Low Back Pain

Typical sources of low back pain include:

• The large nerve roots in the low back that go to the legs may be irritated.
• The smaller nerves that supply the low back may be irritated.
• The large paired lower back muscles (erector spinae) may be strained.
• The bones, ligaments or joints may be damaged.
• An intervertebral disc may be degenerating.

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Many lower back problems also cause back muscle spasms, which don’t sound like much but can cause severe pain and disability.

Most cases of low back pain do not require urgent care, but anyone should see a doctor immediately if low back pain is a result of trauma, or if pain is accompanied by any of the following symptoms:

• Fever and chills.
• Unexplained recent weight loss.
• Significant leg weakness.
• Sudden bowel and/or bladder incontinence—either difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (cauda equina syndrome).
• Severe, continuous abdominal pain (abdominal aortic aneurysm).

In cases where immediate treatment is a required, physicians will investigate possible serious causes of the pain, including any type of spinal infection, tumor or fracture.

Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.

• Low Impact Aerobic Exercise. In addition to exercises specific to the lower back, any low impact aerobic exercise, such as walking, is often an ideal exercise for the lower back because it helps bring oxygen to the soft tissues in the back to promote healing. Swimming or water exercise has the same effect and is an excellent option if walking is too painful.
• Chiropractic Adjustment (also called Chiropractic Manipulation) can help improve spinal function by decreasing pain and inflammation to increase range of motion and physical function. Manual manipulation is also commonly performed by osteopathic physicians.
• Epidural Steroid Injections deliver steroids directly into the painful area of the lower back to reduce inflammation. The steroids do not heal the components of the back, but often provide enough pain relief to allow patients to move, exercise and heal.
• Surgery for Lower Back Pain Surgery is almost always the patient’s decision, and a qualified spine surgeon will be able to explain the pros and cons of each procedure. For sciatica, laminectomy and microdiscectomy have been shown to significantly reduce pain symptoms by relieving the pressure on compressed nerve roots. Fusion surgery, which is used to stop the motion at a motion segment, is a more extensive surgery but can be effective at relieving pain due to a painful motion segment.

The above is not an exhaustive list of all possible treatments for lower back pain, but does include the most common treatments. It is advisable for patients to seek a diagnosis from their primary care physician, chiropractor, or a spine specialist (such as a physiatrist) to determine the underlying cause of their lower back pain and seek appropriate treatment.