Slipped discs, ruptured discs, bulging discs, sciatica, piriformis syndrome – these are all terms commonly known by the public. If you are experiencing low back pain or pain radiating down your leg, these common terms can be scary and concerning. Internet searches offer a treasure trove of information. Just recently, my Google search of “slipped discs” offered me a rabbit hold 7,830,000 results. Internet searches offer information, some of which can be either good or bad. The fact of the matter is that most information on the Internet in regards to low back pain does not provide helpful information and at times can induce fear and anxiety about a very common occurring condition.
Low back pain is a common occurrence that most adults have experienced. In fact about 80% of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days.
The good news is most low back pain is mechanical in nature. This means the structures of the low back are associated with the low back pain. Examples of mechanical low back pain are muscular strains, ligamentous sprains, and joint stiffness. Disc herniations, spinal stenosis, degenerative changes, and spondylolisthesis are further examples of mechanical causes of low back and leg pain. These words sound frightening but are commonly occurring in all humans, even those with no complaints of back pain.
Most people with acute low back pain and even leg pain (commonly called sciatica) will recover completely, in fact, 95% recover in 12 weeks. Serious causes of low back pain, or non mechanical back pain, are uncommon and account for less than 1 % of low back pain.
Low Back Pain Red Flags
If you are suffering from low back pain, how do you know if you should be worried that you are a part of that 1%? The causes of non mechanical back pathology often have red flags associated with a complaint of pain. These would include:
- Progressive motor or sensory loss – inability toe or heel walk, tripping, or buckling of the knee
- New urinary retention or overflow incontinence,
- History of cancer
- Saddle paresthesia (numbness where you would sit on a bicycle seat)
- Recent invasive spinal procedure
- Significant trauma relative to age
- Unexplained weight loss/gain
- Fever, chills, night sweats
- Night pain not relieved by changing positions or medication
If you are experiencing any of these symptoms you should contact your primary care physician to discuss. They may order diagnostic imaging, such as an xray or MRI, or blood work. The good news is these symptoms occur in a small number of patients. Remember, less than 1%.
Good news – you do not have any red flags but you are still having back pain. What to do now? Previously, patients would go and see their primary care physician and get imaging, either an xray or MRI. In the last decade, there has been a push in the medical community to scale back on the use of Xrays and MRIs.
Why is that?
If we performed any diagnostic imaging on most people those images would reveal a positive finding. A study performed by W. Brinjikji et al looked at the prevalence of three common findings on imaging: disc degeneration, disc bulge and disc protrusion. They found the prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age.
What does that mean?
Well it means patients without low back pain have degenerative changes, disc bulges and protrusions AND it will continue to change as we get older. So just like we have wrinkles on our face as we age we get wrinkles on the inside as well.
Low back pain or leg pain, whether acute or persistent (meaning it has lasted for longer than 12 weeks), can be problematic for the individual experiencing symptoms. The aforementioned statistics are not to take away from the suffering and anxiety that low back pain can cause. Rather, we should celebrate how resilient we are!
Bulging/protruding discs do heal. Imaging has demonstrated that six weeks after an individual is diagnosed with a disc herniation a repeat MRI will show that it is being reabsorbed! Muscle strains and ligamentous sprains recover generally in 4-6 weeks much like an ankle sprain will.
Is there anything you can do for your low back pain?
Yes! Physical therapy is a great option for those who are suffering from low back pain. In the acute phase, a physical therapist can assess your symptoms and ensure you are an appropriate patient for physical therapy. Physical therapy will teach you strategies for appropriate posture, movement patterns, utilize pain relieving modalities, and educate you on stress management techniques that will assist in reducing your pain. If you start doing the right things initially, this can accelerate your recovery. In addition, research has shown the most important thing people can do is to get moving early! Motion is lotion is a great mantra. A physical therapist will help determine which exercises and activities will assist in reducing pain and improve activity levels. No longer is bed rest promoted for low back pain.
Physical therapy can also address subacute and chronic pain. In addition to providing the above mentioned benefits, a therapist will assist you in building strength, gaining neuromuscular control, improving flexibility and increasing tolerance to load, ie lifting, gardening, etc of the low back. Finally, there is some exciting information about how we can “retrain” our brain to help mitigate the effects of subacute and chronic pain low back pain. Our goal is to not only help you recover from this episode of low back pain, but also help prevent future episodes from occurring.
If you are suffering from low back pain or leg pain, a visit to physical therapy is a fantastic starting point on your road to recovery. Depending on your insurance, you can see your physical therapist directly without a referral from a physician.
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