Low Back Pain

by Keith M. Rezin, MD

Low back pain is a common finding in the adult population. It is estimated that up to 60-80% of the adult population will experience low back pain at some point. 2-5% of these individuals will have pain on a yearly basis. Low back pain impairments rank among the leading causes of time lost from work and permanent disability. It is estimated to cost between 50 and 100 billion dollars a year. Remarkably, only 10% of those affected with low back pain account for the vast majority of the cost.

Typically individuals with low back pain will describe some type of twisting or stooping incident. They have pain in the lower back without any specific pain going down the legs. Although they may have some buttock and thigh pain, this is more likely referred pain and not due to any disk herniation. The natural history of acute low back pain is one of gradual resolution of their symptoms within 4 weeks no matter what the treatment.

Treatment alternatives, in the short term, can include a short course of rest, followed by appropriate medications, including a pain pill and an anti-inflammatory. Gradual mobilization, whether it be chiropractic manipulation or physical therapy can then be instituted and as mentioned most people will improve on their own.

The acute lumbar sprain should not be confused with a herniated disk or sciatica which typically involves impingement of a nerve and pain down the leg, especially below the knee. The exact mechanism for the low back pain has been somewhat debated and there are those who feel that it is secondary to a degenerative disk process, but it is probably multi-factorial including the muscles as well as the joints of the spine along with the disks. Fortunately, the vast majority of the people will improve and only approximately 2-3% of the patients will go on to have chronic low back pain.

Those individuals with recurrent or chronic low back pain should be on a low back exercise program for strengthening and stabilization of the spine. If you suffer from low back pain or wish to be educated on an appropriate exercise program, you may wish to be evaluated by your physician.