NY Spine Medicine

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Effective Back Pain Treatment


Back pain results when the spine is stressed by injury, poor posture, disease, wear and tear, or poor body mechanics. Most people will suffer from back pain at some point in their life. In fact, back pain is one of the most common reasons people seek out the advice of a physician. More than 90% of Americans have back pain at some point and back pain is the leading cause of disability in people under the age of 45. You play an important role in the prevention and healing process of back pain. Strong, flexible muscles help to promote a healthy back that maintains good alignment, allows movement, and provides structural support.

Types of Back Pain

Back pain ranges from mild to severe, and is classified as either acute or chronic.

Acute low back pain often relates to soft tissue injury (e.g., sprains of muscles, tendons, or ligaments) or disc herniation. Acute pain occurs suddenly and usually heals within several days to weeks. Its severity relates directly to the extent of tissue injury and resolves over time. It is often called acute mechanical back pain, because the source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues.

Chronic back pain lasts more than three months and its source may be hard to determine. Chronic pain may be present all the time, or worsen with certain activities, poor posture, and improper body mechanics. Other contributing factors may be related to nerve cell changes, tissue scarring, arthritic changes, or psychological effects of chronic pain. In some cases, the complexity of chronic symptoms requires consultation with pain management specialists.

What Are the Symptoms?

Signs and symptoms of back pain may include stiffness, tightness, aching, pressure, tingling, or burning, stabbing or shooting pains. Most people experience pain primarily in their low back area. The pain may spread to the buttocks, thighs, or knees. Many people may also experience muscle spasms. The symptoms are generally more noticeable when bending or arching the back, when lifting heavy objects, or when sitting or standing for long periods of time.

If you experience extreme leg weakness or difficulty controlling bladder or bowel function, you should seek medical help immediately.

What Are the Causes?

Back pain can result from injury, poor posture, stress, natural wear, disease, and other sources. Poor spinal alignment (e.g., slouching, sleeping on the stomach) and improper movement (e.g., poor lifting technique) stress the spine and make injuries more likely. Back pain can result from:

  • Injury or trauma: A significant force such as a sports injury or fall can stress the structures of the spine, resulting in a fracture, such as a vertebral compression fractures. A tear in the muscles and ligaments of the back may predispose the discs to bulge or herniate.
  • Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
  • Pinched nerve: When a spinal nerve is compressed, pain may run down your leg into your feet, called radiculopathy.
  • Osteoarthritis (degenerative disc disease): As discs naturally wear out, bone spurs form and the facet joints become inflamed. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.
  • Stenosis: Narrowing of the spinal canal occurs as discs bulge or protrude, facet joints enlarge, and ligaments stiffen over time. As the spinal canal narrows, it compresses the cord and nerves, causing them to swell and inflame.
  • Spondylolysis: A weakness or stress fracture develops in one of the bony bridges that connect the upper and lower facet joints.
  • Spondylolisthesis: A weakness in the muscles and ligaments predisposes the vertebra to slip out of normal position.
Fewer than 1% of people who suffer acute low back pain have a serious cause, such as cancer, infection, or cauda equina syndrome.

What Treatments are Available?

In developing a treatment plan, your NY Spine Medicine physician will assess the type of disease or condition you have and its impact. A team approach for the treatment of back problems is often the most effective. Medical treatments include surgical or nonsurgical care and self-care strategies. The goal is to restore function and prevent re-injury.

Self Care: We believe that most back pain resolves with self-care measures such as rest, ice or heat, massage, over-the-counter pain relievers, or gentle stretches. Applying ice and then heat is helpful to relax the muscles and decrease muscle inflammation. We generally recommend that you apply an ice pack for 20 minutes several times a day during the first 48 hours. A warm shower or a heating pad on the low setting may help relax tight muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If home treatments aren't working within the first couple of days, it is time to see one of our physicians.

Medications: We may prescribe nonsteroidal anti-inflammatory drugs (NSAID) like ibuprofen or naproxen to reduce inflammation and relieve pain. If you have spasms, a muscle relaxant may be prescribed for 3 to 4 days. If the pain is severe, an analgesic that can be taken with the NSAID or muscle relaxant may be prescribed.

Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally in a tapering dosage over a five-day period or as an injection directly into the source of pain, such as an epidural steroid injection or facet injection. Steroids may provide almost immediate pain relief within 24-hours.

Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Our professional physical therapists will instruct you on proper lifting and walking techniques, and they'll work with you to strengthen and stretch your lower back, leg, and stomach muscles. Stretching and strengthening exercises are key elements to your treatment and should become part of your life-long daily routine. Massage, ultrasound, diathermy, heat, and traction may also be recommended for short periods of time.

Surgery: We believe that surgery should only be used after exhausting conservative treatment options. Before major "open back" surgery, we have many minimally invasive procedures that should be tried prior to making a decision to have surgery.

Recovery and Prevention

Most people with acute low back pain respond rapidly to treatment. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, it is in the patient's best interest to return to some kind of modified (light or restricted) duty. Your health care provider can give prescriptions for such activity for limited periods of time.

Recurrences of back pain are common. The key to avoiding recurrence is prevention:

  • Proper lifting techniques
  • Good posture during sitting, standing, moving, and sleeping
  • Appropriate exercise program
  • An ergonomic work area
  • Healthy weight and lean body mass
  • A positive attitude and relaxation techniques (e.g., stress management)
  • No smoking
Healthy supporting muscles can help keep your spine in proper alignment, promote healing after injury, and relieve chronic symptoms. Strong, flexible muscles maintain good spine alignment, allow movement, and provide structural support. When back pain does occur, there are many options to aid in its diagnosis and treatment for each individual's needs.