Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109
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( 617)720-2329


 

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May 14, 2019
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If you’re like most people, all you want to do is sit or lie down after the onset of lower back pain. In some cases, it may be a good idea to rest for a day or two—but read on to learn more about the dangers of prolonged rest for people with lower back pain.

See Lower Back Pain Symptoms, Diagnosis, and Treatment

spinal canal
There are numerous structures in your spine that may be the cause of your lower back pain. See Spinal Anatomy and Back Pain

To help understand this complicated topic, this article presents a model for understanding symptoms, physical findings, imaging studies and injection techniques to come to a precise diagnosis.

See Getting an Accurate Back Pain Diagnosis

Once an accurate diagnosis of the cause of the lower back pain is attained, treatment options can be selected based on today’s best medical practices.

The Lumbar Spine, What Can Go Wrong

The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet.

See Back Muscles and Low Back Pain

Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.

There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.

See Pulled Back Muscle and Lower Back Strain

In This Article:

Range of Lower Back Pain Symptoms

Low back pain can incorporate a wide variety of symptoms. It can be mild and merely annoying or it can be severe and debilitating. Low back pain may start suddenly, or it could start slowly—possibly coming and going—and gradually get worse over time.

Depending on the underlying cause of the pain, symptoms can be experienced in a variety of ways. For example:

  • Pain that is dull or achy, contained to the low back
  • Stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet; can include numbness or tingling (sciatica)
  • Muscle spasms and tightness in the low back, pelvis, and hips
  • Pain that worsens after prolonged sitting or standing
  • Difficulty standing up straight, walking, or going from standing to sitting

In addition, symptoms of lower back pain are usually described by type of onset and duration:

  • Acute pain. This type of pain typically comes on suddenly and lasts for a few days or weeks, and is considered a normal response of the body to injury or tissue damage. The pain gradually subsides as the body heals.
  • Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered, and is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
  • Chronic back pain. Usually defined as lower back pain that lasts over 3 months, this type of pain is usually severe, does not respond to initial treatments, and requires a thorough medical workup to determine the exact source of the pain.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

Types of Low Back Pain

There are many ways to categorize low back pain – two common types include:

  • Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
  • Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.

See Radiculopathy, Radiculitis and Radicular Pain

There are many additional sources of pain, including claudication pain (from stenosis) myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates from another part of the body and presents in the lower back (such as kidney stones, or ulcerative colitis).

It is also possible for low back pain to develop with no definitive cause. When this happens, the primary focus is on treating the symptoms (rather than the cause of the symptoms) and the patient’s overall health.

For subacute and chronic lower back pain, a thorough diagnosis is important to lay the foundation for appropriate treatment and rehabilitation. Lower back pain treatment reduces the likelihood of recurrent back pain flare-ups and helps prevent the development of chronic lower back pain.

References:
  1. National Institute of Neurological Disorders and Stroke. Pain: Hope Through Research. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Pain-Hope-Through-Research. June 9, 2017.
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May 14, 2019
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Sometimes it's the simple, time-tested treatments that offer the most effective relief from lower back pain.

See Lower Back Pain Symptoms, Diagnosis, and Treatment

How to Make a Moist Heat Pack

You can easily make a heat pack at home with a few basic items.
Watch: Video: How to Make a Moist Heat Pack

One such treatment is heat therapy; and below we discuss both how heat therapy can relieve your lower back pain and how to apply it:

See Benefits of Heat Therapy for Lower Back Pain

How heat therapy relieves lower back pain

In as little as 15 to 20 minutes, you may experience the following benefits from heat therapy:

  • Stimulation of blood flow. Heat therapy applied to your lower back dilates the blood vessels in the area. This in turn spurs the flow of healing oxygen and nutrients to the area.
  • Stimulation of sensory receptors. Heat therapy stimulates the sensory receptors in your skin, which inhibits the transmission of pain signals to your brain.
  • Stretching of soft tissues. Heat therapy helps to stretch the soft tissues in your lower back, which can decrease your stiffness and relieve your pain.

See Benefits of Heat Therapy for Lower Back Pain

Of course, no single treatment works for everyone. But even if heat therapy provides only a little relief from your lower back pain, it is worth your time and effort.

How to apply heat therapy

When it comes to applying heat therapy, there is nearly no end to your options. For example, you can use a hot water bottle, hot gel pack, or an electric heating pad.

Once you have settled on a heat therapy option, you can follow these guidelines for application:

  • Place a cloth or towel between yourself and the heat source to prevent burns
  • The desired temperature for heat therapy is warm, not hot
  • The more severe your injury, the longer you likely need to apply heat therapy

See How to Apply Heat Therapy

As a bonus tip, disposable heat wraps are a simple and concealable heat therapy option. These wraps deliver low-level heat over several hours, and are great for the office or for falling asleep at night.

