Common Low Back Pain

 Low back pain is so common, yet when it hits people cannot help but worry that they  have a serious problem.  They notice the ache, and their initial reaction is to ignore it, hoping, it will go away.  But the reality they live, an insidious underlying stress that grows daily as the pain persists.  They notice the limp in those first few steps when they stand after sitting for a while, but assume no one else can see it.  Sitting is not what it used to be, once restful, now that nagging pain in the buttock and leg.  Their beds are suddenly uncomfortable.  Walking is ok, for a while, as long as they are not carrying anything, or stopping and starting too often.  But it is nothing, really.

Four to six months later they think maybe something might really be wrong.  Now there is some serious leg pain, at times maybe some tingling or altered sensation in the buttock and or leg.  The middle back aches and feels weak.  They feel tired and grouchy.  They consult a doctor for help with their “sciatica” and after careful evaluation the well-meaning practitioner confirms the diagnosis, or may even, with great concern hearing how long the issue has existed, suggest a more serious issue such as disc disease.   

The pain from true sciatic nerve compression will look like this:

When the sciatic nerve is compressed significantly and the fibers irritated enough that their function becomes compromised, one will experience symptoms along the entire course of the nerve. 

The pain from a disc injury will look like this: One will experience pain in a particular area depending on which disc is affected.  There may be tenderness over the area of the disc initially when a disc is injured but most disc injuries heal over 6 weeks (approximately). 

More common than these, people experience pain from gluteal strain.  The gluteal muscle that sends pain to the leg is the gluteus minimus and pain from gluteus minimus strain looks like this:   

Now at four to six months, one thinks, sure, I have that pain, but I have so much more than that.  My ENTIRE BACK aches.  There is sharp, stabbing pain that could not possibly be the result of simple butt sprain. 

And sometimes, that is the case.  

Thankfully, it is not usually the case.  A good majority of low back pain is muscle pain.  There are more muscles involved than just gluteus minimus.  Gluteus maximus, gluteus medius and quadratus lumborum account for a significant percent of back pain.

Gluteus Maximus Pain:

 

Gluteus medius pain:

  

Quadratus lumborum pain:

These are the usual suspects, though there are a few more but no need to overwhelm you with details.  The point is to understand that pain originates from numerous structures.  Your healthcare practitioner will recognize the pattern of the pain, the quality of the pain and your functional deficits and from these identify what has been injured.  And yes, it is important to make sure there is no nerve, disc or bone damage because these, left unrecognized can result in serious consequence.  But the major source of low back pain is some injury to the soft tissue structures, the muscles, their tendons, ligaments or the surrounding support tissues. 

Lower back pain that lasts for more than two weeks can lead to muscle weakness (since using the muscles hurts, the tendency is to avoid using them). This process leads to disuse atrophy (muscle wasting), and subsequent weakening, which in turn causes more back pain because the muscles of the back are less able to help hold up the spine. This is another reason why more than one single area feels pain.  Beyond the original strain or injury, additional structures become affected and become symptomatic.  It is wise to acknowledge any persistent ache or pain that exists for longer than a few days. 

 

The initial treatment for any pain in the back is to rest the injured structure.  48 hours should be sufficient to allow recuperation for any mild overuse.  If pain persists after this, there is most likely some degree of true injury.  Next gentle use, and not stretch is the best way to rehabilitate an injured structure.  The goal is to allow ample blood flow to injured tissue to enhance the healing of injury without adding to any strain or tissue damage.  In physical therapy terms, this is known as therapeutic exercise and it entails movements that include simple exertions, usually much more simple than any functional motions involve; something as simple as contracting and relaxing a muscle a few times with rest periods in between, for example.  Once the symptoms are diminished you can advance to trying more functional motions and exercises.

You will find an abundance of therapeutic exercises available to help relieve low back pain.  There is no single right one.  The best depends on your particular problem and your specific abilities (flexibilities, coordination and strengths).  But exercise of some form is usually the best cure.  The back requires motion. 

Physicians will suggest diagnostic tests as needed to ensure your safety.  They will prescribe medications to temper your pain and prevent subsequent injuries to the rest of your body, to keep you moving as normally as possible and prevent overall deconditioning.  The ultimate goal is always to identify the specific cause of the pain, target a therapeutic program that will restore normal motion as quickly as possible to enhance healing.