Lower back pain can make us miserable. After the common cold, it is the top reason adults miss time from work. Lower back pain is also one of the primary reasons we visit our physicians or head to an emergency department. When it flares up, it affects every aspect of our daily routine.

“Pain in the lower back manifests itself in different ways, and can be caused by different problems,” said Richard Levenberg, M.D., an orthopedic/spine surgeon at Delaware County Memorial Hospital.

Lower back pain is often described by its sufferers as tenderness, pain, and stiffness in the back. Some sufferers feel a pain that radiates into the buttocks or even the legs. Standing up straight for a long period of time or walking can be difficult when the lower back is painful.

In most cases, lower back pain lasts anywhere from a few days to a few weeks. It can come on suddenly or develop and worsen over time. Lower back pain is called “acute” when it lasts less than four to six weeks. Pain of a longer duration is called “chronic.”

According to Leonard Hirsh, M.D., chief of the Division of Neurosurgery at Crozer-Chester Medical Center, “The good news about lower back pain is that, in most cases, the pain does not signify a life-threatening problem. In most cases, lower back pain will resolve on its own and is easily treatable.”

While that is good news, many people experiencing an episode of lower back pain are so uncomfortable, they are desperate for relief—and answers. Fortunately, the professionals of the Crozer-Keystone Human Motion Institute are available to offer the best of orthopedic care.

The lower back, also known as the lumbar spine, consists of five vertebrae. The vertebrae connect the upper spine to the pelvis. Between the vertebrae, disks serve as shock absorbers and cushions to protect the vertebrae. Nestled in the spine is the spinal cord. Surrounding muscles and ligaments provide strength, power, support, and stability. With this much going on in one area of the body, it’s not surprising that a lot can go wrong and cause pain.

“Lower back pain is generally caused by overuse, improper lifting, poor posture, and weakness in the muscles,” says Kris Creighton, administrative director of Rehabilitation Services at Taylor Hospital.

Pain in the lower back often “sneaks up” on a person. It can sometimes seem to originate from a specific event or injury. “Sometimes people will swear that all they did was bend over to pick up a paperclip off the floor, and their back ‘went out,’” says Paul Van Thuyne, administrative director of Rehabilitation Services at Crozer-Chester Medical Center.

Sometimes a slip or fall will bring on pain. Additionally, certain repetitive motions—such as cycling or frequently picking up small children—can bring on an episode of lower back pain. “Weekend athletes” who play sports and exert themselves suddenly after a week of decreased activity are prone to lower back injuries.

Preventing Back Pain

Working with a physical therapist can help you learn how to protect your back at work, when you sleep, while you do household chores, and while you participate in activities you enjoy.

“It is always a good idea to take measures to avoid lower back pain every day,” says Carol Seiverd, administrative director of Rehabilitation Services at Delaware County Memorial Hospital. “One basic way is to participate in exercise that improves general muscle tone and ‘core strength.’”

It is helpful to “warm up” before workouts or any work that you know will be hard on your back. Additionally, maintaining a healthy body weight goes a long way in preventing back pain.

Carla DeWald, administrative director of Rehabilitation Services at Springfield Hospital, says that proper body mechanics need to be emphasized to help prevent lower back pain and to promote healing. For example, when sitting, your knees should be slightly lower than your hips. Your feet should rest comfortably on the ground or on a footrest. A built-in lumbar roll in the seat back should support the normal inward curve of the lower back, or a towel can be rolled up and placed in the small of the back to serve the same purpose.

When lifting, keep the object to your body, bend with your knees and hips, and keep your back straight. Avoid lifting heavy objects higher than your waist. Never twist or jerk while lifting. Adds Creighton, “Knowing when to ask for help in lifting goes a long way in preventing lower back injury.”

Additionally, protect your lower back for the future by taking measures to avoid osteoporosis, which can cause back pain and fractures. Talk to your doctor about proper diet and exercise for bone health.

