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Why did I get back pain?
In most cases it is difficult to determine the exact cause of back pain. Common causes include muscle strain, disc degeneration, joint arthritis, and herniated disc.
Approximately four out of every five Americans will have back pain at some point during their lifetime. Low back pain is the second leading reason for missed work. The good news is that over 90 percent of these episodes will resolve on their own, with activity modification, medication and exercises.
Approximately one-third of patients improve within one week, 58 percent are better by three weeks; 90 percent by two months, and 98 percent by three months.
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Will I have back pain again?
Approximately 50 percent of patients with one episode of back pain have another episode. Additional episodes of pain are also likely to improve with appropriate management.
Back pain Do's and Don'ts
DO
- Strict bedrest, 1-2 days, no more
- Moist heat twice a day
- Anti-inflammatory medication as directed
- Back exercise program
DON'T
- Bend/Twist/Stoop
- Lift over 2-3 pounds for first few days
- Sit for more than 15 minutes at a time
- Use tobacco products
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Why do exercises specifically for my back?
By exercising you strengthen the musculature around the spine and provide support, thus taking some of the stress off the bones, ligaments and discs. Additionally, by performing aerobic exercise you increase the blood flow to those tissues, thus speeding up the healing process and increasing blood levels of endorphins (your body's naturally made pain killer).
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Will heat or cold help my pain?
Both heat and cold relieve pain and muscle spasm. Some consider heat better in acute cases, but should not be used if trauma has caused the injury, as it increases swelling. Persons with decreased sensation or circulation, or mental impairment may suffer burns without realizing it.
Cold applications reduce swelling, and some consider cold better in chronic low back pain. Persons who suffer Raynauds, skin sensitivity or long term muscle contractions should not use cold applications
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Does cigarette smoking affect my back problem?
Nicotine found in cigarettes has been shown to increase the risk for disc degeneration and back pain. It can also slow or prevent recovery because it reduces the amount of blood flow to the tissues that are trying to heal. In those patients requiring surgery, it reduces the rate of bone healing after surgery and increases the risk for serious complications from anesthesia.
Patients planning a spine fusion are required to stop smoking four weeks prior to surgery and for six months after surgery to minimize the detrimental effects of nicotine on bone healing.
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Do I need surgery for back pain?
The majority of patients with back pain do not require surgery. The most predictable and safe treatments for most causes of back pain do not involve surgery. Surgery is occasionally required for patients with sciatica (leg pain) that does not recover after appropriate non-operative management, or rare conditions causing back pain.
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How can I prevent back pain from coming back once it is gone?
- Use proper body mechanics during lifting
- Avoid excess body weight
- Avoid cigarette smoking
Exercise for both general conditioning, and specifically for back and abdominal muscles.
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What about lifting techniques?
Make it a practice to bend at the knees, hold the object to be lifted close to your body, and lift it with your knees, not your back. Do not twist or turn your trunk while lifting. Lift smoothly and gently, without sudden movements.
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What about my bed?
A firm, supportive mattress, at an easily accessible height, will enable you to get into and out of bed without difficulty. If you sleep on your side keep your body and knees slightly bent; if you sleep on your stomach place a pillow under your waist; if you sleep on your back place a pillow under your knees. All of these maneuvers straighten the curvature of the low back.
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Should I stop an activity if it makes my back hurt?
Yes and no. After the first week of limited activities, as much activity as possible is important to help the healing process. Some pain is normal and OK, but excruciating pain should be avoided. Staying inactive in fear of "hurting something" in the back will also slow your recovery. Prolonged inactivity further weakens your back, adding to the problem.
You may suffer some soreness with the exercises, but if you develop severe pain, weakness or numbness, or difficulty with urination or walking you should contact your health care provider.
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Why not take stronger (narcotic) pain medications?
Most patients do not benefit from narcotic pain medication. Through anti-inflammatory medications, exercise programs, and proper rest, most patients limit their pain. For patients with chronic pain, narcotic pain medication is addictive and patients become tolerant of it, requiring greater dosages over time. In addition, narcotics can impede the body's ability to make its own internal pain medicine (endorphins). Thus narcotic medications may be hazardous and ineffective.
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Do I need surgery for my neck pain?
The majority of patients with neck pain do not require surgery. The most predictable and safe treatments for most causes of neck pain do not involve surgery. Surgery is occasionally required for patients with arm pain that does not recover after appropriate non-operative management, or rare conditions causing neck pain.
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Do I need surgery for my herniated disk?
The majority of patients (95 percent) with a herniated disc will recover within twelve weeks. The recovery process can be made less symptomatic through conservative measures outlined above. In those that do not improve, surgery for a herniated disc can relieve the arm or leg pain, but it cannot prevent future spine problems.
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What happens to a herniated disk if I don't have surgery?
In some instances the herniated disc resorbs or dries up. Most often the herniated disc will remain where it is, but the associated nerve irritation stops and it is no longer painful. Twenty to thirty percent of the population has a herniated disc that they are unaware of because it does not cause pain.
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What are facet blocks?
These injections are placed into the small joints of the spine. They serve in diagnosis and may relieve pain arising from arthritis in the joints.
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What is an epidural steroid?
An epidural steroid is an injection of an anti-inflammatory medication into or near the spinal canal. By placing the anti-inflammatory medication in the exact location around the irritated nerves, the patient gets the greatest amount of relief. This is done as an outpatient procedure and may be repeated two or three times. It is most commonly performed in patients with arm or leg pain from an irritated nerve.
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Do I need X-rays?
X-rays show bones well, but do not show soft tissues such as muscles, discs and nerves. X-rays rarely help in the diagnosis of back pain during the first six weeks unless the cause is an infection, fracture, or some types of tumors. Your physician has asked you a series of questions and examined you thoroughly. This history and physical are used to determine the need for X-rays or other tests earlier than six or eight weeks.
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What is a bone scan and what does it show?
The bone scan is a diagnostic tool using a small amount of radioactive tracer, which is injected into the vein. This test is helpful in demonstrating areas of infection, tumor and fractures that affect bones.
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Do I need a MRI or CAT scan?
Most people with back problems do not need a MRI or CT scan. Approximately 30 percent (one-third) of normal volunteers without back pain have significant abnormalities (disc herniation, pressure on nerve roots) on MRI/CAT scans. Most people have some signs of aging as well (degenerated disc). MRI/CAT scans are reserved for those patients who may require surgery. Except when complex or unusual diagnosis are likely, the scan should be delayed until just prior to surgery so that the most current information is available. Without a need for surgery, these tests are expensive, unnecessary and rarely change the type of treatment required.
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Why get a CT/myelogram instead of MRI?
Plain CT scans do not provide spine surgeons with enough information to adequately plan for surgical procedures. The CT/myelogram provides information about the bony architecture of the spine and additional information about the spinal cord and nerve roots, and their location within the spinal canal. In patients with pressure on nerve roots from bone spurs, the CT scan/myelogram test can help define the exact location and severity of the nerve root compression. This test is rarely needed except before surgery to help in planning the extent of an operation. In some cases, the CT myelogram more accurately demonstrates spinal cord and nerve compression when caused by bone (as opposed to compression by ligaments or disc material). In some cases both CT/myelogram and MRI are needed.
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