Healthy Perspective by Chris Fissel


Low Back Pain: Rest or Work Through It?

Eight out of ten people will experience back pain at some point in their lives.  Though the pain can be severe, most causes of low back pain are not serious.  Symptoms may vary from pain in the back and buttocks, to signs of nerve irritation with pain, numbness or tingling into the leg(s) and toes.  Common risk factors include a sedentary lifestyle with prolonged sitting, general poor fitness and improper lifting techniques.  Symptoms can be exacerbated by stress and poor sleep.  Age-related changes of muscle weakness and joint stiffness can also increase the incidence.

Evidence suggests that early intervention is beneficial in preventing chronic pain, but not all back pain should be treated the same.  Treatments/interventions that focus on exercise and an active lifestyle lead to more rapid recovery and decrease that chance of recurrence.  Generally, bed rest should be avoided.

The best treatment for acute onset may be manual therapy (mobilization/manipulation) by your healthcare professional, or exercises that restore motion and decrease pain.  Additional exercises for strength, stability and endurance are helpful once the acute pain has subsided.  Moderate to high intensity and progressive exercises that focus on fitness and endurance are helpful in managing chronic pain.

Our society is programmed to expect, if not demand, imaging studies.  MRIs and the like have frequent false positive findings or overall negative results; they are often not truly meaningful in identifying the anatomic cause of your pain, and they are not cheap!  Example:  42 year old female homemaker with back pain has an MRI that shows mild degenerative disc disease, mild arthritis, two bulging lumbar discs and a cyst on the thecal sac.  Wow! That's a lot wrong!  Any, all or none of those things may be the source of her pain.  A thorough examination by a healthcare professional proficient in musculoskeletal disorders would be more appropriate than delaying care and waiting for xrays and MRI results.   Special tests are indicated in the event of trauma, ie Xrays to rule out fracture, and with progressive neurological deficits (numbness, weakness of the legs), ie MRI to identify large herniation, mass or stenosis (bony overgrowth).  Additional "red flags" requiring immediate medical assistance include recent infection, fever, constant/unchanging pain with sleep disturbance, urine retention, bowel incontinence, numbness in a saddle distribution, drop/dragging foot.

Bottom line: stay active.  And discuss your symptoms with your healthcare professional.  I'm happy to assist in your quest to be well!

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