Low Back Pain: Common Causes, Tests, and Treatment
From disc herniation and spinal stenosis to sacroiliitis and osteoporosis, what causes back pain, how it's diagnosed, and my tips to avoid it.
Common causes of back pain include: osteoarthritis (degenerative arthritis); muscle or ligament strain or sprain from repetitive movements or sudden trauma; bulging or herniated discs, when the cushioning material between the vertebrae moves out of its space and/or presses on a nerve; spondyloarthropathy (ankylosing spondylitis, psoriatic arthritis), an inflammatory spinal condition affecting people under 40 where back pain improves with activity; and sacroiliitis, inflammation of the joint connecting the bottom of the spine to the pelvis.
Other causes include fractures from osteoporosis; scoliosis (a sideways curvature of the spine); spinal stenosis, when the spinal canal narrows and compresses nerve roots; infection (especially in drug and alcohol users); and cancer (metastatic disease, multiple myeloma). Sometimes abdominal and pelvic conditions such as kidney stones or inflammatory bowel disease cause pain referred to the back.
Women may also experience sacroiliac joint dysfunction more often, because the sacrum is wider, more uneven, and more tilted in the back, which can cause a dull, achy pain in the back and buttocks. Pregnancy, childbirth, and endometriosis can also cause back pain.
Diagnostic tests may include X-rays; MRI or CT scans; nerve tests to assess compression from disc herniation or spinal stenosis; and blood tests looking for inflammation markers or abnormalities in calcium.
What to do? Most acute back pain can be treated with over-the-counter anti-inflammatory agents, acetaminophen (Tylenol), and heat. Prolonged rest may not be the best course of action. You can continue light activities like walking, but stay away from motions or activities that worsen the pain. Always speak with your physician first to confirm which activities are allowed.
Other treatments may include physical therapy and exercise; prescription NSAIDs like naproxen; muscle relaxants; topical ointments or creams; some antidepressants used for chronic pain; and epidural injections. In special cases, a physician or pain specialist may prescribe a limited course of narcotics, but always be aware of their addictive properties; they should never be used long term, and I am not a fan of these pain medications. Surgery may be recommended for a herniated disc or spinal stenosis that doesn't respond to other therapies.
Alternative treatments. Some individuals report improvement with acupuncture, yoga, and massage therapy.
My tips to avoid back pain: (1) ENGAGE in low-impact aerobic exercise that builds back muscle strength. Try swimming, and STAY ACTIVE! (2) MAINTAIN a healthy weight, since excess pounds stress your back. Get that Fitbit and increase your daily steps! (3) INCREASE abdominal and core strength. Conquer that plank position! (4) STOP SMOKING. Smoking decreases blood flow and the nutrients your lower spine needs. (5) LEARN how to lift heavy objects properly.
(6) AVOID excessive twisting or bending. (7) PAY ATTENTION to your posture to reduce stress on your back. (8) CHANGE sitting and standing positions frequently to relieve your back load. I love to do CHAIR YOGA during my workday! (9) TRY a different chair with better back support at work, or use a pillow for assistance. Reference: CURRENT Diagnosis and Treatment in Rheumatology, Second Edition.
Dr. Maggie Cadet, MD