LOW BACK PAIN

Unfortunatelly pain in the low back is perceived as something trivial and can
be mistakenly dismissed as a self limiting conditions by patients and doctors
alike.

LOW BACK PAIN (LBP) is a pain felt in the lower area of the spine. The pain
in the lumbar spine can have multiple anatomical location. Pain from hip or pelvis
as well is from thoracic spine can project to the area of lumbar vertebrae and is
perceived as pain in the low back.

SYMPTOMS
Symptoms will be dependent on which structures are irritated. Usually pain in
the low back which changes location is functional in origin.
Low back pain with radiation into the leg, burning sensation ,numbness and
tingling should always be taken very seriously and requires immediate medical
attention.

CAUSES
Low back pain can be caused by structural pathology such as: herniated or
protruded disc, arthritis of the lumbar joints. It can also be caused by pinched nerve
within or around the structures of spinal canal or spinal foramens. It could also be
functional such as muscular or ligsmentous pain.
- poor posture
- developmental aberrations
- muscular or ligamentous strain
- poor motor control of the lumbar spine
- poor function of the lumbopelvic-hip complex

- trauma
- bulging or herniated disc
- sacroiliac joint restriction or hypermobility
- poor function of the core (deep spinal stability mechanisms)
- poor breathing mechanism
CHRONIC LBP
Chronic LBP is usual a result of combination of following factors:

Poor, inadequate and untimely treatment, poor beliefs, poor copping

strategies, overuse of structural diagnosis as well as emotional stress.

DIAGNOSIS
Diagnosis of LBP is almost always clinical with exception of very severe pain
with numbness, tingling, radiation and loss of strength.

DIFFERENTIAL DIAGNOSIS
Rarely low back pain can arise from structures inside the viscera (organs), however
dysfunction of motility of visceral organs as well as breathing can be an important
causative factor in LBP. Most often differential diagnosis requires the differentiation
of anatomical areas below or above the lowback as well as carefully examination of
the whole locomotor system.
TREATMENT OF LOW BACK PAIN

Since low back pain is so multifactorial individual approach is paramount.

The successful treatment of low back pain is one that addresses the cause
rather then the symptoms. In order to attack the cause two factors must be identified:
1) movement dysfunction;

2) pain generator- structure irritated during specific movement (ligament,

muscle, joint, nerve,disc and etc...) Since multiple structures can refer pain to low
back, primary load transfer failure must be identified. The spinal stability system has
to be addressed from perspective of dynamic stability rather then the core strength.
At NYDN we provide very individual and comprehensive approach based on our
meticulous examination skills and most integrative treatment . We combine most
advanced scientifically proven low back treatment methods such as:
DNS (dynamic neuromuscular stabilization), ISM (integrated system model
approach), clinical Pilates, structural integration, postural retraining, myofascial
release and acupuncture just to name a few.

Low Back Pain: Causes, Symptoms, Diagnosis and Treatment

What is Low Back Pain?

Lower back pain is a condition that affects all human beings at one point of their
lives. It mainly occurs in the lumbar region, which is the area below the ribcage. The
discomfort associated with this medical condition is often intense. It may end on its
own, or may require specialized treatment, more so if it persists.

What Causes of Low Back Pain?

This condition is usually caused by various conditions. Problems occurring in the
spinal nerves, muscles, discs, tendons and bones often result in lower back pain.
The condition may be caused by the irritation of large nerve roots, which run from the
back down to the legs. Smaller nerves, which are spread throughout the lumbar
region may sometimes get overworked, thus causing intense pain in the region.

Whenever muscles that are located on the lower back get strained during intense
activities, you are likely to experience pain. In rare cases, damage to the joints and
ligaments, or the regeneration of the intervertebral disc causes slight pains in the
lower back region.
Every so often, the occurrence of the condition depends with age. Younger adults
aged between 30 to 50 years have a higher chance of experiencing the condition
due to the degeneration of the intervertebral disc, or from back muscle strains.
Those who are 60 years and above often experience discomfort due to the
degeneration of the joints, or from compression fractures. This occurs due to their
advanced age. Over-activity has been proven to be a major cause of this medical
condition. When you overwork yourself, your muscles tend to get sore. This results
from overstretched or injured ligament fibers.
Spinal Stenosis is another major cause of low back pain. This condition comes about
when space that surrounds the spinal cord gets smaller. This exerts excess pressure
on the spinal nerves and the cord itself. In the event that the intervertebral discs
collapse, osteoarthritis often starts developing. When this occurs, the human body
responds by allowing a new born to grow in the facet joints to offer extra support to
the vertebrae. This bone causes discomfort with time, which explains why you might
start experiencing low back pain.

