Low Back Pain
Low back pain is a very common painful condition which affects 49-90% people in developed countries at least once in their lifetime1-5.
Causes of Low Back Pain
Back pain can be caused by a variety of factors including mechanical issues involving muscles, nerves, joints, bones and/or intervertebral discs. A large number of people suffer from low back pain due to postural issues including sitting for long periods, slumped posture and deconditioned back and abdominal muscles. Low back pain can also be caused by issues affecting the internal organs such as kidney problems, bowel issues, an aneurysm or even cancer. Injuries are another important contributor to low back pain as chronic low back pain can be the result of an old injury.
Some body-type and lifestyle factors increase the risk of developing low back pain including being overweight or obese, a lack of exercise, improper lifting, past injuries and advanced age.
Symptoms of Low Back Pain
The severity of back pain doesn’t always indicate the extent of damage or injury to related structures. For example, a muscular spasm in the low back can cause severe, immobilizing pain but it is a fairly quickly and easily reversible problem. On the other hand a chronic degenerative condition such as osteoarthritis may be associated with less or even no pain in some cases. Low back pain can radiate down into the buttock and even further down into the thigh or lower leg. Pain radiating down the thigh or leg indicates nerve involvement, commonly the sciatic nerve.
Low back pain is most often diagnosed with physical exam and history taking as most cases are caused by mechanical and lifestyle factors which can be diagnosed fairly easily. Imaging (x-ray, CT scan or MRI) is also used especially when osteoarthritis, intervertebral disc herniation or other less common causes of back pain are suspected or when results are not being achieved with conservative treatment.
Treatment of low back pain depends on the factors which are causing the pain. A spasm of the quadratus lumborum muscle would be treated differently than a herniated disc or a kidney stone, for example.
Strengthening the affected muscles of the back as well as supporting musculature is important to promote recovery from low back pain and for preventing future episodes of low back pain. A faithfully performed rehabilitative exercise program can lead to significant improvements in pain and mobility issues.
Acupuncture is an excellent means of treating many painful conditions but is especially effective for the treatment of hypertonic (overly-tight) muscles. Muscle spasm of the back including muscles of the erector spinae group, quadratus lumborum and trapezius all respond well to acupuncture. Acupuncture with electrostim (similar to transcutaneous electrical nerve stimulation) is especially effective for relaxing tight musculature, including muscle spasm.
Platelet-rich plasma (PRP) is an excellent treatment for osteoarthritis of the spine which is a very common cause of low back pain in people who are middle aged or in their senior years. Platelet-rich plasma uses platelets from a person’s own blood to treat painful conditions including osteoarthritis. The natural abundance of growth factors in platelets are the trigger which induces and encourages healing in PRP treatment. Read more on platelet-rich plasma for osteoarthritis.
Neural prolotherapy is a treatment which uses an injection of a 5% dextrose solution for the treatment of superficial nerve impingement including in back pain. Neural prolotherapy helps neural impingement through creating a hydrodissection (pillow of water) which mechanically frees the nerve. Neural prolotherapy also acts directly on the nerve’s TRPV1 receptors (pain receptors), down regulating pain directly. Read more on neural prolotherapy.
- Devereaux MW. Low back pain. Primary Care: Clinics in Office Practice. 2004;31(1):33-51.
- Margarido MS, Kowalski SC, Natour J, Ferraz MB. Acute low back pain: diagnostic and therapeutic practices reported by Brazilian rheumatologists. Spine. 2005;30(5):567-71.
- Nyiendo J, Haas M, Goldberg B, Sexton G. Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001;24(7):433-9.
- van Tulder M, Koes B, Bombardier C. Low back pain. Best Practice & Research Clinical Rheumatology. 2002;16(5):761-75.
- Woolf AD, Pleger B. Burden of major musculoskeletal conditions. Bulletin of the World
Health Organization. 2003;81(9):646-56
Pain Medicine: Conditions
Last updated Aug 31, 2017