This is the first article in a two-part series on lower and upper back pain causes, treatments, relief, and management.
It affects all age groups, nationalities, and income levels. As one of the leading reasons why Americans miss work, low back pain doesn’t discriminate (1). It’s so common that one study found that, over three months, an astounding quarter of all Americans experienced this type of pain (2). It may even be the most common disability across the world (3). But, unlike other illnesses and injuries, what’s unique about low back pain is that the majority of the time it’s difficult to determine its origin (4).
Most of the time when someone falls ill or becomes injured, it’s possible to pinpoint the cause of symptoms. Maybe the person fell off a ladder or contracted the flu from a coworker. But in the case of low back pain, it’s likely the sufferer won’t know what they did or what happened to cause the pain they feel. Was it caused by stress, repetitious physical demands at work, lifestyle choices like smoking, bad posture, or something else? Even if there was an initial injury (e.g., a fall from a ladder), these injuries typically resolve within weeks, and are unlikely to be the cause of pain many months or years later. Not knowing the cause of pain can lead to understandable frustration and confusion--and can be a major challenge for finding effective treatment.
In this article, we’ll delve into the potential causes of low back pain (when the cause can be identified, that is), and what can be done to mitigate, manage, and hopefully eliminate it.
Causes of Low Back Pain
Although it can be notoriously challenging to determine the cause of low back pain, one common reason it begins is an injury that is caused by exercise, lifting heavy objects, a fall, or playing sports. Any of these activities can lead to soft tissue injuries like strained muscles. Generally, injuries like these tend to heal within weeks and are rarely the cause of chronic back pain (pain lasting more than six months).
In other cases, back pain may be the result of a joint or disc issue instead. Some of the conditions that can lead to chronic low back pain include a herniated lumbar disc, facet or sacroiliac joint dysfunction, spinal stenosis, osteoarthritis, and spondylolisthesis.
However, these joint and disc issues are highly prevalent in people who experience little to no back pain at all. In fact, most people over the age of 30 who have no back pain will have a joint or disc finding in an X-ray or MRI -- and by the time people are in their eighties, almost everyone has a joint or disc finding, whether they experience back pain or not (5). It is now widely recognized that in most cases, the findings of an X-ray or MRI are not the cause of pain -- which is why current guidelines recommend against taking X-rays and MRIs in most cases of back pain (6). In fact, it is recommended that only higher-risk patients with serious brain deficits, or those who might have a particular underlying condition, or those who could benefit from invasive treatments undergo advanced imaging.
Recent research suggests that in many cases, changes in the brain cause back pain to persist after initial injuries have resolved (7). Many scientists and clinicians now believe that these changes in how the brain processes sensory input from the back amplify pain for most patients. These changes in the brain also explain why back pain frequently re-occurs over time, often in the absence of an obvious new injury. So, it can be very important to include behavioral or psychological treatments to relieve chronic and recurrent back pain (see below).
Self-Administered Treatments for Low Back Pain
No matter what the cause of low back pain, the goal is to “break the cycle” vs get rid of it.
But how? There are lots of ways to treat low back pain. Here are some of the most popular:
PLEASE NOTE: If you have had an injury in the past few days, it is important to rest and avoid strenuous activity. But if the pain has been with you for months or years, staying active is vital. (see below)
- Alternating between icing and heating the painful area
- Gently stretching your back after periods of inactivity
- Using over-the-counter pain medications to temporarily alleviate the pain
- Following a strengthening exercise regimen tailored for your back issues
- Engaging in a low-impact aerobic exercise program (e.g., walking, stationary bikes, ellipticals, etc.) in the short term and building up to impact-related exercise
- Physical therapy
Conventional Medical Remedies for Low Back Pain
Beyond self-administered treatment methods, there are a wide array of medical approaches that can be considered. Keep in mind, though, that these approaches typically only focus on pain relief and should only be used in the short term. Often, these options are used in conjunction with physical therapy, which boosts flexibility, improves posture, and strengthens muscles via exercise. Some medical remedies include:
- Muscle relaxants (also used for short-term pain)
- Steroid injections (e.g., cortisone) are best for back pain clearly due to nerve root inflammation, which typically presents with radiating or shooting pain. For dull, achy back pain, steroid injections are usually not recommended.
- Topical pain relievers
- Braces that offer support and many times a reduction in pain
- Opioids (e.g., oxycodone and hydrocodone) are only recommended for acute (short-term) pain because they are highly addictive
Surgical Alternatives for Low Back Pain
If low back pain is chronic and unbearable, sometimes people opt for or are pressured into having back surgery. This is rare and usually only considered an option if everyday activities are highly limited due to the pain and the cause of the pain is detectable and viewable by doctors (i.e, structural). There are different surgeries (e.g., lumbar spine surgery, decompression surgery, fusion surgery, etc.), some of which are more invasive and time-consuming than others. And with new technologies on the horizon, other surgical options might include disc replacement, radiofrequency neurotomy, and implanted nerve stimulators (8).
Back surgeries are high risk. If you are considering taking this route, be sure to weigh all of your options and get multiple opinions from doctors before moving forward. Surgeries can have many unintended effects, and many patients later regret their decision to have surgery (9). Up to an estimated 40% of the time, people experience new, ongoing pain after surgery. This is referred to as Failed Back Surgery Syndrome (FBSS) (10), and it can be caused by several different reasons, including infection, scar tissue, nerve injury, the formation of a hematoma (11), or a failed spinal fusion. It can also occur when the surgery fixes one spinal problem only to create another or when a disc herniation is repaired but then another occurs during recovery. Surgery for low back pain should only be considered as a last resort.
Alternative Care Options for Low Back Pain
Outside of the commonly used traditional medical and surgical treatments for low back pain, some alternatives can also help relieve back pain.
- Manual manipulation performed by a physical therapist or chiropractor
- Meditative techniques like mindfulness-based therapy and deep breathing exercises
When someone knows how and when they hurt their back, there’s a good chance that a few days of rest and maybe some over-the-counter medication will have them back to their normal activities in a matter of weeks. In fact, the majority of back pain resolves spontaneously within 6 weeks without any intervention.
But what do we do when low back pain becomes chronic and we haven’t been able to figure out what is causing it? Living with persistent pain can impact our happiness and well-being over time. If this is something you want help with, reach out to Lin today to be paired with a personal health coach who will assess your specific condition and help you settle on and implement an effective care plan that picks the treatment course from all the options above that is best for you. Get moving towards the life you are designed to live...without chronic pain.