Strategies for low back pain

Low back pain is one of the most common problems in the U.S. As a matter of fact, more than 80 percent of Americans experience at least one episode of low back pain (LBP) in their lifetimes. Usually this pain is not serious and goes away on its own.

Most people experience “nonspecific LBP,” which means there is not a specific spine problem causing the pain. Rarely is back pain caused by a potentially serious condition.

In some situations, people experiencing LBP should be managed by their primary care provider, such as a family physician, internist, nurse practitioner or physician assistant. However, those with low back pain should call their primary care provider immediately if any of the following apply:

• Weakness in one or both legs or problems with bladder, bowel, or sexual function;
• Pain accompanied by unexplained fever or weight loss;
• New back pain occurring in an individual age 70 or older;
• The pain is the result of a fall or an accident, especially if you are age 50 or older;
• Pain that radiates into the leg, especially when accompanied by weakness;
• If you have been diagnosed or treated for cancer, weakened immunity or osteoporosis;
• If you have used corticosteroids for a prolonged period; or
• If the pain does not improve within four weeks.

Factors that increase your risk for LBP include being older; being female; physically strenuous work and/or sedentary work. Additional risk factors include smoking, obesity, job dissatisfaction and high levels of anxiety. Unless LBP is caused by a serious medical condition, a rapid recovery is expected, even in cases of a herniated disc. Care during an acute episode should include:

• Stay active. Staying active will not delay your recovery or cause further injury. Moving can prevent loss of muscle strength and spasms. High-impact activities should be avoided during acute episodes, but light exercise and day-to-day activities can be continued. Avoid prolonged sitting or standing, heavy lifting, and twisting.
• Use heat. A heating pad can help relieve LBP during the first few weeks.
• Use over-the-counter pain medications. Try medications such as aspirin, acetaminophen, ibuprofen, or naproxen. These are usually more effective if you take them regularly for the first three to five days, instead of only using them when the pain cannot be tolerated.
• Exercise. After the first few days, exercise, such as walking, swimming, stationary bicycle, or low-impact aerobics, can increase flexibility and strengthen your core muscles. While this may temporarily increase your pain, often it will reduce the duration of pain and prevent recurrent episodes, especially if you continue the program indefinitely. You should avoid activities that involve twisting and bending or that are high impact.
• Physical therapy. If you continue to have LBP for more than four to six weeks, your healthcare provider may refer you to physical therapy to evaluate and develop a formal treatment program.
• Steroid injections. In some cases, your healthcare provider may refer you to a specialist for evaluation for epidural steroid injections. These can reduce swelling and inflammation, and thereby reduce pain. King’s Daughters physical medicine/rehabilitation specialists, anesthesiologists, and interventional radiologists can provide these services.
• Other therapies. Some people with LBP find benefit in acupuncture or massage. Yoga, as well as other restorative exercise programs, can also sometimes provide relief.

You can prevent future episodes of low back pain by staying active and performing exercises such as walking and yoga to stretch your back. Exercises that strengthen the muscles of the hip and abdomen are important in supporting the lower back and preventing pain. Learning proper bending and lifting techniques will also help to avoid future LBP. Finally, if you sit or stand in the same position for long periods of time you should change positions frequently or take short breaks.