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Julie Gawith

Responding to Back Pain

November 9, 2016

You are out doing yard work or playing a sport and suddenly your lower back begins to act up.  Maybe, one morning you wake up and get out of bed and suddenly a pain shoots down your back and into your legs.   As you grimace in pain, a sense of dread and uncertainty fill your mind. Back pain is among the top two reasons that people go to the doctor and accounts for around 40% of days missed at work.

   To effectively confront lower back pain, it is essential to understand and recognize the types of back pain, how to determine its seriousness, and how to most effectively deal with and treat it.  Although back pain often subsides and improves, around 30% of those affected will be plagued with it again in 6 months and 40% will have to deal with it again before a year passes.

   Within your back, numerous joints, ligaments, disks and nerves interact in order for you to move around effectively.  Occasionally, when these tissues do not work together as effectively as they should, you experience lower back pain known as mechanical back pain.  There are two main types of lower back pain: back dominant pain and leg dominant pain. 

  ~Back dominant pain. Pain can be felt moving down the back and into the hips and sometimes even the legs.  However, with this type of pain, the pain is predominantly centered in the lower back.  This pain, which will often show up sporadically, can be accompanied by spasms.  Arching your back or bending forward can instigate this pain or relieve it. 

  ~Leg dominant pain.  The first type of leg dominant lower back pain is where your nerves become irritated by pressure applied from malfunctioning discs and is often called sciatica.  Lying down often minimizes this type of pain.  The other type of leg dominant pain is known as neurogenic claudication and occurs when a person is standing, walking or running.  Heaviness of the legs is common with this type of pain that is caused by a shrinking volume within the spinal column.

   When evaluating your back pain, it is helpful to be aware of the presence of certain red flags or warning signs, before deciding what is the best method of action.  These red flags include the following:

1.Sudden changes in bowel or bladder control

2.Numbness in the groin or rectal vicinity

3.Signs of an infection

4.Risk of fracture from traumatic injury

5.Cancer symptoms

6.Inflammatory diseases 

   If any of these red flags are present, then imaging such as X-rays, MRI’s or CT scans may be necessary.  However, in the absence of these red flags, imaging may lead to you developing a paralyzing attitude towards your recovery process.  A study was conducted where 98 people with no back pain received MRIs.  The resulting images showed that two-thirds of them had disc abnormalities which were apparently not causing any issues.  The problem with imaging is that it can lead someone to view themselves as being worse off than they actually are and developing an illness mentality. 

   Certain ways of thinking by an individual can lead to a greater risk in developing chronic low back pain.  These attitudes include thinking back pain will cause permanent harm or disability, an unwillingness to move because of back pain, experiencing low mood or isolation, and adamantly believing that passive treatments (someone working on you) of back pain are better than active treatments (you actively participating in your care). Effectively dealing with and treating your back pain may involve you beginning to move more, spinal manipulation and massage, and thinking correctly about how to respond when your experience low back pain.  It is good to remember that about 90% of people experiencing acute low back pain recover from the pain.  Improving your posture, walking away from your desk for a while and implementing other small changes that increase movement throughout your day can all help you deal the right way with back pain and avoid a long-term slump.  People with chronic back pain may need to take a few additional steps in managing their pain long-term, but most show improvement after a few months if they have a resilience plan in place. This plan should include specific exercises to treat the pain and underlying causes of the issue. 
    Improving your movement, maintaining a positive attitude and having healthcare providers who assist in active therapy are essential components of effective low back pain management.  All of us at True Physical Therapy are here to assist you in your journey of triumph over low back pain. 

Source: Low Back Pain (Doc Mike Evans):

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