When Back Pain Strikes

People who are experiencing their first episode of lower back pain are generally advised to take anti-inflammatories (such as ibuprofen) and to rest. According to Creighton, moist heat or ice can be helpful for some. Long periods of rest are no longer recommended for back pain. If, after two days, anti-inflammatories and rest are not offering relief, then it is time to call a health care provider.

In some cases, the primary care physician will be the first to see the patient. In other cases, the patient will be referred to—or will opt to see—an orthopedic surgeon or neurosurgeon for an initial evaluation.

Patients who are seen for evaluation of lower back problems are evaluated in the same way. “When you visit a physician for lower back pain, you can expect to receive a physical examination, discuss your history, and possibly undergo diagnostic studies such as an MRI (magnetic resonance imaging) or X-ray,” Dr. Levenberg says. “Sometimes, CT (computer tomography) scanning is prescribed if the patient is claustrophobic or has a pacemaker. Bone scanning might also be useful, as it can help distinguish between older and newer fractures in the spine.”

Medical Conditions or Injuries That Can Cause Back Pain

While most common lower back pain is due to spasm or strain that will resolve itself, there are many medical conditions and injuries can result in lower back pain. These include: 

• Congenital spinal deformities
• Degenerative spinal conditions
• Fractures, dislocations and subluxations, including compression fracture
• Herniated disc lesions
• Soft tissue sprains, strains and contusions
• Spondylolysis and spondylolisthesis
• Systemic diseases affecting spinal function
• Traumatic and overuse injuries to the spine
• Whiplash injuries

 “A herniated disc, for example, causes pain that travels from the lower back and often into leg,” Dr. Levenberg says. “Many people describe this pain as ‘sciatica,’ which means that the sciatic nerve has been affected.” Many women who have been pregnant are familiar with “sciatica” pain.

Disc degeneration, in which discs become injured, becomes increasingly common as we age. Degeneration in the spine also can lead to spondylolisthesis, a condition characterized by the slippage of a vertebra in the spine. One vertebra slips forward over another, stretching or pinching the sciatic nerve and causing pain.

Non-surgical Treatments

Patients with more serious back injuries and problems that do not resolve in a short period of time often assume that their ailment means they will need surgery. However, there are many non-surgical treatments and modalities available to manage back injuries and keep pain under control.

Physical therapy is instrumental in facilitating recovery for lower back pain sufferers. Patients seen for physical therapy have a prescription from their physician that details their diagnosis, their origin of pain, and the projected outcome. Patients are generally seen for about one hour per visit, two to three times a week, often for a period up to six weeks. According to Van Thuyne, “We want you to manage on your own. The goal of therapy is to have the patient return to independent function, and learn how to manage symptoms with proper positioning and exercises.” After a course of physical therapy, the patient returns to their physician to see what the next step will be.

Additional non-surgical approaches to back pain are administered by physiatrists, who evaluate patients and oversee a lower back pain care plan, which can involve the use of narcotics management and acupuncture. Interventional pain management specialists are another option. These specialists perform a series of epidural steroid injections or other nerve blocks to relieve pain.

When Surgery Is Indicated

When surgery is necessary, there are a number of options available. According to Dr. Levenberg, the options available today get patients back on their feet much sooner than in the past.

Kyphoplasty, for example, is used to treat compression fractures, and offers a very short recovery time. Diskectomy is useful for treating a ruptured or herniated disk and is the most commonly performed surgical procedure for lower back pain with pain radiating into a leg. Laminectomy offers relief to those suffering from neural impingement, or a “pinched nerve.” Spinal fusion, in which two or more of the vertebrae are fused together with bone grafts and internal devices such as metal rods, helps those with serious lower back pain.

With newer procedures such as kyphoplasty, recovery and return to functioning is almost immediate. With more traditional back surgeries, the patient can spend anywhere from one to five nights in the hospital, depending on the diagnosis and surgery.

There are many new options on the horizon for back pain sufferers. These include biological disc regeneration and computer-assisted and image-guidance technologies and artificial discs. “The options continue to increase for those with lower back problems,” Dr. Hirsh says.

To find a Crozer-Keystone Human Motion Institute physician who’s right for you, call 1-800-CK-HEALTH (1-800-254-3258).