Roadmap to Recovery

Pain in the lower back is very common. Fortunately 70 percent of people who have low back pain get better within two weeks. And more than 90 percent get better within four to six weeks. Inflammation (swelling) of the joints, muscles or discs in the back often causes low back pain. Physical activities especially repetitive lifting, bending and twisting can make low back pain worse. Poor posture also can worsen low back pain. Rarely do serious problems, such as infection or other medical conditions, cause low back pain.Understanding how back problems are cared for and what to expect if they do not improve is important.

The care you receive for your lower back pain is specific to your needs

The flow chart below shows the usual process for treating back pain problems and is based on guidelines developed by a team of healthcare experts. It is reviewed and updated regularly as scientific evidence changes. This is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis and treatment. Your care may follow this path or your doctor may recommend a different treatment plan.

Types of Low Back Pain

• Acute Low Back Pain - low back pain that lasts for six weeks or less is called acute low back pain, lumbar muscle strain or backache. Although quite painful, it usually improves after a few days of simple care.

• Acute Sciatica -Acute sciatica is low back pain that lasts for six weeks or less and extends below the waist. It also is called radiculopathy or radiating leg pain. Feeling better usually takes longer than with acute low back pain. Nerve irritation in the lower back often causes sciatica pain.

• Chronic Low Back Pain & Sciatica -Back pain and sciatica that lasts longer than six weeks with no significant improvement is considered chronic. Specialized treatment may be needed. Your doctor may refer you to an expert in medical problems that causes chronic back pain. Usually, these are doctors in rehabilitation or occupational medicine, neurology or neurosurgery, orthopedics and rheumatology.

In some situations, your doctor may want to do tests to rule out any uncommon causes for your back pain. Keep your doctor up-to-date on how you are doing. Schedule a follow-up visit one to three weeks after your initial exam, if recommended immediately report any of the following symptoms or conditions:
          • Unexplained weight loss
          • Constant night pain
          • Fever
          • Urinary difficulties, such as incontinence and retention
          • Leg weakness

Diagnosing Low Back Pain
X-rays usually are not necessary early in treatment. X-rays may be needed for trauma (for example, a fall or car accident), patients older than 50 years or those with other medical problems CT or MRI may be used for chronic sciatica pain.

Treatment
The following simple recommendations may help control your pain. Talk with your doctor if you are not getting enough pain relief.

• Bed Rest -Prolonged bed rest is not necessary for most back problems. Staying in bed for more than two days may increase the pain and stiffness. Moderate activity that does not significantly worsen the pain is more helpful.

• Ice and Heat -Ice or cold packs can reduce the pain and swelling of a muscle strain or spasm (tightening of the muscle). Use ice or cold packs for 20 minutes three or four times a day during the first few days. A hot bath or heating pad after 72 hours of the onset of the injury may further reduce pain. Continue to use ice if it
  helps to reduce the pain more.

• Stress Management -Family, work or financial pressures can affect back pain. Learning to effectively manage everyday stress can help your recovery.
  Talk with your doctor about any concerns.

• Medication - Anti-inflammatory medicines, such as ibuprofen (Motrin®, Advil®) or aspirin, can help ease the pain and swelling. If these medicines upset your stomach, use acetaminophen (Tylenol®) instead. Your doctor also may prescribe muscle relaxants to ease muscle spasms. Muscle relaxants, however, often cause drowsiness.
  Sometimes your physician may order steroid injections that can ease sciatica pain. Steroids are injected into the epidural space of the spine, which surrounds the nerves within the spinal canal. For localized (limited to a small area) back pain, steroid injections into the joints of the spine may be an option as well. Your doctor also may prescribe oral steroids.

• Posture, Sleeping and Weight -Good posture keeps the body’s weight aligned (straight) and reduces stress on the back muscles. When sitting, use a chair with enough lower back support or place a pillow behind your back. Change positions frequently.
  When sleeping, lie on your back with a pillow under your knees or on your side with a pillow between your lower legs.
  Being overweight increases stress on the lower back. Weight loss is important to prevent future problems. Also, smoking can cause back pain and hamper relief.

• Returning to Usual Activities - Returning to work or usual daily activity in a few days or less is important to your recovery. Modifying your responsibilities or limiting your hours may be necessary. While you can expect some discomfort, getting back to regular activities helps prevent your back from becoming weak and stiff. Avoid lifting heavy objects and repetitive bending and twisting.

• Spinal Therapy - If you experience severe pain or no improvement after two weeks of minimal treatment, or if you are unable to return to work or your daily activities, your doctor may recommend spinal therapy. Spinal therapists include physical therapists or osteopathic physicians. They work to help restore your normal strength and ability to move and do activities. They provide special exercises, gentle manual techniques, pain-relieving tools (ultrasound, heat, cold) and health education.

• Surgery - Surgery rarely is needed for back pain or sciatica. Only five to 10 percent of patients with sciatica need surgery. Conservative (non-surgical) treatments and exercise often are as effective in relieving and preventing pain from returning. Surgery usually is only considered after months of conservative treatment have failed to ease your pain.