Mechanical Low Back Pain

What is it?
Mechanical low back pain is an extremely common affliction. It is estimated that 90% of Americans will experience an episode of significant low back pain at some point in their lifetime. It is one of the most common causes of disability in the US.

The symptoms most people experience typically include aching pain in the lumbar region, that may radiate into the buttocks. The pain can be very severe at times, occasionally making even routine activities difficult. Pain that radiates into the legs below the knees is usually indicative of nerve root irritation (sciatica) and is a different problem than typical low back pain.

The majority of low back pain episodes, no matter how severe the initial pain, resolve completely by a few weeks and almost all cases resolve on their own by 3 months. Usually the job of the treating physician is to help patients get though this period, until the pain resolves by itself.

What causes it?
Despite extensive and exhaustive research, no one is sure what causes typical low back pain episodes exactly. The pain can come from irritation of the small nerves supplying the discs and facet joints, or it can be from muscle spasm, or it can be from arthritis in the joints in your back. Usually after a thorough exam and imaging a rough diagnosis can be found.

It is important to determine if you have typical low back pain or other conditions such as herniated discs, spinal stenosis, or disorders affecting the bones in your back.

What is the conservative (first line) treatment?
Since the majority of cases go away with time without any intervention (no matter how painful the episode) the first line of treatment is always conservative. Rest is the best first step. It is important NOT to lie in bed however. You should try to be as active as you can be – this will help you recover much more quickly. Bed rest more that 2 days can be harmful to your recovery.

Exercises are very important to do, once the acute pain is gone. These help stabilize your back and help prevent recurrences.

Exercises: exercises that may significantly help you recover

Non-steroidal anti-inflammatory medications like ibuprofen can help with the pain and may help with nerve root irritation. I do not prescribe narcotic medications for initial presentations of low back pain because this can hurt your recovery and can lead to other problems, such as nausea, confusion, constipation, and addiction.

Muscle relaxants have not been found to speed recovery. I will prescribe these only very rarely.

What if that fails to relieve my condition?
If you have not recovered after trying conservative measures, and you have nerve root problems, you may be a candidate for steroid injections. This is done by a pain specialist.

You may need an MRI and/or X-Rays to determine if anything is abnormal in your low back.

How successful is surgery for this?
Surgery can be very successful for herniated discs that cause irritation to the nerves, but for typical low back pain with no nerve irritation, surgery is very rarely indicated and not very successful. Some surgeons will do fusions for certain types of low back pain conditions. I do not perform this surgery.

What can I do to prevent this from happening again?
Keep your back and abdominal muscles strong. Get regular exercise and keep your weight down. Aerobic exercise can significantly help prevent the development of low back pain. Most importantly, do not smoke. Smoking causes degeneration of the discs and joints in your back and it also prevents your ability to heal.