At any given time, a quarter of the United States population has suffered from lower back pain within the past three months. Lack of exercise, sedentary lifestyles, long-distance driving, and obesity have all contributed to make lower back pain one of the most common problems in modern society. It is the second most common reason people take a sick day behind only the common cold. The majority of lower back pain is not severe or long-lasting, but some lower back pains persist or recur. They decrease quality of life and may lead to disability.
Lower back pain can be roughly divided into three categories:
1. Non-specific lower back pain: Symptoms are localized in the waist region and aggravated by movement in the waist region.
2. Lumbar radiculopathy (herniated disc): Symptoms are numbness, tingling, pain, and/or weakness in the lower extremities. Bending, sneezing, and coughing make the symptoms worse. Most commonly occurs between the ages of forty and sixty.
3. Spinal stenosis (narrowing of spinal canal): Symptoms may include lower back, buttock, and lower extremity pain and weakness. Standing and walking makes the pain worse. Sitting alleviates the pain. Most commonly occurs after the age of sixty.
Lower back pain may be acute (pain lasts less than three months), chronic (pain lasts more than three months), or recurrent (acute symptoms recur after a period without pain).
Overuse often leads to lower back pain: too much bending, twisting, or lifting; soft tissue sprains or strains; improper body mechanics; or even too much sitting can cause symptoms. Very often, symptoms subside naturally while the cause and actual source of acute pain remain unknown.
Good Lifestyle Prevents Lower Back Pain
Prevention is better than cure. Instead of passively waiting for a problem to occur and then seeking treatment, we should promote health proactively.
Exercise provides great benefits to health. The United States Department of Health and Human Services recommends two and a half hours a week of medium-intensity exercises for adults. Exercise not only prevents lower back pain but also combats chronic diseases, manages body weight, boosts energy levels, increases muscle strength and definition, improves sleep, improves mood, strengthens bones, and is fun! Adequate exercise will increase the strength of the back and abdominal muscles, as well as the strength and flexibility of muscles in the lower extremities.
According to a Consumer Reports survey of fourteen thousand subscribers, Americans consider exercise the most effective self-help for lower back pain. The same survey showed that people who suffer from lower back pain are very satisfied with manual treatment provided by chiropractors, physical therapists, acupuncturists, and massage therapists. In fact, patients are more satisfied with manual treatment than medication for lower back pain.
Maintaining one’s ideal body weight may help prevent lower back pain. United States leads the world as the country with the highest body mass index (BMI), as approximately seventy percent of adults in America are overweight or obese. Increased body weight amplifies stress on the lumbar spine and accelerates aging of spinal joints and intervertebral discs. People who are overweight tend to have weak abdominal muscles and excessive lumbar lordosis (forward curvature in the lower back). They have higher risk for lower back and leg pains.
Smoking cessation is another key method to decrease the likelihood of suffering from lower back pain. Smoking is well-known for increasing the risks of many diseases and problems; it also accelerates aging of the intervertebral discs, leading to early pathologies and pains in the spine.
An ergonomic work environment prevents lower back pain. Seat height should be appropriate: feet flat on the ground, with knees slightly lower than the hips. There is less stress on the lumbar spine sitting in this position as opposed to sitting slouched, because of the neutral lordosis attained in a good sitting posture. Most couches are too low and seats are too deep. Try not to sit in the couch for too long. Sedentary workers should get up to walk every hour. Get out of the car to walk every hour during a long-distance drive.
Good body mechanics lower the risk of lower back sprains and strains. Before moving a heavy object, plan the move well and clear obstacles along the moving path. Divide a heavy load in half or get help. Bend at the knees and keep the upper body relatively vertical: use the strength of the legs instead of bending over to lift. Keep a heavy load close to your body, and avoid twisting while carrying it. Move your feet to change direction. If moving a long distance, use a cart. Push the cart, do not pull.