What is Low Back Pain Symptoms?

Most patients report varying symptoms. The intensity of the pain experienced also
differs from one patient to another. Some patients complain about a piercing,
stabbing sensation while others experience a dull cramp. This variation is influenced
by the causal factor of the back pain. Generally, individuals who are affected by this
disorder complain about back pains, which worsen whenever they bend or lift up
objects. These activities strain muscles fund on the back.
There are some who complain about a sharp discomfort, more so when they sit
down. Standing or walking for prolonged periods worsens the pain in some cases.
Normally, the soreness may recede or disappear altogether, only to return a few
days later. The pain is often experienced on the lumbar region but may extend to the
buttocks. Sometimes, there is numbness or tingling sensations.

Diagnosis
The first step that physicians take when diagnosing low back pain is discussing the
symptoms with patients. Thereafter, they evaluate a patients medical history before
the back is examined. The examination process involves massaging the back to

pinpoint areas where the pain is more intense. In severe cases, physicians often
measure the level of nerve function in the leg region. This may involve testing
reflexes, more so at the knees and ankles. A patients level of reflex greatly
determines the extent to which he or she is affected by the condition.
Low back pain is sometimes diagnosed by imaging tests. X-ray imaging, magnetic
resonance imaging, computerized axial topography scans, bone scans and bone
density scans can be used to diagnose the condition. X-ray imaging is used to
determine whether the cause of back pains is broken bones or any bone deformity.
Magnetic resonance imaging is used to highlight the condition of intricate muscle and
nerve tissues. It establishes the presence of medical conditions like herniated disks,
or tissue infection.
CAT scans come in handy in the event that a physician thinks you have a bone
disorder. Bone scans are recommended if your physician needs to have a better
understanding of the bone structure in your lower back region. Data garnered from
the scan will tell the exact cause of the discomfort that you are experiencing. Bone
scans are also used to pinpoint the presence of bone cancer, which sometimes
causes lower back pain.

Treatment Options
The main challenge that faces physicians is how to treat low back pain in an effective
manner. The intervention used on each individual case greatly depends on his or her
medical history, and the severity of the condition. In as much as lower back pain is a
largely self-remedying condition, there is need for medical intervention if the pain
recurs. The treatment offered may either be surgical or nonsurgical.
1. Surgical Treatment
This intervention is often considered after the failure of nonsurgical interventions.
The latter should be tried for at least six months before surgical treatment is
considered. Besides this, surgery ought to be an option only after the exact source of
pain has been pinpointed. There are several surgical procedures used in the
treatment of lower back pain. These include spinal fusion and disk replacement.
Spinal fusion involves fusing together the vertebrae to enhance healing. Movements
between segments of the vertebrae is painful. Fusing the components together
eliminates such movements, and the pain that comes along. The procedure is used
on patients who have extensive degeneration of the disks. Spinal fusion has been
proven to be quite effective in the elimination of lower back pain.

Disk replacement is a surgical intervention, which entails the removal of the disk so
that it can be replaced by an artificial one. This procedure is often carried out to
maintain flexibility and restore normal motion, which is usually hampered by back
pain. Disk replacement is carried out through the abdomen.
2. Nonsurgical Treatment
This involves the use of therapies to alleviate pain. Medications have been offered
for years to relieve back pain. Anti-inflammatory medications such as brufen can
eliminate pain and inflammation. Aspirin, codeine and steroids have similarly been
used successfully to treat the condition. However, the three medications have
different side effects.
Owing to the fact that severe back pain is incapacitating, a combination of medical
and therapeutic interventions is preferred. Physical therapy, which entails the use of
inactive modalities such as massages, electric simulations and ultrasound, is often
combined with exercises to increase lower back strength. Chiropractic therapy,
traction and the use of braces have all been found to have the ability of substantially
reducing lower back pain.

