Acute low back pain
Overview
Back pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute low back pain is abrupt, intense pain that subsides after a period of days or weeks. It typically resolves with rest, physical therapy, and other self-care measures. You can play an important role in the prevention, treatment, and recovery of back pain. However, if chronic, pain will persist despite treatment and need further evaluation.
Figure 1. (side view) The low back region is called the lumbar spine. Protected within the bones of the lumbar spine are the spinal cord and nerves. The five lumbar bones (vertebrae) are numbered L1 toL5. Each bone is separated and cushioned by shock-absorbing discs. The spinal nerves pass through bony canals to branch out to the body and legs.
Types of low back pain
Supporting the weight of your body, the lumbar spine can be prone to injury and pain (Fig. 1). Back pain ranges from mild to severe depending on the amount of injury and can be acute or chronic.
Acute low back pain occurs suddenly and usually heals within several days to weeks. The source of pain is usually in the muscles and ligaments, joints, or discs. Sometimes mechanical back pain is caused, not by a pinched nerve, but by tight muscles, degenerative discs, and inflamed facet joints.
Chronic back pain persists for more than 3 months; it may be felt all the time or worsen with certain activities. Although its source may be hard to determine, contributing factors may include nerve damage, tissue scarring, arthritis, or emotional effects of pain.
What are the symptoms?
Signs and symptoms of low back pain may be stiffness, tightness, aching, burning or stabbing or shooting pains, pressure, or tingling. The pain may spread to the buttocks, thighs, or knees. People may also experience muscle spasms. The symptoms are more noticeable when bending or arching the back, when lifting heavy objects, or when sitting or standing for long periods of time.
Seek medical help immediately if extreme leg weakness or loss of bladder or bowel function develops, a condition called Cauda Equina Syndrome.
What are the causes?
Excess weight, lack of exercise, poor posture (e.g., slouching) and improper lifting stress the spine and make injuries more likely. Causes of acute low back pain are identified only 20% of the time. Although the specific cause may not be determined, some conditions that cause back pain are:
- Muscle strain: A sports injury, fall, or strenuous activity can strain muscles and ligaments. Lack of exercise increases the risk.
- Bulging or herniated disc: The gel-like centre of a spinal disc can bulge or rupture through a weak area in the disc wall and compress nerves.
- Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord and nerves.
- Osteoarthritis: As discs naturally age, they dry out and shrink. Small tears in the disc wall can be painful. Bone spurs can form. The facet joints enlarge, and ligaments thicken.
How is a diagnosis made?
A careful chiropractic exam will attempt to determine the type and cause of your back problem, and the best treatment options. A diagnostic evaluation includes a physical exam.
What treatments are available?
Healing begins with self-care and nonsurgical strategies (Fig. 2). The goal is to correct the problem, restore function, and prevent re-injury.
Figure 2. Most people with acute low back pain respond rapidly to non-surgical treatment. Exercise, strengthening, and ideal weight are key elements to your treatment. Make these a part of your life-long daily routine.
Self-care: Back pain often resolves with rest, ice or heat, massage, pain relievers, and gentle stretches. Reduce muscle inflammation and pain using an ice pack for 20 minute several times a day during the first 48 to 72 hours. Thereafter, a warm shower or heating pad on low setting may be added to relax the muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If self-care treatments are not working within the first couple of days, see your doctor.
Medications: Many people get pain relief with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen. A muscle relaxant may be prescribed for spasms. If pain is severe, an analgesic may be prescribed that can be taken with the NSAID or muscle relaxant.
Steroids can reduce the swelling and inflammation of the nerves. They are taken orally, as a Medrol dose pack, tapered over a five-day period or by an injection directly into the pain source. (epidural steroid injections and facet injections.) Steroids may provide immediate pain relief within 24 hours.
Chiropractic therapies/exercise: For most back pain, we recommend a nearly normal schedule from the onset. Chiropractic therapies can help you return to full activity as soon as possible and prevent re-injury. Chiropractors will show proper lifting and walking techniques, and exercises to strengthen and stretch your back, leg, and abdominal muscles.
Surgery: Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, severe stenosis, cauda equina syndrome, or severe pain that does not resolve after a reasonable course of nonsurgical treatment.
Recovery and prevention
Most people with acute low back pain respond to treatment. Around 70% are symptom-free within 1 to 2 weeks and 10% recover within 3 months. 20% aren’t so lucky and need longer for the body to adapt and heal. A positive attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time.
Prevention is key to avoiding recurrence:
- Proper lifting techniques
- Good posture during sitting, standing, moving, and sleeping
- Regular exercise with stretching and strengthening
- An ergonomic work area
- Good nutrition, healthy weight, lean body mass
- Stress management and relaxation techniques
- No smoking
Glossary
Acute: a condition of quick onset lasting a short time, opposite of chronic.
Arthritis: joint inflammation caused by infection, immune deficiency (rheumatoid arthritis), or degeneration of the cartilage that causes pain, swelling, redness, warmth, and restricted movement.
Chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.
Disc (intervertebral disc): a fibrous cushion that separates spinal vertebrae. Has two parts, a soft gel-like centre called the nucleus, and a tough fibrous outer wall called the annulus.
Osteoporosis: Loss of bone or atrophy of skeletal tissue that causes bones to weaken and become brittle, and prone to fracture. Preventive measures include adequate calcium and regular exercise to stimulate bone metabolism.
Radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg.
Sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
Acknowledgements
Banita Bailey, RN
Mayfield Clinic, Ohio
Cannington Chiro Services
Patients attending Cannington Chiro help us by first filling out a “New Patient Questionnaire”, followed by a thorough consultation, examination, and assessment. This helps us help you.
Beginning treatment ASAP is a priority to us, with the aim of, in most cases, commencing treatment from day one. Healing, repair and rehabilitating the body after being injured is a process – and processes take time – so with understanding and patience a positive long-term outcome can be expected.
We look forward to helping you and demonstrating that we may be the missing link in your recovery.