It has been estimated that 80 percent of people will experience back pain at some point in their lives due to back injuries or other disorders. Lower back pain can be the result of numerous problems with spinal nerves, bones, discs, muscles or tendons in the lumbar spine. Many treatments are available, and for most patients the good news is that back problems do not have to result in surgery.
The first step to low back pain relief is identifying the symptoms and pinpointing the source of the pain. At the Orthopedic & Sports Medicine Institute (OSMI), we use the most cutting-edge methods to avoid surgery for our patients. Spine treatment is a specialty for the physicians at OSMI and we work to determine the most effective procedure for each individual case.
Common Sources of Lower Back Pain
- Injury – bone, joint, muscle or ligament strain may be damaged
- Sciatica (pinched or irritated nerves or nerve roots)
- Normal wear and tear from repetitive use, arthritis, or degeneration of intervertebral discs
- Slipped disc or vertebrae (spondylolisthesis)
- Scoliosis
Irritation and damage to any of these structures may cause low back pain or pain that radiates to other parts of the body. Even muscle spasms can be disabling and cause severe pain. Low back pain is common, but can vary from mild discomfort to intense pain, necessitating a visit to the emergency room.
Symptoms of Lower Back Pain
Back Injury
Symptoms
Sudden movement, lifting a heavy object or twisting can cause stretching of the muscles and ligaments triggering severe symptoms in the lower back. Pain from muscle or ligament strain may include any combination of these symptoms:
- Pain that may be dull, achy or locally sore when touched
- Confined to lower back (does not radiate to buttocks or legs)
- Pain severe enough to limit standing or walking
- Muscle spasms due to inflammation
Other injuries, such as spinal fractures, will also cause acute pain and may lead to chronic pain or deformity. These injuries are rarely associated with nerve or spinal cord damage.
Diagnosis and Treatment
Your doctor will examine and ask you to describe your pain to determine the course of treatment. Most often injury can be treated with rest, heat and ice packs, and medication for inflammation. If pain persists or becomes worse, more in-depth diagnostic procedures may be required.
Sciatica
Symptoms
Low back pain that travels through the buttocks and down the leg and foot is called sciatica. Symptoms associated with sciatica include:
Symptoms develop gradually over time- Pain is typically ongoing (sometimes severe) without subsiding, and worsens with standing, walking or bending backward
- Pain may be in the leg or foot rather than in the lower back
- One or both buttocks/legs may be affected
- The pain is typically more severe (shooting, burning, tingling) than an ache or dull pain; sitting often makes the patient feel better
- Difficulty walking or moving the leg, accompanied by weakness and numbness
Diagnosis and Treatment
Diagnostic imaging, such as x-rays or CT scans may be needed to diagnose sciatica pain. For most, non-surgical remedies such as exercise, heat and cold therapy, over-the-counter or prescription medications will reduce or relieve sciatica pain.
Sciatica pain that does not improve or worsens may need additional diagnostic imaging, to determine additional treatment. Acute sciatica pain can also be caused by more severe conditions such as a lumbar herniated disc or spinal stenosis. Severe pain is often relieved with an epidural steroid injection to reduce inflammation. As a last resort, surgery may be indicated if all non-surgical treatments have been ineffective.
Normal Wear and Tear on Your Back
Symptoms
- Not all people will develop symptoms from normal wear and tear, but there are a few symptoms that are common from people that have degenerative disc disease.
- Pain is typically related to activity, flaring up and then returning to low-grade or no pain
- Pain can be chronic, from a nagging ache to severe, and may last a few days or a few months
- Rarely is this chronic pain completely disabling
- Certain activities and positions will increase the pain; sitting increases the load on the lumbar discs, increasing pain where standing or walking may feel better
Diagnosis and Treatment
Pain from normal wear and tear of the lumbar spine may eventually decrease, rather than worsen, because fully degenerated discs no longer have inflammatory proteins (that cause pain). Patients with degenerative disc disease may experience flare-ups of severe pain during their 40’s, be able to control the pain with medication and exercise, and find by the time they are in their 60’s, the pain is almost gone. For most, non-surgical treatments, through trial and error, work best. Patients are advised to give best effort to control and relieve pain with non-surgical treatments for at least six months before surgery becomes an option.
Wear and tear of the cartilage around the lumbar joints can create inflammation for some patients. When the bones rub together, bone spurs and osteoarthritis of the spine or spinal stenosis can develop, irritating nerves in the joints between the vertebrae. This irritation may result in severe pain and loss of flexibility.
Slipped Disc or Vertebra (Spondylolisthesis)
Symptoms
A slipped vertebra is a condition where one vertebra slips forward over the vertebra beneath it. The condition is common in younger adult patients, and causes lower back and leg pain that limits activity. Symptoms for spondylolisthesis are very similar to those of spinal stenosis.
- Lower back pain and/or leg pain
- Sciatica pain in one or both legs when standing or walking any distance
- Pain is less when sitting
- Tight muscles in the back of thighs and leg weakness
Diagnosis and Treatment
Diagnostic testing, such as an MRI or EMG, is generally used in diagnosis. Modifying activity, heat and cold therapy and over-the counter pain relievers will reduce pain for most patients. Exercise in a warm swimming pool or using a stationary bike will be beneficial to increase range of motion and stamina. Surgery is rarely needed, but may be considered if the pain is disabling or if nerve damage occurs.
Scoliosis – Abnormal Lateral Curvature of the Spine
Symptoms
Scoliosis is an abnormal side-to-side curvature of the spine. In children and teens, symptoms may not be noticeable until the condition has progressed. The earlier the diagnosis of scoliosis, the more effective the treatment. Children with a family history of spinal deformity are at greater risk of developing scoliosis. 
- One shoulder blade sticks out more than the other
- One shoulder or hip appears higher than the other
- The body may tilt or appear to lean to one side
- One leg may look shorter than the other one
- The patient’s waist may look uneven
- Pain is not usually associated with scoliosis
Diagnosis and Treatment
Scoliosis can be detected early (frequently in a school exam or well-child check-up) by having the patient perform a bend forward test. If a curvature is detected, an x-ray of the spine will ordered. There are three main treatment options for scoliosis: observation, back braces and scoliosis surgery. Exercise has not been a proven treatment to reduce the curvature but will help keep the back strong and flexible.
If you have a back injury, or even mild back discomfort that you would like to relieve, contact the Orthopedic and Sports Medicine Institute today to see what our shoulder specialists can do for you.