Most of us have been through it, a throbbing ache in the lower back that lingers, making us feel miserable through long car rides and hours at our desks. More than 80 percent of Americans experience low back pain within their lifetimes, and sometimes the cause of low back pain is quite serious. But for the majority of us, mild low back pain goes away on its own. You should call your primary care provider if you have back pain and you also:
• Have numbness or weakness in your legs.
• Experience problems with bladder or bowel control.
• Take a steroid medicine such as prednisone regularly.
• Have a history of osteoporosis or cancer.
• Have a fever or feel sick in other ways.
When low back pain is not caused by a serious medical condition, there are many simple ways to care for your back on your own.
Remain active: We know from clinical studies that people with low back pain get better faster when they remain active. Prolonged bed rest can make things worse; movement helps relieve muscle spasms and prevents loss of muscle strength.
Heat: During the first few weeks of low back pain, a heating pad may help relieve discomfort.
Work: We generally recommend that you continue to work if you can avoid prolonged standing or sitting. You should also be careful to avoid heavy lifting and twisting.
Pain medications: If you need over-the-counter pain medication, aspirin, acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) are all good choices. It’s usually more effective to take regular, timed doses of these medicines over a period of three to five days than to only take them when pain feels unbearable.
Exercise: Immediately after a new episode of low back pain begins, back exercise or stretching routines aren’t a great idea as they could make the pain worse or make it last longer. But as the pain begins to subside, it’s a good idea to start some exercises to strengthen the muscles that support your back and increase your back’s flexibility.
Swimming, walking, stationary bikes, and low-impact aerobics all can help with strengthening and stretching the back; avoid activities that have twisting, bending or are high-impact, as these could hurt your back even more.
Physical therapy: If your back pain persists for more than four to six weeks, then your primary care provider may recommend that you work with a physical therapist to develop a formal exercise program.
Other conservative treatments: Chiropractors, physical therapists and massage therapists use manipulation to treat acute and chronic low back pain. Clinical trials using two treatments a week for two to three weeks show that manipulation can be safe and effective for people who’ve had back pain for more than four weeks.
Your primary care provider may also recommend injections for chronic low back pain. Injections may be either a local anesthetic or a steroid medication injected into different areas of the back for pain relief.
Of course, conservative treatment doesn’t work for every patient. Your primary care provider may order an imaging study such as an X-ray, MRI or CT scan if low back pain persists for more than four to six weeks. If conservative measures fail to improve your pain or you have a structural abnormality, then a consultation with neurosurgery is necessary to see if there are any surgical treatment options. Your primary care doctor may refer you to a specialist if:
• You have back and leg pain that limits your normal activity or impairs your quality of life.
• You develop leg weakness and/or numbness.
• You experience loss of normal bowel and bladder functions.
• You have trouble standing or walking.
A neurosurgeon or other spine specialist will review your imaging and your low back pain symptoms with you and will also evaluate you for neurological deficits. If surgery is recommended, be sure to ask your surgeon about the risks and benefits of surgery, your expected course of care and your anticipated health outcomes. It’s important to be well-informed about your condition and the different treatment options available to you.
Physician assistant Nick Armano works with Dr. David Miller and Dr. Claudio Feler at High Mountain Brain and Spinal Surgery at Valley View in Glenwood Springs. Miller and Feler will be speaking at the Eagle County Senior Health Fair, which is today from 8 to 11 a.m. at Colorado Mountain College in Edwards.