What is acute low back pain?
Acute low back pain (LBP) is defined as low back pain present for up to six weeks. It may be experienced as aching, burning, stabbing, sharp or dull, well-defined, or vague. The intensity may range from mild to severe and may fluctuate. The pain may radiate into one or both buttocks or even into the thigh/hip area.
Low back pain may begin following a strenuous activity or jarring trauma, but often is seemingly unrelated to a specific activity. The pain may begin suddenly or develop gradually.
Who experiences acute low back pain?
At least 80% of individuals experience a significant episode of LBP at some point in their lives. At any given point in time, at least 15% of individuals report that they are experiencing LBP. Some consider the symptom of LBP to be a part of the human experience.
What causes low back pain?
The exact source of acute LBP is often difficult to identify. In fact, there are numerous possible pain producers including muscles, soft connective tissue, ligaments, joint capsules and cartilage, and blood vessels. These tissues may be pulled, strained, stretched or sprained. Additionally, annular tears (small tears that occur in the outer layer of the intervertebral disc) can initiate severe pain. Even if the actual tissue damage is minor, and likely to repair quickly, the pain experienced may be quite severe.
No matter which tissue is initially irritated, a cascade of events occurs which contributes to the pain experience. Numerous chemical substances are released in response to tissue irritation. These substances “stimulate” the surrounding pain sensitive nerve fibers, resulting in the sensation of pain. Some of these chemicals trigger the process of inflammation, or swelling, which also contributes to pain. The chemicals associated with this inflammatory process feed back more signals which perpetuate the process of swelling. The inflammation attributable to this cycle of events may persist for days to weeks.
Muscular tension (spasm) in the surrounding tissues may occur resulting in a “trunk shift” (the body tilts to one side more than the other) due to muscular imbalance. Additionally, a relative inhibition or lack of the usual blood supply to the affected area may occur so that nutrients and oxygen are not optimally delivered and removal of irritating byproducts of inflammation is impaired.
How long will an episode of low back pain last?
The good news is that even if the exact source of pain is not determined, usually the acute pain subsides spontaneously over time. The originally irritated tissue heals. Fifty percent of episodes nearly completely resolve within two weeks, and 80% by six weeks.
Unfortunately, the duration and severity of a single episode cannot be predicted based on the onset, location of pain, or even the initial severity. Excruciating initial pain may resolve within several days, while moderate or mild symptoms may persist for weeks. However, up to 30% of individuals will experience recurrent pain or develop persistent pain in the future.
Is this pain dangerous?
The seriousness of LBP is relative. The symptoms of acute LBP is are usually benign and self limited. Even a ruptured disc has a chance of improving without surgery. Rarely, however, LBP is caused by a more serious process such as a fracture, infection or cancer.
This is more common in individuals over age 50, those with a history of cancer, those with severe pain at rest, with associated fever, with underlying medical problems such as diabetes, heavy alcohol or drug use, long time corticosteroid use, or osteoporosis. Pain in the legs, weakness, or difficulty with bowel or bladder control, warrant prompt medical evaluation.
How should acute LBP be managed?
Some of the best advice for treatment for acute LBP is to continue to remain active “as tolerated”. Continuing to perform everyday activities may seem counterintuitive, and the natural inclination may be to stay in bed or “freeze”, to guard and avoid activity. Yet, activity keeps blood and nutrients flowing to the affected area, inhibiting inflammation and reducing muscular tension. Many individuals with LBP find that they can perform their usual, but more controlled cardiovascular activities, such as walking, in spite of the pain and often feel better after the activity. More vigorous or uncontrolled activities such as weight lifting or competitive or contact sports are inadvisable while pain is severe.
Local application of heat or ice can temporarily reduce pain and heat may facilitate stretching, but does not necessarily speed long term recovery.
The multi-disciplinary Health Team at In Motion is ideally suited to help you manage your low back pain. The chiropractors at In Motion will perform a detailed history and physical examination to determine the specific pain generator in your condition. As specialists in manual therapy, Doctors of Chiropractic will provide you with a plan to get you out of pain, and stay that way. When appropriate you will be referred to the other members of the Health Team, providing you with an unmatched array of professional services under one roof. We will get you back In Motion, and help you stay that way.
Chronic Low Back Pain
Low back pain is considered to be chronic if it has been present for greater than three months. Chronic low back pain may originate from an injury, disease or stresses on different structures of the body. The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achy, burning, stabbing or tingling, sharp or dull, and well-defined or vague. The intensity may range from mild to severe.
Many times, the source of the pain is not known or cannot be specifically identified. In fact, in many instances, the condition or injury that triggered the pain may be completely healed and undetectable, but the pain may still continue to bother the patient. Nevertheless, even if the original cause of the pain is healed or unclear, the pain felt by the patient is real and the treating physician knows this.
Chronic low back pain may be the result by many different conditions. It may start from diseases, injuries or stresses to a number of different anatomic structures including bones, muscles, ligaments, joints, nerves or the spinal cord. The affected structure sends a signal through nerve endings, up the spinal cord and into the brain where it registers as pain.
A number of different theories have developed to try to explain chronic pain but the exact mechanism is not completely understood. In general, it is believed that the nerve pathways that carry the pain signals from the nerve endings through the spinal cord and to the brain may become sensitized. Sensitization of these pathways may increase the frequency or intensity with which pain is perceived. A stimulus that is usually not painful, such as light touch, can be amplified or changed by these sensitized pathways and experienced as pain. Sometimes, even after the original injury or disease process has healed, sensitized pathways continue to send signals to the brain. These signals feel just as real and sometimes worse than the pain caused by the original injury or disease process.
Imagine an old television set or computer screen in which the same image is projected continuously. This image is eventually “burned” into the screen. Even when the screen is turned off, the image can still be seen on the screen. In the same manner, after the original source of pain is healed or no longer present, chronic pain patients may continue to feel pain. Although this is an oversimplification of what may happen in chronic pain, it helps to illustrate the current understanding of this condition.
How is chronic low back pain diagnosed?
As mentioned earlier, chronic low back pain is defined as back pain that lasts greater than three months. During the evaluation of chronic back pain, the goal is to rule out any injuries or disease processes that place the patient at risk of further injury if not treated or addressed. In addition, a specialist will consider diagnoses that can be treated in order to reduce the pain. A good patient history and a thorough physical examination by a member of the In Motion Health Team are the most important aspects of the evaluation. Serious injuries and illnesses can often be diagnosed or ruled out based on the history and physical exam alone. Lack of a definite diagnosis does not necessarily mean more testing is needed. Needless tests do not add anything to what the doctor has already discovered in his or her physical examination and review of previously performed studies and treatments. In fact, unnecessary testing is not only expensive to the patient, but can expose the patient to unnecessary risks or radiation.
If the doctor feels that more testing is needed based on the patient’s history and physical exam findings, he or she will discuss this with the patient. Often, the exact cause of the pain is still not well defined at the end of the evaluation. Nevertheless an evaluation is successful if it has ruled out those processes that place the patient at risk if they are not treated.
What treatments are available?
Treatments for chronic back pain can vary greatly depending on the type and source of the pain. If a treatable source of the pain is found, then the underlying process can be addressed. When the underlying cause is either not specifically identifiable or not amenable to treatment, then the symptoms are treated. The goals of the treatment are to reduce pain, improve quality of life and increase function.
There are several different general categories of treatment that are usually recommended for chronic back pain. These categories include chiropractic, physical therapy, medications, coping skills and acupuncture. In Motion will tailor a program involving a combination of these options to address your needs.
