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Low Back Pain

Back pain is the number one condition of musculoskeletal problems. It is a degenerative condition of the intervertebral discs, which leads to a decrease in the cushioning capacity of the discs and compresses the nerve. In a large number of cases, the pain is related to a herniated disc. Up to 8 out of 10 Americans will experience back problems in their lifetime. Every day, more than 6.5 million Americans undergo some sort of treatment for low back pain. Low back pain is one of the most common ailments in the United States, and it is preceded only by colds and flu for lost time at work. The total amount of money spent each year on this condition exceeds $16 billion.

The risk factors are:

Age

o Obesity

o Type of work sitting or standing (without movement)

o Weightlifting work or exercises

o Congenital or acquired vertebral malformations

Symptoms

Those most often affected are young adults in their most productive years, between the ages of 17 and 45.

o The pain may be localized in the region of the lumbar spine or radiate via the sciatic nerve to the buttock and the posterior part of the thigh.

o The pain can range from a dull, bothersome ache in the chronic phase to absolute agony in the acute phase and a herniated disc.

o The pain gets worse during the day and after weight lifting and eases somewhat after rest due to muscle relaxation. In acute low back pain and in most chronic cases, simple relaxation is usually not enough.

o Local pain in the lower back and increased local temperature to touch during the acute phase.

o Muscle spasms in the lumbar region

o Decreased range of motion

o Relief in the morning

Herniated disc

The peak incidence is at the age of 45-46 years and usually occurs at the L4-5 or L5-S1 level. It begins with a sudden onset of pain precipitated by forced movement. Extremely severe pain radiating down the leg (some people describe it as “an electric shock that knocks the leg down”). Pain exacerbated by coughing, sneezing or defecation. To avoid pain, people hold the affected leg flexed (extending causes excruciating pain).

Diagnostic

The clinical diagnosis is sufficient, but it must be confirmed by a simple X-ray or an MRI (in the case of a herniated disc – MRI). This is done to rule out serious pathology and to track people (disease progression).

Treatment

Non-pharmacological treatment – weight loss, reduction or avoidance of all weight-bearing work or exercise. Special exercises and stretching during work.

In case of herniated disc – bed rest for 3 weeks.

The goal of physiotherapy is to reduce the symptoms of acute or chronic low back pain and to slow down or stop the degenerative process of the spinal discs.

Drug treatment: symptomatic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the acute phase of the disease.

Surgery might be beneficial in rare cases, which are tolerable to other treatment modalities. Again, surgery may only give the patient symptomatic relief.

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