A little pain in the back

Monday, April 7, 2008

A twinge here and an ache there, no big deal until the pain in the back really starts hurting. Ask Le Bron James of the Cleveland Cavaliers. For the past few weeks, his back has ached a little, but as a driven athlete he continued to play until most recently, enough spasm existed to prevent him from sitting during timeouts in a recent game.

Low back pain is one of the common complaints that will bring a patient to a doctor or chiropractor and most often, it is caused by irritation and inflammation of the muscles of the low back. Sometimes the cause can be pinpointed to a specific event like lifting or bending over, but often, the pain just happens and starts to get worse. So what to do?

Home care starts with a few of questions. Does the pain radiate into the buttock or down the leg? Is there change of sensation in the leg or foot? Is there weakness in the leg? Radiation, numbness and weakness may be signs that there is irritation of the sciatic nerve, which runs from the low back down the legs. Sciatica can be caused by a variety of reasons from disc problems to arthritis to muscle spasm.

But the two big questions to ask that make a huge difference in what happens: Have you lost control of your bowel and are you able to urinate? If the bowel and bladder function are affected, then the spinal cord may be at risk, a situation called cauda equine syndrome, where the last part of the cord is affected. This is a true neurosurgical emergency and one of the few indications for an emergency MRI of the back to look for cord problems. This is an uncommon problem, but one that all care providers consider when dealing with back pain patients.

If all the self check questions are negative, then it’s time for self treatment. Most recommendations include bed rest for 24 hours or less and then a return to activity as tolerated, reminding ourselves that everybody will be able to tolerate different levels of activity. It is not a competition. Add ice and heat to the back and an anti-inflammatory and most back pain will respond.

Unfortunately, part one: Those people with sciatica may need further evaluation and care. Plain x-rays aren’t useful unless there is a history of trauma or in the elderly when there might be consideration for compression fractures of the spine due to osteoporosis. MRI may be considered but only if the symptoms and the physical exam are consistent with sciatica and initial care plans fail. This is the time where pain medications and muscle relaxants may be offered as well as physical therapy or chiropractic care.

Unfortunately, part two: Once the first episode of pain is resolved, patients can expect recurrences unless they work hard at prevention. Exercises to strengthen core muscles and to increase flexibility may ward off the evils of back pain.

Unfortunately, part three: Low back pain tends to occur at inconvenient times, as if there is ever a good time to be hurt. The treatment plan needs to happen sooner than later. The time invested early in rehab will pay dividends long term. It’s easy to say but hard to do. Imagine telling the Cavaliers that their star, Le Bron, can’t make it for their playoff run.

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