to a standing position, it is important to use the correct technique. Shuffling to the front of the chair, standing up, and straightening the low back is key. Often people use poor technique when bending and lifting, which can result in a lot of stress on the lower back and predispose injury. An example of this would be bending at the waist when picking objects up from the ground. The correct way to do this would be to squat, spread the feet shoulder width apart, and remember to keep the back straight while using arm and leg muscles to lift the object.
To understand what proper posture is, one must first comprehend the body’s frame and its numerous functions. The human spine is made up of 24 spinal bones, normally referred to as vertebrae, and 24 discs that act as the shock absorbers for the vertebrae. The spine has 4 major functions to the body: protecting the spinal cord, providing support and balance to maintain an upright posture, and allowing flexible motion in all directions. The spine’s ability to maintain three balanced curves (cervical, thoracic, and lumbar) is what determines ideal posture. When any of these natural curves are increased or reduced, the vertebrae are subjected to abnormal amounts of stress. This may result in increased levels of deterioration of the discs and joints in the spine, which can cause back pain. In saying that, bad posture has been identified as a common cause in the development of chronic musculoskeletal pain, and various faulty movement patterns have been linked to specific pain conditions.
Weight Management
The result is a higher incidence of low back pain from people with obesity with a higher level of disabling chronic pain. Weight loss can reduce the loading on the low back and improve symptoms. A recent systematic review of obesity and low back pain found that weight loss can lead to a significant reduction in low back pain. The review also found that in RCTs for weight loss, an improvement in low back pain was a secondary outcome that was improved upon dietary management and exercise. This indicates that there is a potential for dietary intervention in prevention of low back pain.
Weight management is a crucial part of the long-term prevention of disturbing and troublesome low back pain. Excess body weight places excess loading on the structures of the low back, such as the vertebral bodies and intervertebral discs. Loading on the intervertebral disc increases with higher body weight. For those with vertebral end plate changes or disc herniation, the hydration and swelling of the disc with extra load can increase painful symptoms.
Self-care task is relevant to primary deterrence in that it will prevent the incident of lower back pain. Once in a while, it prevents the worsening of an existing condition. For example, enhancements in posture and weight handling can prevent or improve lower back pain in line with minimizing drug therapies, eliminating the requirement for medical interventions, and in the long term prevent disabling chronic pain.
Core Strengthening Exercises
Core strengthening exercises are designed to help develop muscles to support the spine. When the muscles that support the spine are in better shape, the spine is too. Exercises that promote core strength include yoga and pilates. These two types of exercises enhance flexibility, strengthen muscles, and improve posture. It is essential to achieve spinal health by using fitness techniques that can strengthen the core without putting too much stress on the lower back. Patients with back pain are often instructed to avoid excessive flexion and extension of the spine, particularly in the standing position. Ironically, some aerobic exercises may require this type of movement. It is okay to use a treadmill, stair climber, or stationary bike, but it is best to avoid exercises that include heavy lifting or frequent bending and twisting. Once you have insight into the different types of exercises you can do to enhance core strength, it must be said that it may take up to 8-12 weeks to see noticeable results. It is a slow process, but stick with it! A strong core will help provide support and stability for the lower back and, in turn, protect the spine when engaged in physical activity. This can help offset future episodes of low back pain. Core muscle conditioning is an important component of a well-rounded back care program.
Back on Track: Taming Lower Back Pain After Running
Lower back pain is a common complaint among runners, often derailing training plans and leaving runners frustrated. Fortunately, several treatment options can get you back on track, combining self-care, physical therapy, and potentially even medication.
The first step is identifying the cause. Common culprits include muscle strain, improper running form, weak core muscles, and tight hamstrings. A professional assessment by a doctor or physiotherapist is crucial to diagnose the issue accurately.
Lower back pain after running treatment often starts with self-care strategies like rest, application of ice or heat depending on the pain stage, and over-the-counter pain medication. Stretching, particularly focusing on hamstrings and glutes, can help improve flexibility and reduce tightness.
Physical therapy plays a vital role. Therapists create personalized programs that strengthen core muscles, improve running form, and address specific muscle imbalances. Exercises might include core stabilization exercises, planks, and bridges to enhance core strength, which forms the foundation for proper running posture. Additionally, they can teach proper running mechanics, focusing on foot strike, posture, and stride length.
For more severe cases, anti-inflammatory medications or injections may be prescribed to manage inflammation. In rare situations, physical therapy techniques like manipulation or ultrasound therapy may be used to directly address specific pain points.
The key to successful treatment is a multi-pronged approach. By combining self-care, physical therapy, and potentially medication, runners can effectively address lower back pain and prevent future occurrences. Additionally, implementing a gradual return-to-running program, increasing distance and intensity slowly, allows the body to adapt and heal.
Remember, prevention is key. Maintaining proper running form, strengthening core muscles, and staying flexible with regular stretching routines can significantly reduce the risk of future lower back pain, keeping you pounding the pavement pain-free.