With a partner, rotate or flip your mattress every three to six months to prevent sagging. To reduce overnight stress on the lower back, put a pillow between your knees while sleeping on your side, and place the pillow below your knees while sleeping on your back. Talk to your physical therapist or physician if your back bothers you while sleeping, especially if you have other discomfort.
Individualized Physical Therapy Treatment Plan
Not all lower back pains are created equal. In recent years, studies in clinical prediction rules help physical therapists categorize patients into different treatment-based classifications. Physical therapists can individualize a patient’s treatment and exercise plan based on the patient’s symptoms and classification. The best treatment results can only be achieved by discovering the contributing factors of pain and treating accordingly.
In a typical physical therapy outpatient clinic, half of the patients are there for lower back pain. The most effective treatment options for lower back pain include patient education, manual therapy, and exercise. Modalities such as ice, heat, and electrotherapy may temporarily lessen symptoms, but will not resolve the problem.
It is important to educate patients with lower back pain that it is a very common condition and that most patients will get better soon. People with lower back pain should remain active. Bed rest should not be more than one day; otherwise core muscle strength will diminish significantly. Too much bed rest will also delay normal recovery. If you suffer from lower back pain for more than a few days or the pain gets worse, you should visit your physical therapist or physician.
The clinical guidelines shared by the American College of Physicians and the American Pain Society recommend spinal manipulation for both acute and chronic lower back pains. Physical therapists utilize mid-joint range, highvelocity, low-amplitude spinal manipulation. This is different from joint mobilization, or chiropractic adjustment. For patients who are in the “manipulation” treatment-based classification, spinal manipulation helps in both immediate and mid-term recovery.
Physical therapists utilize therapeutic exercises to help patients alleviate pain; improve muscle strength, flexibility, and endurance; and prevent recurrence. Specific exercises target core muscles. For recurrent lower back pain (i.e., patients who are in the “stabilization” treatment-based classification), specific exercises can effectively prevent symptom recurrence. Generalized exercises help strengthen back muscles, abdominal muscles, and lower extremity muscles, and also improve flexibility.
Studies show that lower back pain patients recover faster and spend less on overall medical care when they see physical therapists early. For lower back pain, physical therapy works better than medication, has fewer complications, and reduces the need for pain medication. Physical therapy patients also are less likely to need invasive, high-risk treatments like injection or surgery.
Prevention is better than cure.
Considering Spinal Surgery? Think Again!
In the past two decades, overuse of MRI and spinal fusion surgery has steadily increased in the United States. Lower back pain patients overuse MRI, undergo many spinal surgeries, and increase medical spending with no improvement in patient conditions. The United States has the highest rate of spinal surgery in the world. However, the most accurate predictor of whether a patient will have spinal surgery is not the cause or symptoms, but where the patient lives! If a spinal surgeon owns an MRI, the surgeon’s patients are thirty-four percent more likely to have spinal surgery! Although MRI reports often mention terms like degenerative disc disease, disc bulging, disc herniation, or spinal stenosis; most “findings” on the MRI are not the cause of patient’s symptoms, but rather false positives. In fact, the vast majority of lower back pain patients do not need X-ray, CAT scan, or MRI, unless care providers suspect their symptoms are caused by other diseases.
Although few lower back pain diagnoses may require surgery, among all lower back pain surgical patients, half reported problematic recovery including long and painful recovery, no improvement in pre-surgical symptoms, or worsening of symptoms. According to a study published in 2011, 27% of workers’ compensation patients who underwent surgery to treat lower back pain needed multiple operations, while 36% suffered significant complications (including a higher death rate), and 74% had not returned to work after two years.
For lower back pain, patients should try conservative treatments first. A physical therapist, chiropractor, or family doctor can rule out fracture, infection, cancer, or other diseases as the cause. Care providers will also make sure there are no complications that require surgery before they begin treatment. Only when conservative treatment options fail should patients consider surgery as a last resort. And remember: prevention, prevention, prevention!
Disclaimer: The information above is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician, physical therapist, or other qualified health provider prior to starting any new treatment.
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