Lower back pain -treatment and investigations

Sometimes the pain comes on very suddenly after a specific incident. Other times the pain gradually creeps up and its not always clear what caused it in the first place. It can come on after a change in activity levels or employment or leisure activities.

Case Studies- Typical Examples

1. A 24-year-old man had started a job in a call centre 12 months ago. His job involved sitting down most of the day. He first noticed that he was starting to get a bit of backache at about lunchtime each day. He ignored it to start with and then as the weeks went on and it worsened he managed it by standing up and walking about which eased it off. Gradually he found that as the day went on it worsened and eventually by the end of the day he was really struggling.

He found that sitting up tall helped a bit. His pain was better after a good night’s sleep and not nearly as bad at weekends. However, he had noticed that the pain was starting to come on earlier and earlier in the day and he couldn’t shake it off at weekends, this made him decide to get some advice about how to manage it.

2. A fifty year old woman had back pain on and off for 25 years. The very first time she got back pain was when she was in her 20’s. One day during moving house her back had felt a bit sore. It had become increasingly painful and stiff that evening. She took painkillers and rested for a few days and it went away by itself. This happened again 6 months later, following a long car drive and again the following year for no apparent reason at all. Gradually over the years the episodes of pain got closer together and it took longer and longer for the pain to go away. Eventually, she had pain all the time and it was interfering with her job and leisure pursuits/pastimes so she sought tteatment.

Both of these individuals managed to get back in control of their back problem with treatment.

How is simple lower back pain treated ?

The latest evidence from research findings clearly shows that keeping active helps. It is especially important to avoid bed rest in the early (acute) stages. Research findings suggest that exercises are helpful when you have a problem that is a bit more longstanding (chronic).

There are many types of treatement on offer for this problem but in this section I want to concentrate on the treatment that I feel is most helpful to help you regain control of this problem.

I believe that maintaining or improving fitness levels and a strong supple spine is very helpful and helps you get back in control of the problem.
I like to explain this in terms of improving your spinal fitness.

There are five main principles for improving spinal fitness and successfully managing this type of lower back pain problem.

Reduce or change the postural stresses that you and your back are having to deal with
Improve your spinal flexibility or mobility with mobilising exercises- work on getting a more supple spine.
Ensure that you have strong, supple muscles to help support the spine by following a program of stabilising exercises.
Improve or maintain your cardiovascular fitness levels (the type of exercise that makes you slightly hot and a bit out of breath).
Ensure that you have no fear of movement or worries about the nature of the problem – If you fear movement will damage you and that pain is a signal of that damage you are naturally not going to want to move.

It is really important that you have a good understanding of your problem and the right mindset. It is essential that you work with your health care provider to get a diagnosis so you can be reassured that you have simple lower back pain and nothing more serious.

X-rays and scans often show very little wrong, aside from the usual changes of age that are very common and are not always associated with pain.

Sometimes an investigation is helpful as it may reassure you that there is no serious problem. More often though the x-ray or scan will just show that you have some common changes.

1. The things most often seen are changes of age or degenerative changes; these are common findings even in quite young people. Disc bulges are another very common finding.

2. These findings are as common in people with no back pain as they are in people with back pain.

3. There is no relationship between the findings on MRI and either the likelihood that you will get back pain, the severity of your symptoms or the likely outcome following an episode of back pain.

4. MRI scans taken before someone had back pain and after they got it look exactly the same.

5. MRI can be helpful to identify problems that may need surgery eg disc bulges causing a nerve root impingement.

“In most guidelines for the management of LBP, MRI is not recommended unless the diagnostic triage suggests serious spinal pathology or nerve root involvement for which surgical treatment is foreseen. This is because many structural changes seen on MRI appear to be as common in asymptomatic individuals as in people with LBP and are, therefore, considered of little value in either explaining the cause of pain or deciding the subsequent course of management.” 1

So, if there is no relationship between MRI findings, symptoms or recovery, sometimes common findings are labelled as the cause even though they may not be. When this happens these findings don't help at all - they may cause more anxiety and make you want to move even less - and that makes the whole problem worse.

If there is any doubt that you may have a serious problem then an MRI may be helpful, you would need to discuss this with your healthcare provider before making the decision.

1.Kleinstück-Frank, Dvorak-Jiri, Mannion-Anne-F

Are structural abnormalities on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic non-specific low back pain?

Spine, 1 Sep 2006, vol. 31, no. 19, p. 2250-7

2.Carragee-Eugene, Alamin-Todd, Cheng-Ivan, Franklin-Thomas, van-den-Haak-Erica, Hurwitz-Eric.

Are first-time episodes of serious LBP associated with new MRI findings?

The spine journal: official journal of the North American Spine Society, Nov-Dec 2006 ,vol. 6, no. 6, p. 624-35

The Lower Back Pain Toolkit

How does it start?

How is simple lower back pain treated ?