What causes back pain? Surprisingly, the most common cause of back pain is aging. “Back pain occurs most frequently between the ages of 40 and 60,” says Douglas Brunner, M.D., medical director of Physical Medicine and Rehabilitation at Taylor Hospital. “As we get older, we experience wear and tear on our spines that results in back pain and back problems.”
In addition to age, other risk factors for back pain include obesity, smoking, physical inactivity and improper body mechanics. Medical conditions that can contribute to back pain include pregnancy, muscle spasm, joint inflammation, tendon tears, infection, cancer, osteoporosis, osteoarthritis and disc degeneration.
When should you see a doctor for back pain? Dr. Brunner advises that you seek medical attention if you have severe back pain that is unrelated to movement or is preventing you from sleeping at night, if you have had an injury to your back, if you have had a recent infection and are now having acute back pain, and for any back pain that doesn’t subside after a few days. “You should also contact your doctor if you are experiencing pain or numbness in your legs,” says Dr. Brunner. “This could be an indication of nerve damage and prompt medical attention could prevent further damage.”
The first thing your doctor will do is take your medical history to determine when your back pain started and the cause of the pain. He will also perform a physical exam to check for neurological problems and muscle weakness, and to locate the source of your pain.
The results of your physical exam will determine the next step. “If your doctor thinks your problem is a muscle spasm, he may suggest medication and physical therapy,” says Dr. Brunner. “If you are experiencing neurological symptoms, he will most likely order an x-ray or computed tomography (CT) scan of your back to look at your bones. He may also use magnetic resonance imaging (MRI) to look at your ligaments, tendons and blood vessels.”
Other important diagnostic tools are electromyography (EMG), which is used to detect nerve damage, and a bone scan, which is used to diagnose infection. “A bone scan lights up the area that is infected,” explains Dr. Brunner. “It can also be used to take a closer look at any fractures that show up on an x-ray.”
Treatment for back pain often begins with pain control. “This is usually accomplished with nonsteroidal anti-inflammatory agents but narcotics or antispasmodics may also be prescribed for acute pain,” says Dr. Brunner.
Additional options for pain management include epidural block injections and facet block injections. “An epidural block injects steroid into the sac that lines the spinal cord and the nerve root,” explains Dr. Brunner. “It helps decrease inflammation and alleviate nerve pain. A facet block injects steroid into the facet joints that connect the vertebrae to alleviate joint pain.”
Acupuncture is a form of alternative medicine that is also used to relieve back pain. Very thin needles are placed just under the skin in certain areas of the body to help restore the body’s natural flow of energy and stimulate the release of endorphins, which help relieve pain.
Pain management is only part of the approach to treatment for back pain. It is often used in conjunction with physical therapy to rehabilitate the back. “The goal of physical therapy is to restore the back to its pre-injury function,” explains Scott Law, supervisor of Outpatient Therapy at Taylor-Made Physical Therapy.
Participation in physical therapy begins with a referral from your physician. On your first visit, the therapist will perform a complete physical evaluation to confirm your diagnosis and determine your range of motion. Your treatment will include an exercise plan designed to strengthen your muscles as well as lessons on proper body mechanics, such as the correct posture for sitting, standing and lifting.
“The most important rule of proper body mechanics is this: Never bend, lift and twist in combination,” says Law. “This is the number one mechanism injury to the back. To avoid twisting, do a step-turn instead.”
The duration of your physical therapy regimen will be based on your individual needs. “We usually see patients two times a week for three or four weeks, but sometimes we can help patients in a single visit,” says Law. “The most important thing is to get help. If you take care of your back, your back will take care of you.”