See Early Treatments for Lower Back Pain

When to avoid heat therapy

Heat therapy is generally considered a very safe option for lower back pain relief. However, you should avoid heat therapy if you suffer from any of the following:

  • Diabetes
  • Open wounds
  • Dermatitis
  • Deep vein thrombosis

If heat therapy fails to provide you with sufficient pain relief, you can experiment with alternating between heat and cold therapy. But if your pain continues to persist, make sure to schedule an appointment with your doctor; as this may be a sign of a serious underlying problem.

See Causes of Lower Back Pain

Learn more:

Ice Massage for Back Pain Relief
Back Muscles and Low Back Pain
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May 14, 2019
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A strained or pulled lower back muscle is a common, but painful, injury. Treating these overstretched or torn soft tissues is typically straightforward, and it helps if you act fast. Here’s how:


Lower back muscle strains, commonly called pulled back muscles, occur when fibers in a muscle begin to tear from being overstretched or overused. Read Pulled Back Muscle and Lower Back Strain

Stop what you’re doing

When your back pain suddenly flares up, discontinue the physical activity that you’re doing. Don’t push through your workout or continue to do chores around the house. Your immediate priority is protecting your lower back from further injury. Overusing a strained back muscle may worsen the damage and delay the recovery.

See Lower Back Muscle Strain Symptoms

Consider nonsteroidal anti-inflammatory drugs (NSAIDs)

Typically when a lower back muscle is stretched or torn, the surrounding area becomes inflamed. The body’s natural response is to rush blood to the injured area, which causes swelling and can sometimes trigger spasms.

Watch: Video: What Is Your Back Muscle Spasm Telling You?

Certain over-the-counter medications can help to reduce the inflammation. These nonsteroidal anti-inflammatory drugs (NSAID) include ibuprofen (Advil, Motrin) and naproxen (Aleve). Taking these medications may temporarily reduce swelling and provide relief. Talk to your doctor or pharmacist and follow the label’s directions before you use these medications.

See Medications for Back and Neck Pain

Ice it

Applying ice to your lower back is another way to keep the inflammation and swelling down. Applying ice can also decrease tissue damage and ease your soreness.

See Ice Packs for Back Pain Relief

If you don’t have an instant ice pack on hand, you can:
  • Take a small plastic bag and fill it with ice (and include water to smooth out the bumps).
  • Grab a bag of frozen vegetables from the freezer.
  • Put a wet sponge in the freezer. Once it’s frozen, put in a small plastic bag.
  • Fill a sock with rice and place it in the freezer.

Watch: Video: How to Make 5 Quick and Easy Ice Packs

Whatever you use, wrap it in a towel first to protect your skin from ice burn.

Apply cold therapy for no more than 20 minutes at a time with at least 2 hours rest between applications.

See Ice Massage for Back Pain Relief

Lie on your back to sleep or rest

Sometimes a back muscle strain can make it difficult to sleep. Find a firm surface—such as a floor, recliner, or mattress—and lie on your back to minimize stress on the spine.

If you’re on a mattress or floor, use pillows to recline. Place two or three pillows behind your upper back and a pillow under your knees to elevate them. This position, as opposed to lying on your stomach, may be most comfortable when managing a lower back strain.

See Mattresses and Sleep Positions for Each Back Pain Diagnosis

If needed, get plenty of rest in this position for the next day or two. And remember to take short walks occasionally to reduce discomfort and stiffness.

Change it up after a day or two of rest

After 24 to 72 hours, you may consider:

  • Switching from ice to heat. Place a heat pack or electric heating pad against your lower back. The warmth will soothe your strained muscles and increase blood flow to the injured area. Heat therapy can also reduce stiffness so you can more easily get up and exercise. Apply heat for up to 20 minutes at a time and use a barrier to protect your skin.
    See How to Apply Heat Therapy
  • Gentle exercises and stretches. Don’t stay immobile for too long; your muscles could become weaker, leading to more pain and stiffness. Get up and walk around, even if for just a few minutes at a time. Incorporate gentle back-strengthening exercises into your day to restore your mobility and protect your back against future injury.
    See Exercises for Lower Back Muscle Strain

Some pain and stiffness are expected for the next couple of weeks as your muscles heal. If symptoms don’t improve or they continue to interfere with daily activities, contact your health care provider.

