Low Back Pain

Low back pain (LBP) is one of the most common complaints and the second most common reason for physician visits. At least 75-85% of U.S. adults will experience back pain at some point during their lifetime. 

Although symptoms are usually acute and self-limited, recurrent episodes are common, and as many as 50% will suffer from recurring lower back pain within a year.

This blog post dives deep into the symptoms, causes, and treatment options of lower back pain. 

What are the symptoms of low back pain?

Low back pain manifests differently, so pinpointing the specific symptoms can offer valuable clues about the underlying cause. Here are some common telltale signs:

• The pain can vary from a sharp, stabbing sensation to a dull ache or a burning feeling. It might be constant or come and go, intensifying with specific movements like bending, twisting, or lifting.
• Stiffness in the lower back region
• Reduced range of motion
• Other symptoms such as weakness, numbness, or tingling in the legs. 
• In rare cases, there might be difficulty controlling bladder or bowel movements.

What causes low back pain?

Low back pain has many different causes, each of which may be more prominent in specific populations and age groups. Here are some of the most common culprits:

1. Injury or wear and tear

By far, the most common cause is injury or wear and tear of the intervertebral disc. The disc is the gelatinous shock absorber between each vertebral body, providing motion for the lower back. 

As we age, the discs can develop small fissures, which can progress to tears, protrusions, and frank disc herniation; these changes can also result from trauma or work injury. 

The disc itself can be painful (discogenic back pain) or compress nearby nerves, causing radicular leg pain (sciatica).  

2. Degenerative disease

Degenerative changes in the joints of the spine (osteoarthritis) or inflammation of the spinal joints (spondylitis) can contribute to low back pain.

3. Underlying medical conditions

Other common causes of back pain include spondylolysis, spondylolisthesis, lumbar stenosis, fracture, sagittal malalignment, kyphosis, and rarely infection, tumor, or inflammatory conditions. 

Furthermore, pain referred from visceral organs (pelvic, renal, vascular, and GI) must also be considered, especially in patients with chronic pain that hasn’t responded to standard treatment.

How is it diagnosed?

The diagnosis of low back pain begins with a detailed history and physical examination with an experienced spine specialist. Most cases of acute low back pain are self-limited and respond to a short period of rest, NSAIDs, activity modification, and gradual resumption of activities. 

Pain that does not respond to these efforts or pain with “red flag” symptoms (severe pain, non-mechanical pain, fever, neurologic changes, h/o trauma, cancer, or weight loss) should prompt a more detailed evaluation, including possible imaging with MRI. 

Do not accept a “trash can diagnosis” that can not be confirmed, such as muscle sprain or myofascial pain, as this is one of the most common reasons for delay of diagnosis and treatment.

What are the treatment options for low back pain?

The appropriate treatment ultimately depends on an accurate diagnosis. A spine doctor may recommend either conservative treatment options or surgery, depending on the severity of your condition.

Non-surgical treatment

Most cases of acute low back pain (2-4 weeks) that are related to discogenic sources are self-limited and may not require a definitive clinical diagnosis (with imaging confirmation).  Here’s what your doctor may recommend during these situations:

• A short period of bed rest (1-2 days) with a gradual return to activities as symptoms allow is most appropriate. Longer periods of bed rest and inactivity are more likely to lead to chronic pain. 
• NSAIDs (ibuprofen, naproxen, aspirin) are helpful, especially for herniated discs, which are filled with inflammatory chemicals. 
• Local steroid injections are also helpful for similar reasons, while muscle relaxants are appropriate for significant muscle spasms. 
• Narcotic medications (Tramadol, hydrocodone, oxycodone) are helpful if there is more severe pain but should be used sparingly over a short period as they are prone to abuse and dependency. 

Once pain has improved, patients should return to normal activities as their pain allows. Rehabilitation with an exercise regimen that includes trunk and lower extremity range of motion, strengthening, and aerobic condition is key to long-term improvement. 

Patients with risk factors for back pain (genetic predisposition, manual labor, smoking, structural lesion, osteoporosis, or psychiatric diagnosis) would benefit from a structured exercise regimen with a physical therapist. 

The role of other modalities, including acupuncture, chiropractic care, and traction, is less clear, although some patients may find them helpful. 

Surgical treatment

Surgical treatment may be a consideration in a small percentage of patients who fail an adequate course of non-operative treatment and have a structural lesion and or neurologic injury. Some examples of surgical techniques include:

1. Microdiscectomy

This is a minimally invasive surgical procedure performed to relieve pressure on a spinal nerve caused by a herniated disc, most commonly in the lower back.

2. Laminectomy

A spinal surgery where part or all of the lamina is removed. The lamina is the bony roof of the spinal canal, which houses the spinal cord and nerves. 

By removing this bone, surgeons create more space in the canal, relieving pressure on the spinal cord or nerves.

3. Spinal fusion

Spinal fusion is a surgical procedure that permanently connects two or more vertebrae in your spine. The vertebrae are the individual bones that stack up to form your spine. 

There are many types of spinal fusion that differ depending on the approach used to access the spine:

• Posterior lumbar interbody fusion – access the spine from the back
• Transforaminal lumbar interbody fusion – access the spine through a smaller incision near the foramina (nerve canals).
• Extreme lateral interbody fusion – access the spine through the side of the body. 

How to prevent lower back pain?

Preventative measures are essential for long-term function and to minimize the chance of recurrent back pain. These include:

• Participating in a regular exercise regimen. Focus on strengthening your core and maintaining flexibility in your back muscles.
• Activity modification (avoid or employ proper spine mechanics when bending, lifting, twisting, or prolonged sitting)
• Practicing proper posture
• Smoking cessation
• Weight reduction. Aim for a healthy weight through a balanced diet and regular exercise.
• Adequate sleep

Further information

• Handout about Acute Low Back Pain
• Overview of Back Pain and its Treatments

Dr. Matthew Hepler: Your Trusted Partner in Spinal Health

If you’re searching for the best spine surgeons in South Florida who can provide effective solutions for your lower back pain, you’ve come to the right place!

When it comes to addressing low back pain, Dr. Matthew Hepler stands out as the premier choice for comprehensive spine care. With leading expertise in both operative and non-operative treatments, his practice is dedicated to providing the highest quality of care for patients of all ages.

Contact us today and experience the difference that expert care and innovative solutions can make. You can also visit one of our locations below:

• Spine specialist in Fort Lauderdale
• Spine specialist in Delray Beach, FL

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.