Oh My Aching Back!!

April 5, 2004

By Tari Roche, DO
Cascade Valley Smokey Point Clinic

Back pain is one of the most common complaints I hear as a family practice physician. It seems to happen to everyone sooner or later, with varying degrees of severity. Feared by insurance companies, employers, and those who suffer from it, back pain is responsible for huge amounts of lost revenue and lost work tine annually. What causes it and how is it diagnosed? How is it treated? How can you tell if it might become more serious and chronic? At what point will it require more aggressive methods of treatment, such as surgery?

You may hurt your back by overdoing activities, using your back incorrectly, or in an accident of some sort (a fall, car accident, etc.) At this point, you need to be examined to determine the extent of the damage. You may need a x-ray or another type of imaging study. Sometimes a bone scan or CT scan is considered necessary. Usually one of these tests will be enough to determine if there is a fracture. Fortunately, in most cases there is no fracture. However, if you do have a fracture, you may be referred to an Orthopaedic surgeon.

The most common type of back fracture is a compression fracture, which is usually treated with pain medication and conservative measures such as physical therapy. This type of fracture occurs when a vertebra is “squished” by compression forces and collapses inward on itself. This type of fracture is more likely to happen to you if you have osteoporosis or thin bones.

More often, back pain is caused by injuries to the “soft tissues” around the bones. This can include muscle, fascia (the shiny, white, fibrous tissue surrounding muscle), ligaments, and joint tissues. You may have a lot of pain with these injuries, but they are not easy to see on plain X-ray films. Even if you are told there is no fracture, it certainly does not mean there is no injury.

Strain or sprain injuries account for most of the back pain I see in my office. When you strain a muscle the fibers and/or surrounding tissue, such as the fascia, are stretched or even torn a little. Depending on where this type of injury occurs, your symptoms will vary from headache or neck pain (as in a whiplash injury) to mid or lower back pain and muscle spasm. Often the tissue in the area swells, and bruising can even occur.

In the first 24 to 48 hours after a soft tissue injury, there are some general measures you should use to minimize the damage and lessen the pain:
1. Ice the area (try a bag of frozen peas if you don’t have an ice pack.)
2. Use an anti-inflammatory such as aspirin, ibuprofen, or naproxen to help control the pain and inflammation.
3. Rest is generally recommended, although gentle stretching is sometimes beneficial if it is not painful.
(While muscle relaxors and pain medication may be obtained by seeing a health care provider, they are usually for managing more severe pain.)

Your strain and sprain injuries will typically heal by using the measures outlined above. After two to six weeks, you should be able to return to most of your activities. Your provider might prescribe physical therapy to help speed things along.

Sometimes there may be injury to nerve tissue or nerve roots as they leave the spinal cord, exiting between each of the vertebrae. This occurs when the disc or “cushion” between the vertebral bone is squeezed out of place and begins to put pressure on the nerve root. You may feel “radiating symptoms” or pain and numbness traveling down your arm or leg on the afflicted side. Special tests can help identify if and where nerve compression has occurred. Some of these tests are done by physical exam. Also, a test called an EMG (electromyelogram) can help determine if actual nerve damage has occurred. If this is suspected, a MRI (magnetic resonance imaging) test may be ordered to see if an area of damage that was indicated by nerve testing is visible. However, a MRI is a very expensive test and usually only ordered when more extensive damage is suspected based on your physical exam.

In many cases nerve root compression can be treated by conservative measures (rest, medication, and physical therapy.) However, if your symptoms persist you may want to try other treatment options such as massage, acupuncture, biofeedback, and chiropractic or osteopathic manipulation. I personally believe that if these treatments alleviate your pain without hurting you, and their use should be encouraged.

Once your pain is better, you need to think about ways to prevent future injuries. Weight control, body mechanics, ergonomic factors (position used in work) should be considered. A regular exercise program that strengthens and stretches your back and maintains its symmetry and freedom of movement is probably the best insurance against reinjury