Prevention of Lower Back Pain

It is quite difficult to prevent lower back pain due to the typical wear and tear that
occurs on the back. Certain practices can however be used to minimize the
occurrence of the condition. Regular exercises, including swimming and jogging
keep back muscles strong and agile. This makes them more resistance to wear and
tear. Another effective way of preventing back pain is lifting items using the legs as
the center of support, not the back. When picking heavy items, avoid bending your
back. Maintaining a manageable body weight also goes a long way in preventing
lower back pain. Standing and sitting using the right posture is helpful too.
Most people tend to ignore discomfort in the lower back region because they think
the condition is not serious. With time however, it might cause further problems. You
need to understand where is low back pain mostly occurs so that you can seek
medical attention promptly. Living a healthy lifestyle, and avoiding strenuous
activities helps avert back inflammation. You also need to consult your physician
regularly so that conditions, which cause low-back pain can be detected early.

Acupuncture May Help Reduce Low Back Pain

Low back pain has become a major global health concern with nearly 70% of the
industrialized worlds population afflicted. The lack of adequate treatment for this
chronic pain has caused severe comfort of life problems among the millions of
individuals who combat it day and night. While physical therapy and pain
medications are the standard care for most patients, many seek alternative
treatments to either augment or entirely supplant the usual care methods. One such
treatment is acupuncture, an ancient Chinese practice using thin needles to release
pressure points on the body. Acupuncture for pain management has increased lately
in popularity because of the lack of options patients face when combating the day to
day struggle of a sometimes debilitating pain.
Like most non-Western approaches to medicine, the academic community has
relatively little to say about acupunctures effectiveness. However, a recent study by
the Centre for Health, Activity and Rehabilitation at the University of Otago examines
the effectiveness of acupuncture for the treatment of low back pain and reveals that
the practice may be useful in relieving pain and increasing functionality when used in
addition to physical therapy. The study, a survey of sixteen unique clinical trials,
reveals that even in a scientific study, there are no clear cut answers that prove or
disprove the effectiveness of acupuncture for low back pain.
Often, these studies do little to separate acupuncture from the stigma that it is
unscientific, but this overview reveals that some trials that have treated the practice
as medicine and studied its effects in the same manner as more mainstream low
back pain treatments. Ultimately, an open-mindedness of the medical community to
study alternative treatment will be the key to understanding more about pain
treatment, which can only bring positive results to the millions of individuals afflicted
by this debilitating pain. Cultural bias or fear of the unknown should not deter
scientific progress, a role which the public plays just as strong of a role to be willing
to explore new treatments. However, the public cannot put its trust in new methods

of treatment unless their physicians can speak to the benefits and shortcomings of
each method knowledgably.
There are several conclusions we can make about acupuncture based on these
trials. Though no study supports a recommendation of only acupuncture for low back
pain, the use of acupuncture as an addition to a more standard pain management
plan is either tolerated as not harmful or, in some cases, is encouraged due to
positive results. There were many instances in which patients using true acupuncture
versus those who were administered a kind of placebo (i.e. no penetration of the
needles, incorrect points on the body) experienced very positive results while the
placebo groups reported nothing. Though there were some cases that contradicted
this, a general statement about the use of acupuncture for low back pain is that it can
be helpful if used in addition to physical therapy but should not fully replace a more
standard pain management program.
Ultimately acupuncture is a personal choice for individuals open to exploring
alternative possibilities to treating pain. According to the most modern science on the
practice, patients may feel relief in the short term after acupuncture treatment- many
have reported comfort and less pain. However, the disappointment that accompanies
another failed pain treatment method may be too frustrating. Both instances have
occurred as evidenced in these trials. It seems that currently, pain relief is far too
personal for the scientific process to make a definitive statement on this particular
method, which may a comfort more personal than a study can explain. Ultimately,
what the recent study reveals is that there has not been enough clinical examination
of acupuncture for low back pain. While the medical communitys support remains
with the standard method of low back pain treatments, management of pain
medication and physical therapy, there is an ever-growing community of individuals
exploring new methods of treating their pain. In the case of acupuncture the new
treatment is an ancient practice with a history rooted deeply in Chinese culture.
Perhaps a little more relief can be found through acupuncture, time will tell if it should
be a part of the long-term plan.
https://nydnrehab.com/what-we-treat/back-pain-and-neck-pain/low-back-pain/