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Causes and Treatment of Low Back Pain

What do you do when you have back pain? In part 2 of our low back pain series, learn the more common causes and treatment of low back pain.

By
Sanaz Majd, MD,
Episode #234

What Is Sciatica?

You may have heard this term that refers to the sciatic nerve that leaves the lower spine and travels down the back of the leg. If that region around the spine is inflamed from a muscle strain, or if a herniated disk is impinging on the sciatic nerve, then this nerve can also become inflamed. This will cause radiation of the pain from the lower back down to the back of the leg. As the inflammation in the lower spine diminishes, the sciatica resolves as well. 

Unfortunately, Lori’s left muscle strain has aggravated her sciatic nerve and that is the reason for the radiating pain down the left leg.

Diagnostic Testing for Low Back Pain

Most patients with acute low back pain do not require imaging. Studies show that imaging the low back, via X-rays or MRI, do not typically change the ultimate treatment or outcome of acute low back pain. Most low back pain is short-term and treated in the same way conservatively – no matter what imaging shows. Imaging is recommended, however, if there are severe or progressive neurologic symptoms, if there are “red flags” that may indicate more serious roots of the pain, or if surgical treatment or epidural injections are being considered.

Studies show that total health care expenditures over 100 billion dollars annually in the U.S. Unnecessary MRI’s contribute to the skyrocketing health care costs of this country, and ultimately places the financial burden on all of us.

Treatment of Low Back Pain

Low back pain is typically treated conservatively. What does this actually entail? Well, if you know how doctors typically treat non-concerning low back pain, you can use the following tips to treat it on your own at home (but, of course, check with your doctor first):

Ice and/or Heat: Ice aids with acute inflammation and heat loosens the muscles. Rotating each for 20 minutes also can help. But in general, use whatever improves your symptoms.

Stretching:  The last thing you want is to remain inactive. Bed rest does not help low back pain. Continuing with your daily routine activities is vital, and stretching exercises on a daily basis can keep the muscles from stiffening.

Back brace:  A structural support for the back can help take some of the pressure off the inflamed muscles.

Pain relievers:  Over-the-counter (OTC) anti-inflammatories, like ibuprofen, are one of the mainstays of treatment. Not only do they help relieve pain, but they also fight the inflammation. A common regimen is ibuprofen 600mg (always with food) three times a day for a time period (like one week), and then as needed. Not everyone can take them, however, so please ask your doctor first. Otherwise, acetaminophen is another OTC option but lacks anti-inflammatory property.

Muscle relaxants:  These can help loosen up the muscles for some, but does not attack the underlying problem – which is the inflammation. They tend to be sedating, therefore must be taken at bedtime.

Corticosteroids:  With sciatica, doctors may consider a short course of prescription steroids to quickly calm down the nerve.

Activity modification:  Use common sense – if you are weight lifting 100 pounds at the gym, lay off that machine until your pain is resolved. Perhaps you can refrain from carrying your 5 year old for some time. If you drive long distances, stop to take a stretch frequently. Proper posture and work ergonomics are also important to address, because they are common causes of low back pain. Ask your employer for an ergonomic evaluation of your work station, a place you spend hours each day. 

Physical therapy:  Physical therapy can aid in strengthening your lower back muscles and improving your range of motion and functioning.

For Lori’s 3 days of low back pain, I prescribed her one week of ibuprofen around the clock (and then as needed), asked her to use a heating pad and rotate it with ice every 20 minutes several times a day, gave her a handout on low back stretching exercises, and asked her to return in 1 month if not improved. We also discussed the need for weight loss to help prevent future flare ups. Lori came back to see me in 1 month, but this time for a pap smear. Her low back pain resolved after 2-3 weeks and she’s now back to her normal activity.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

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