If you have lower back pain, you’re not alone. One-quarter of Americans report that at least once during the past three months they’ve had lower back pain that lasted all day. Lower back pain is actually the fifth most common reason for all doctor visits in the United States.
Yet the cause for a “simple backache” can’t always be found on X-rays or MRIs. In fact, only 15 percent of back pain patients have an underlying structural cause that would be found on such a scan. That means a whopping 85 percent of patients may have multiple issues affecting their spine.
But whether you’re in the 15 percent or the 85 percent, there is good news.
Researchers, physical therapists and surgeons continue to improve treatments suitable for the many causes of lower back pain. On a recent evening at the 92nd Street Y, Spine Hospital physical therapist Evan Johnson, D.P.T., and neurosurgeon Dr. Christopher Mandigo gave an excellent summary of the common and uncommon causes and the treatments for this widespread problem.
First, Dr. Johnson explained why there are so many causes of back pain. The spine is made of many complex systems—bones, discs, nerves, ligaments, muscles—all interconnected in complicated ways. A problem with one of these systems can cause pain directly, and it can also have troublesome effects on other parts of the spine.
The spine is also interconnected with the rest of the body. That’s why pain in the lower back can sometimes be caused by an underlying problem in a nearby area, like the hips. The mind also has a powerful effect on the entire body.
Fear of movement, for example, can lead to reduced use and muscle atrophy, which in turn can lead to more pain and therefore more fear and more atrophy—a vicious cycle.
But research is demonstrating the effectiveness of various ways to break the cycle (or even better, prevent it altogether). For example, exercise is now considered the best first-line treatment for back pain that doesn’t have an obvious underlying cause on MRI or X-ray.
Videos available for free on the Spine Hospital website demonstrate specific exercises that can improve or prevent many cases of back pain.*
The exercises can strengthen targeted muscles, making it easier for patients to attain proper posture and use proper body mechanics when lifting. These small changes have big effects over time, reducing wear-and-tear on all the spine’s complex systems.
Dr. Johnson also stresses the importance of proper ergonomics at computer workstations and strategic rest breaks from screen time—taking 30- to 60-second “micro-breaks” every 15 minutes, and standing up to move around or exercise every 60 minutes.
The majority of low back pain cases will improve on their own or require no more than conservative measures like medication and physical therapy. Unfortunately, some cases of back pain may require surgery. At the 92nd Street Y, Dr. Mandigo described some of the red flags that indicate a patient may need to consult with a neurosurgeon.
These red flags include back pain accompanied by bowel or bladder dysfunction; back pain that includes weakness, numbness or pins-and-needles in the legs; back pain accompanied by a fever; back pain accompanied by unexplained weight loss and intractable pain that does not respond to conservative care.
Surgeons use specialized instruments to see inside the body and perform surgery without needing to expose the entire surgical site to the naked eye. Compared with traditional surgeries, minimally invasive surgeries often are shorter, cause less discomfort and allow for quicker recovery times.
Dr. Mandigo and Dr. Johnson’s talk was well attended and prompted some good questions from the audience. Whether they seek out treatment or not, audience members certainly left with the knowledge that today there are more options than ever when life gets to be a pain in the back.
*The videos are not intended to make or address a specific diagnosis; it is always best to speak to a doctor or physical therapist about your particular case.
Learn more about physical therapist Dr. Johnson on his bio page here.
Learn more about neurosurgeon Dr. Mandigo on his bio page here.
Learn more about the many causes of low back pain on our condition page here.