Few conditions can compete with back pain when it comes to prevalence. As one of the most common reasons for visiting a doctor, about 25% of Americans have dealt with low back pain in just the past three months, and up to 80% of the population will encounter it at least once in their lives. This, unfortunately, means that if you've never had a bout of back pain, there's a strong chance that you will at some point in the future.
But you don't need to worry. If you're dealing with back pain now or it strikes down the road, you can take solace in knowing that most cases will eventually improve without the need for any drastic measures. Read on for a closer look at low back pain through a series of frequently asked questions about what usually causes back pain, why the cause is not usually very important, and what you should do if you're affected by it.
Q: What conditions can cause my lower back pain?
A: The list of conditions that can lead to low back pain is extensive, but some of the most common causes include sprains and strains, spinal stenosis, a herniated disc, joint issues, and degenerative disc disease. To understand how these conditions affect the spine and surrounding structures, we first need to give a quick anatomy lesson.
The spine consists of 33 bones called vertebrae, which are stacked on top of one another and interlocked to form the spinal column. The vertebrae are connected by small joints that allow the spine to move in various directions, and in between each vertebra is a structure called an intervertebral disc. These discs consist of a tough exterior and are filled with a jelly-like substance, and their purpose is to absorb shock and prevent the vertebrae bones from rubbing against each another.
- Sprains and strains: sprains involve ligaments and strains involve muscles; both are injuries that result from these structures being pushed beyond their limits, either from a single incident or due to repeated stress over time
- Spinal stenosis: a condition in which the spinal canal narrows, which puts pressure on the spinal cord; it usually occurs later in life
- Joint dysfunction: a term used to describe when any of the joints of the spine - including the facet joints or sacroiliac joint - are not working properly
- Herniated disc: a condition in which the softer jelly-like substance of the intervertebral disc pushes out through a crack in the tough exterior ring; a "bulging disc" means that the inner layer has protruded outwards, but the outer layer remains intact
- Degenerative disc disease: an age-related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to disc herniation and other problems
Q: Is it essential to identify what's causing my lower back pain?
A: In most cases, no. While it's good general knowledge to be aware of these common causes of low back pain, the truth is that getting an accurate diagnosis is usually less important than you might think, especially when the pain is not chronic. For starters, because the anatomy and mechanics of the spine are so complex, only about 20% of patients with back pain actually end up receiving a specific diagnosis. In addition, most cases of low back pain are managed with a fairly similar set of treatments, regardless of what condition is believed to be responsible. This is because low back pain is typically approached based on the symptoms present rather than the exact malfunction of the spine.
But there are certain situations when obtaining an accurate diagnosis may be necessary. The biggest concern is that a more dangerous condition or disease is causing low back pain, and if so, it may require immediate treatment. These are generally the same indications that warrant a diagnostic test like an MRI for low back pain (discussed next) and include severe neurological symptoms and other red flags that could suggest an infection, spinal fracture, cancer, or a condition called cauda equina syndrome. These problems only account for a very small percentage of low back pain cases and are unlikely to be responsible, but your healthcare provider will remain aware of the risk for them nonetheless.
Q: Do I need to get an MRI right away?
A: Probably not. As we described above, MRIs are only recommended in rare cases when there is suspicion of a potentially dangerous diagnosis. In the absence of any of these red flags, an MRI will not do much good, and can actually lead to unnecessary treatments that may not address the pain. The reason is that "abnormal" findings from MRIs and CT are extremely common, as one study found that 80% of 50-year-olds and 96% of 80-years-olds with no back pain symptoms had signs of disc degeneration on their imaging tests. This shows that the imaging test usually does not reveal the source of the pain, which means that repairing a herniated disc may not truly fix the problem.
Q: What if I have a herniated disc?
A: Understand that many other people have the same condition, and as we've just explained, and it may not be responsible for pain. And if you do have low back pain and a herniated disc, that still doesn't guarantee that it's the cause of your symptoms. Plus, most herniated discs eventually regress - or heal - on their own when surgery is not performed. This is why the best thing to do is to address the pain through treatments like physical therapy while avoiding surgery.
Q: What should I do after I experience low back pain?
A: First off, don't panic! The prognosis for low back pain is good, and most cases will eventually get better regardless of what's done to address it. But there are certain steps you can take to increase the chances of making your pain subside, such as:
- Stay physically active and avoid too much bed rest
- Try returning to normal activities as soon as possible
- For persisting pain, try nonsteroidal anti-inflammatory drugs
- Avoid opioids under most circumstances, as these drugs are frequently associated with misuse, abuse, and dependence
- Consider seeing a physical therapist to get started on treatment early, which weâll discuss in more depth later
Q: Should I see a physical therapist?
A: Absolutely! We can't be any clearer about this one. Physical therapy addresses the symptoms of low back pain right away and is one of the safest and most effective options to reduce pain and help patients regain their function. Read our last post of this series for a closer look into physical therapy.