Back Pain

Don't Gamble With Your Low Back Pain

If you like to play the odds, here is a sure bet. 80 percent of all adults will experience low back pain at some time in their life - so chances are pretty good that if you haven't already been sidelined by it, low back pain could be on the horizon for you. It is the second most common reason for people to visit their primary care physicians.

So if (when!) it does happen to you, what should you do? Wait for it to go away? Maybe you've heard the statistic that 45-50 percent of patients with low back pain improve within a week? Well, that may be true. But, here's the morning line from researchers:

  • Over 40 percent of all patients with low back pain will have persistent complaints of pain one and two years later.
  • 62 percent of patients are likely to have one or more relapses during a one-year followup.
  • Continued problems with low back pain are even more likely in patients who wait six to 10 weeks from the first onset of pain before seeking medical care.

Ignore that persistent back pain and it probably WILL come back. If you have the pain for more than two weeks, consider a visit to a Physical Medicine & Rehabilitation physician.

In a survey on back pain published in New York magazine, patients reported greater long-term relief from low back pain when treated by PM&R physicians than any other medical specialist or healthcare professional, including orthopedists and chiropractors.

The PM&R treatment approach emphasizes comprehensive or "whole" care. PM&R physicians take the whole patient into account, not merely a specific symptom. Then they match treatment goals to a patient's overall functioning and lifestyle.

Low back pain can be triggered by a variety of causes, and it is often difficult for physicians to pinpoint the source during a routine examination. Since back pain can be caused or aggravated by many things - including illness, injury, work environment, and lifestyle - a PM&R physician works to address more than just relieving the immediate symptoms. Their treatment extends to the overall functioning of the patient.

Although some recreational sports, such as golf, can be associated with significant frequencies of low back complaints, recreational activity often is associated with lower rates of low back pain and then are seen in the general population. In fact, participation in recreational sports may help protect against the occurrence of low back pain and lumbar disc herniations.

Medical care should be directed toward maintaining and improving the athletes functional status and progress through rehabilitation that include sports specific activities achieving an optimal outcome requires accurate identification of these issues and the use of a comprehensive treatment plan that emphasizes functional training and education.

The athletes age may place him at risk for specific conditions adolescent athlete with low back pain have a higher rate of symptomatic spondylolysis than do older athletes.

Disc herniations are particularly frequent persons in their 30s, 40s and early 50s; older persons are increased risk for fractures, degenerative conditions, and a variety of neoplasms.

Physical examination should include a standard orthopedic and neurological examination as well as a functional assessment of motion, balance, strength, and movement patterns relevant to the athletes situation. Examination for local tenderness, spinal range-of-motion, strength, sensation, and reflexes can be accompanied by examination of balance and lower extremity alignment and range of motion. In overhead or throwing athletes, shoulder, trunk, and cervical mobility; strength; and dynamic control should be evaluated.

This assessment helps the physician identify limitations in motion or strength that can be addressed through rehabilitation and any underlying pathology (for example hip arthritis or rotator cuff problems) that is contributing to the acute spinal process.

Decisions on when to obtain imaging and what type of study to perform depend on the particular clinical situation. Generally, imaging of athletes with low back complaints needs to be obtained sooner than imaging for other patients. Athletes often are at increased risk for fracture or other significant structural injury because of the nature of their sports participation and the forces to which there spine is exposed. In addition, decisions on treatment or timeout of sport and returned to play depend on an accurate diagnosis of the injury; both positive and negative findings are pertinent.

MRI is the imaging study of choice would disc and other soft tissue injuries, such as ligamentous and musculotendinous injuries. MRI also may be useful in the diagnosis of stress fractures and other bony processes.