Learn more:

Pulled Back Muscle Treatment
Causes and Diagnosis of Lower Back Strain
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April 22, 2019
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Our Sciatica Video Helps You Visualize the Pain

If you think sciatica is a confusing topic, you are not alone. So we're here with a video walk-through to help you better understand both the causes of sciatica and the associated symptoms:

See What You Need to Know About Sciatica


Sciatica is a symptom of an underlying medical condition, not a medical diagnosis.
Watch: Sciatica Animated Video

Video highlights

As you can see in the image above, your sciatic nerve is quite long. It stretches from your lower back down through the back of both legs and into your feet; making it the longest nerve in your body.

While sciatica symptoms are often felt through your leg, the source of the problem is actually in your lower back (where your sciatic nerve roots originate).

Causes of sciatica

Often, the underlying cause of sciatica is a spinal disc problem. This may be a herniated disc or a degenerated disc (caused by degenerative disc disease) that affects a sciatic nerve root adjacent to your disc.

See Lumbar Degenerative Disc Disease (DDD)

Degenerative disc disease occurs when one of your discs start to break down, dry out, and flatten. This process usually occurs over time due to ordinary wear and tear.

See The "Degenerative Cascade" of a Degenerating Disc

Disc degeneration can release proteins (pictured above as small white dots) that may irritate the nearby nerve root.

Sciatica symptoms

Typically, sciatica symptoms are felt on only one side of your body.

You may experience numbness, tingling, or radiating pain through your buttocks, leg, or foot. Which symptoms you experience depends in part on your unique anatomy and which of your nerve roots is affected.

Sciatica may also be referred to as lumbar radiculopathy, which is the same thing.

See Radiculopathy, Radiculitis and Radicular Pain

Sciatica treatments

While treatments can vary based on the specific underlying condition causing your sciatica, most people can benefit from the following treatments:

See Sciatica Treatment

It is important to note that certain kinds of stretches and exercises can make your symptoms worse. So the first step in treating your symptoms is to have your doctor accurately diagnose the underlying cause of your symptoms.

After you uncover the underlying cause, your doctor can help you create a treatment program that is tailored to your specific needs.

The good news is that surgery is rarely needed to treat sciatica symptoms, and symptoms typically subside within 6 to 12 weeks.

 

Learn more:

Types of Sciatic Nerve Pain
When Sciatica Pain Is a Medical Emergency

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April 17, 2019
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The best office chair is largely based on personal preference, but there are several ergonomic features you may want to look for when making your selection. This quick guide will get you started.

Illustration of a man sitting at a desk in an ergonomic chair

When choosing an ergonomic office chair, consider features like lumbar support, adjustable armrests and height, high backrest and headrest, and a deep seat. Read Office Chair: Choosing the Right Ergonomic Office Chair

Office chair features to look for

Typically a comfortable, supportive office chair is designed with several ergonomic qualities, such as:

Lumbar support. Your lumbar spine (lower back) naturally curves inward. Without lower back support it’s easy to round your back and flatten this curve when you sit for a prolonged period of time, which can strain the lumbar spine. An ergonomic chair should offer adjustable lumbar support. For some chairs with mesh backrests, adjustable lumbar support looks like a piece of reinforced plastic that is built onto the backrest and can be raised up or down. For padded chairs, you should be able to adjust the height of the backrest, which is designed with a supportive curve.

See Types of Lumbar Support and Ergonomic Office Chairs

Adjustable armrests. Armrests can help to support your elbows and take some weight off your shoulders, reducing neck and shoulder strain. Your elbows should rest lightly on the armrests and bend at about a 90-degree angle when using a keyboard and mouse. Look for armrests that have adjustable heights and can slide inward, so you can keep your arms close to your body.

Watch Video: 6 Tips to Improve Posture While Sitting

Adjustable height. An office chair that encourages correct posture should allow you to scoot all the way to the back of the seat with your feet flat on the floor, thighs horizontal and arms even with the height of the desk. It is thought that a seat height ranging from 16 to 21 inches off the ground is suitable for most people. An office chair that comes with a pneumatic adjustment lever can help you find the right height.

See Types of Lumbar Support and Ergonomic Office Chairs

High backrest and headrest. Look for an office chair that has a backrest that supports the natural curve of your spine. A backrest high enough for your upper back to stay flush against can help to keep you from hunching your shoulders. A headrest can also encourage you to keep your head back rather than drooping your neck forward, a position that load dozens of extra pounds of pressure on your cervical spine.

See How Poor Posture Causes Neck Pain

Deep seat. The seat should be deep enough so that you can sit with your back against the backrest while leaving 2 to 4 inches between the back of the knees and the seat of the chair. For extra customization, keep an eye out for office chairs that allow you to adjust the forward or backward tilt of the seat.

See Office Chair Back Support

Test out a variety of office chairs before you make a purchase, and see which one offers you the most comfort and support. You may even find that you prefer an office chair solution with an alternative design.

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