Back Pain

Below, University of Maryland Spine Program surgeon Dr. Steven Ludwig answers commonly asked questions about back pain.

Click on a question below for an answer to a specific question, or scroll down to view the complete list of questions.


What can I do to prevent lower back pain?

Low back pain is very common. It affects 80 percent of people at some time during their lives. It's the leading cause of disability for people ages 19 through 45 and is the second most common cause of missed work days and visits to a primary care physician. Low back pain is a significant health care problem and the risk increases with age. 

However, there's some good news. The number of back injuries in the workplace is decreasing, perhaps because of increased awareness and improved measures to prevent back injuries. 

Here's what you can do to prevent low back pain: exercise regularly, an inactive lifestyle contributes to lower back pain. Avoid improper lifting such as bending over; lift an object by bending your knees and squatting to pick up the object. Make sure you keep your back straight and hold the object close to your body. Also, avoid twisting your body while lifting. 

Push rather than pull moving heavier objects. If you must sit at a desk or at the wheel of a car or truck for long hours, take breaks and step out to stretch. If you need to stand up for prolong periods of time, wear flat shoes or shoes with low heels. That will place less strain on your low back muscles.

Finally, stop smoking. This not only improves your overall health, but can also slow down the degeneration in your discs in the back that cause common back pain.

What are the chances my back pain will get better without treatment?


Back pain usually goes away on its own. About 90 percent of patients with low back pain will recover within 6 weeks. Many things can cause back pain and some people recover faster than others. The pain may feel either sharp or dull, it can be felt constantly or intermittently, and the pain can range from mild to severe. 

The most common type of back pain is often referred to as mechanical and is characterized as low back pain that gets worse with certain activities; low back pain that gets worse with certain positions such as sitting for long periods of time; and low back pain that is relieved by rest. 

Again, with time the symptoms should get better. However if low back pain persists for more than 6 to 8 weeks, then additional testing may be advised to diagnose and treat the source of low back pain.

I have lower back pain and was told my reflexes are weak. What does that mean?

Reflex tests are simple physical tests of nervous system function. A reflex is a simple nerve circuit. A stimulus such as a light tap with a rubber hammer causes sensory nerves to send signals to the spinal cord. Here the signals are conveyed both to the brain and to nerves that control muscles affected by the stimulus. 

Reflex tests help to assess the integrity of the nerve circuits and are performed to quickly confirm the integrity of the spinal cord, or specific nerve root function. The knee jerk and ankle jerk tests evaluate the integrity of the nerves originating in the lower back region. 

The strength of the reflex response should be the same for both sides of the body. If the response is weak, or absent, that may indicate damage to the nerves. The nerve roots that exit the spine to form the sciatic nerve are extremely sensitive. When the disc bulges that can easily irritate the nerve. Therefore if the inner portion of the disc becomes too close to the nerve, the nerve may be irritated and become inflamed causing sciatic pain, or sciatica. 

Symptoms of sciatica are pain, numbness, tingling and weakness in the leg. The patient's pain and sciatica symptoms can usually be traced to an injured or irritated nerve in the lower back. This will manifest itself on a patient's physical examination as loss of motor strength, sensation as well as diminished reflex.

 

What causes muscle spasms and what is the best way to treat muscle spasms?

Muscle spasm results from inflammation that occurs when a muscle is overstretched or torn. It begins as a muscle strain, which doesn't sound like a serious injury, but it can cause severe low back pain. Many people go to the emergency room each year because of a muscle strain. In fact, most episodes of acute lower back pain are caused by damage to the muscles and/or ligaments in the low back. Muscle strains are also known as a pulled muscle. When the muscles in the lower back are strained or torn, the area around the muscles can become inflamed. 

With inflammation, the muscles can spasm leading to severe low back pain and difficulty moving. Lower back pain from a muscle strain occurs most frequently after lifting a heavy object, lifting while twisting, or a sudden movement or fall. The pain is usually localized, meaning it doesn't radiate to the leg. The area may be sore to the touch, the patient usually feels better when resting. Fortunately, muscle strains usually heal with time in a couple of days or weeks because muscles in the lower back have a good blood supply to bring the necessary nutrients and proteins for healing to take place. 

If the pain is severe, the patient may be advised to rest, but for no more than one to two days. Pain medications and applying ice or heat may all help alleviate the pain. If an episode of low back pain lasts for more than two weeks, the muscles may start to weaken. Since using the muscle hurts, people tend to avoid using them. This process leads to muscular atrophy and subsequent weakening, which in turn causes more low back pain because the muscles are less able to help hold up the spine. 

As a general rule, people who are active and well-conditioned are much less likely to suffer from low back pain due to muscle strain, as regular exercises stretches the muscles so they are less likely to strain, tear or spasm. A complete exercise program for the low back should consist of a combination of stretching, strengthening and aerobic conditioning.

What is Facet syndrome?


Facet syndrome is a condition in which the joints in the back of the spine degenerate and subsequently cause pain. The facet joints are found at every level on both sides of the lumbar spine. They provide about 20 percent of the twisting stability in the low back. Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation. Facet joints also prevent each vertebra from slipping over the one below. 

A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus when the joint is injured or irritated. Inflamed facets can cause a powerful muscle spasm. Facet joints are in almost constant motion with the spine and it is quite common for them to simply wear out in many patients. When facet joints become worn or torn, the cartilage may become thin or disappear. 

The bone in the joint underneath can produce an overgrowth of bone spurs and an enlargement of the joints. When that happens, we say the joint has arthritic changes, or osteoarthritis, which can produce considerable back pain when a person moves. This condition may also be referred to as facet joint disease, or facet joint syndrome.

I was told my MRI shows a pinched nerve.  What does that mean?

The MRI scan is an imaging test that allows physicians to assess a patient's spinal anatomy and investigate the cause of the patient's back pain and pain down the leg. The physician will correlate the findings on the MRI scan with the patient's symptoms in order to arrive at a clinical diagnosis. The doctors and other healthcare practitioners use many different terms to describe spinal disc problems and pain. 

A pinched nerve means that the nerve is being compressed, and the compression is causing the pain radiate down the leg. A pinched nerve can be cause by a herniated or bulging disc. Other causes of a pinched nerve can be arthritis, causing narrowing of the spinal canal, trauma, tumor or even an infection. When a person has a herniated disc that is causing pain, the bulge in the disc is pinching on a nerve in the spine. This produces pain that is called radicular pain, nerve root pain, or sciatica. Symptoms typically involve pain traveling down the leg in a very specific location.