Low Back Pain and Sciatica
Low back pain is among the most common medical problems, with Americans spending at least $50 billion each year on job-related disability for this reason alone. Back pain is the second most common neurological ailment (after headaches) in this country.
The spinal column has three segments: cervical (neck), thoracic (chest area) and lumbar (lower back). The lumbar region, which connects the upper and lower body, is the most complex. It must be more flexible (for twisting and bending) and able to bear more weight (for walking, standing, lifting and running).
The reason lower back pain, with or without sciatica (pain that shoots along the leg's sciatic nerve), is such a frequent complaint is because it is more actively used than the rest of the spinal column. The pain can be temporary and uncomfortable or chronic and extremely painful.
What Causes Lower Back Pain?
- Herniated or ruptured disks. Disks are the spine's shock absorbers. As a result of normal wear and tear, the disks can collapse or protrude, which limits their ability to cushion the vertebrae. This, in turn, can put pressure on the sciatic nerve root, causing sciatica.
- Osteoporosis.
- Inflammation of the sacroiliac joints (sacroiliitis)
- Infection in the bones of the spine (osteomyelitis)
- Pregnancy can cause lower back pain and sciatica, due to the stress of carrying additional weight that isn't distributed equally around the body.
- A sedentary lifestyle … and, most especially, when it is punctuated infrequently with too much exercise.
- Strain from lifting heavy objects or twisting.
- Overloaded backpacks.
- Problems with spinal ligaments and tendons.
Although no one is sure what causes it, theories range from genetic propensity to repetitive stress to the lower back. Lower back pain can be aggravated by stenosis and spondylolisthesis.
Spondylolisthesis (spon-dee-low-lye-sis) occurs when there is stress fracture in one of the vertebrae, most typically in the lower back (lumbar) area. The fracture weakens the bone, causing it to shift out of place. If it shifts too far, the bone starts pressing on nerves. It occurs most frequently in teen athletes.
What Are the Symptoms of Lower Back Pain?
Symptoms can vary as widely as the causes. Some people feel a sharp temporary pain when they bend while others report a dull ache most of the time. If sciatica is involved, a sharp, intense pain radiates down the leg. Lying down or arching the back can provide relief.
When Should You Seek Treatment?
See your physician if symptoms don't improve after two weeks of self-care or if the pain is intense enough to interfere with regular activities.
How Is Back Pain Evaluated?
Keep a pain diary of your symptoms to show your physician. Write down:
- The day, time and duration of pain
- Pain location
- Pain intensity, rating it from one to ten (ten being excruciating)
- If the pain intermittent or chronic. If intermittent, what movement causes it?
- What you were doing before or during the pain onset
- Physical activities that you participate in, making special note of anything new
- Medications you take regularly
Your physician will conduct a physical exam to look for evidence of nerve problems and the extent of your mobility. The following diagnostic tests may be ordered:
- Bone density test
- Bone scan
- CT (Computed Tomography) scan
- EMG (Electromyography)
- MRI (Magnetic Resonance Imaging)
- NCV (Nerve Conduction Velocity) test
- Ultrasound imaging
- X-rays, Discography and Myelograms
How Is Low Back Pain Treated?
Self-Care
- Over-the-counter pain reliever, such as acetaminophen (Tylenol), a nonsteroidal anti-inflammatory drug (Advil, Motrin) or naproxen sodium (Aleve), as directed
- Rest (but do not stay in bed for more than two days).
- Sleep on your side with a pillow between your knees.
- Alternate heat and cold: Ice your neck for 20 minutes a few times each day. Wrap ice in a towel -- do not put directly on skin. In between, apply heat (hot water bottle, warm shower).
- Massage your back to stimulate blood flow to the affected area
- Gentle stretches
- Over-the-counter topical anesthetic creams containing menthol or camphor
- Wear shoes with good arch support. Avoid heels higher than two inches.
- Do not lift heavy objects.
If pain doesn't improve after two weeks, your physician may prescribe:
Non-surgical options
Surgical options
Surgical treatment options are typically considered if more conservative methods have failed to produce a good result. Your surgeon will determine if you are a good candidate for any of these procedures, all available at Stamford Hospital:
For more information or to make an appointment please call
1-877-233-WELL (9355).