Low back pain is one of the most common reasons why individuals go to their primary care physicians (PCP). Almost everyone will experience occasional low back pain, especially after strenuous activity. When the pain lingers, it can become debilitating and is one of the top reasons for missed work and decreased productivity in the workplace and at home.
Chronic lower back pain can be caused from a variety of sources. Low back pain can occur as a result of trauma (motor vehicle accident, fall, etc.), but often occurs without any specific incident. The patient may report performing repetitive movements, such as bending forward or twisting. Jobs that involve heavy lifting or whole-body vibration, such as truck drivers and sandblasters, are at higher risk. Other risk factors include age, pregnancy, stress, smoking, obesity and sedentary lifestyle. Medical conditions that may influence back pain include scoliosis, spinal stenosis or kyphosis, fibromyalgia and arthritis (both osteoarthritis and rheumatoid arthritis).
Symptoms can vary, depending on the mechanism of injury, but frequently, pain is reported with prolonged static positions, such as sitting or standing. Movement may be limited in one or more directions, or the patient may be able to move throughout the entire range, but changing direction may elicit pain. Most commonly, this occurs when the person straightens up after bending forward, or when standing up from a chair. The pain may be sharp, or described as an ache that may be one-sided or travel across the low back. With prolonged pain, it may even travel into the buttocks. If burning, numbness, or tingling occur, especially down the legs, then the patient may be experiencing radicular symptoms.
Common physician diagnoses include dorsalgia and lumbago. X-Rays may show degenerative joint disease (DJD), degenerative disc disease (DDD), or spondylosis, all of which are normal age-related processes. With a thorough evaluation, a physical therapist can determine the cause of the low back pain, without first seeing a PCP or a specialist. An MRI is not necessary and generally does not shed any further light on the condition.
Treatment involves many inter-related approaches. As most chronic low back pain started without a defining incident, the physical therapist will examine and address postures that provoke or increase the pain. In the clinic, manual therapy techniques, including soft tissue mobilization and joint mobilization, will help to restore normal movement patterns. Exercises will specifically address strength deficits, as well as motor control. Lifting techniques, proper sitting and standing postures will be assessed and modified as necessary. As our society has shifted to more work-at-home situations, workstations have become makeshift, and ergonomics are less than ideal. Low back pain can be resolved or significantly reduced, allowing for return to normal daily and recreational activities. Rarely, if ever, is surgery indicated for this condition.
Prolonged sitting is one of the common triggers for low back pain, especially for those who work at a computer. Sitting with hips and knees at a right angle, and feet flat on the floor, will keep the spine in a neutral position. For those whose feet cannot reach the floor without sitting on the edge of the chair, placing the feet on a book or stool will help. Also, take frequent breaks to stand up and move around. Standing without the knees locked out will reduce the compression through the joints. When lifting heavy items, use the legs and not the back and arms and avoid lifting and twisting at the same time. Ice or heat can reduce the pain and muscle guarding, if it does occur.