Back pain is a problem people often take care of themselves, but it is still one of the top three reasons why people visit doctors. For most of the athletes, back pain is not a disease it is more a part of a normal experience since we have walked on two legs. Spinal structures such as bones, ligaments, discs, joints, and nerves interacted in many marvelous ways to support us to do a million things we do with our backs. But, occasionally this backfires us what we call mechanical back pain. The severity of the pain which can be extreme but always reflect the seriousness of the underlying problem and the vast majority gets better by itself without the medical intervention. On the other hand, we know that when it does get better, 30% have a recurrence in 6 months and 40% within a year. If this sounds familiar it may be helpful to stop seeing your recurrent back pain is a discrete event and more as a chronic vulnerability. Create a back resilience plan, make small changes and focus on basics like getting quality sleep.
Back Dominant Pain
Most commonly this pain radiated down the back, to our butt, and or around the hips. Some patients just have pain in the back and others can sometimes feel the pain all the way down the leg. But it is a back pain that is dominant. Most of these patients get relief or aggravation of pain with particular movements or positions for example when they arch backward or bend forwards. Typically this kind of back pain comes and goes, or comes in spasms as you move. In fact, back dominant pain is a good pain because there is no damage to the nerves or spinal cord. No surgery is needed.
Leg Dominant Pain
There are two common presentations when it comes to dominant leg pain. The first one typically comes from a disc problem that puts pressure on the nerves in your back, and it travels down the legs. This is often referred to as sciatica. When this nerve is compressed or irritated, we get pain down the leg anywhere from below the buttock to the foot. There may be a pain in the back as well, but this time the leg pain is dominant. It is a constant pain but tends to get better when we lie down. Sciatica often gets better by itself.
The second is a leg pain that predictably comes only when you stand or walk or run, and is relieved when you bend forward, especially when you sit. It can be described as heaviness in the leg when you walk. The medical term for this pain is called “neurogenic claudication”. It often happens to people over 60, and when this gets severe, it makes harder for your nerves to keep up with the activity.
Pain in the back in general especially if it is intermittent or short lasting is almost always benign. But, there are red flags:
A sudden change in your normal bowel or bladder control, numbness in the groin and rectal area which makes us think that something might be pressing on the spinal nerves there.
Second red flag wonders whether the infection is the source of your back pain. For example, if you have a sustained fever, if you are an IV drug user, if you have a weakened immune system or at high risk for urinary or other infections.
Risk For Fracture
The third red flag is about your risk for fracture in your back. So if your pain started with a big fall, or a car accident, or perhaps your bones are brittle because of osteoporosis.
That being said, should you have an X-ray, CT scan or MRI? Less than 5 in 100 people have a red flag. The problem with this is, in many cases, it turns out your outlook or your attitude. People tend to think that having “back disease” or back pain stops them from exercising, or every time they feel a twinge they feel they have an illness. Therefore, there are yellow flags.
Yellow flags are when somebody’s acute low back pain will become chronic.
- Belief that back pain is harmful or potentially severely disabling
- The fear and avoidance of activity or movement because of back pain
- low mood and isolation
- Passive versus active treatment – having strong expectations that passive rather than active treatments will help
Own the fact that is is not just the therapist that needs to do the work, you do too. Spinal manipulation, massage, acupuncture are considered active therapies. Some exercise strategies may be effective once your pain is reduced like Pilates or Yoga to improve your core and trunk strength. Complex problems rarely find a solution in one place. Sometimes people with back pain do have to rest, but people who do not move at all do worse. Motion is lotion.