Low back pain is most often managed through a combination of treatments, lifestyle changes and exercise.
For some people, surgery may be an option.
The types of treatment that are most effective for you will be determined by your diagnosis, overall health and personal preferences.
For the vast majority of types of low back pain, the first line of treatment is physical therapy.
The goals of physical therapy are to reduce pain and improve function and a good physical rehabilitation program will be progressive, controlled and guided by a physical therapist, physiatrist, chiropractor, or other qualified health professional. Almost everyone can benefit from stretching muscles in the low back, buttocks, hips and legs. The more mobile these muscles are, the more the back can move without injury. For example, stretching the hamstring muscles in the back of the legs reduces the stress across the low back.
Pain medications may become necessary depending on the level of your pain. The purpose of the medication is to help control your pain so that you can then participate actively in your physical therapy program. There are different types of medications that are used for different situations. Most commonly mild pain can be managed with Tylenol or acetaminophen or over the counter anti-inflammatories can be used. If the pain is more severe than oral steroids and muscle relaxants may be used. If the pain is severe, then sometimes a opioid medication may be required.
So I'd like to tell you just a little bit more about a few of these ways to control your pain.
Ice therapy is surprisingly effective. To protect your skin, place a towel or other dry material such as a t-shirt between your skin and the ice pack, and apply the ice for 10 to 20 minutes at a time. Ice therapy can be used after physical therapy and exercise to reduce activity related pain and inflammation.
If some of the treatments that I've already mentioned don't help reduce your pain enough to proceed with physical therapy, sometimes a selective injection can be used.
There are different types of selective injections and they're all done under x ray guidance or with the use of ultrasound so that the doctor can see exactly where the medication is going and it makes the procedure safe. There are different types of injections, and one of which is an epidural injection. And this type of injection helps get medicine around the nerves themselves.
Now, if the pain is also coming from the facet joints, the joints in the back of the spine, a needle injection targeted directly at that joint can be used to help reduce pain from the facet.
On the other hand, if the pain is coming from the nerve which is going down the leg and causing a lot of leg pain, then the medication may be placed around the individual nerve and that's called a selective nerve root block.
The other location the pain may be coming from is the sacroiliac joint. The sacroiliac joint is located between your sacrum and your hip. That joint can get inflamed and also cause pain.
In addition to physical therapy, there are other approaches that can help reduce pain, in a smaller way help calm the inflammation around a painful disc. These approaches include a tens unit, manual manipulation and therapeutic massage. Warm packs or heat may be applied prior to physical therapy to warm up the lower back muscles and ice therapy used after to reduce inflammation and soreness.
Depending on the diagnosis and the severity of pain and dysfunction, an implanted spinal cord stimulator may be an option. Prior to implantation, a trial procedure is done to see if the spinal cord stimulator will effectively relieve a patient's pain.
Surgery to anatomically remove the source of pain may also be an option. The types of surgery range from minimally invasive to major surgery.
If your pain is severe and is continued for more than 3 to 6 months despite non-surgical treatments, it may be time to consider consulting a spine surgeon about your options.
While all of the things I've talked about are the most common treatment approaches for lower back pain, there are many additional approaches that have been shown to be effective in managing pain. Examples include back braces, acupuncture, yoga, tai chi, nutrition and supplements that reduce inflammation. Other treatments include water therapy or swimming and ergonomic and lifestyle changes.
Clearly, there are many approaches to treat your low back pain. For most people, finding what works best is a process of trial and error, and it includes a multifaceted approach. As always, this video is for your educational purposes only, and please be sure to work closely with your personal health care team to find what works best for you.
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