Back pain is extremely common. Almost everyone will suffer from an episode of back at least once in their life. In fact, it is the second most common reason to visit the doctor. Unfortunately, back pain is as complex as it is common. There are many causes of back pain which can lead to a variety of ways to manage it.
Back Spasm or Strain
The most common cause of back pain is a muscle strain, or back spasm. This often occurs from having poor posture while lifting a heavy object or twisting while bending. That’s why you may have heard the phrase “bend from the knees, not your back” before. This is good advice, but sometimes it’s also easy to forget. A back strain is typically felt on one side of the back as this is where the major back muscles are located next to the spine in the middle. This type of back pain typically resolves within a few days to a few weeks and rarely last for a few months or longer. It can occur at any age. It is typically treated with rest, NSAIDs, muscle relaxers, and physical therapy. Any form of imaging is almost never required to diagnose a back strain.
Arthritis of the Spine
The second most common cause of back pain is arthritis in the small joints of the spine. Although our spine is a stable structure that helps support us upright, it is also a mobile structure that has small joints within the bones, or vertebrae, which allow us to move in different directions (bend forward or backward, lean side to side, and twist left or right). As we age, arthritis becomes more common throughout the different joints in our bodies and the small joints in our spines are no different. The wear and tear of using these joints for many years may eventually cause painful arthritis. This pain is typically felt around the middle of your back, but in some cases it can refer to other parts of our bodies such as the side or down to the leg.
Physical therapy to help strengthen the core and take pressure off these joints is a proven form of treatment for this type of back pain. NSAIDs and topical pain medications may also be useful. If the pain is severe or does not improve, it may be necessary to consider steroid injections to relieve the pain. These injections include either facet joint injections to the small joints in the spine, or medial branch blocks to the nerves that supply sensation to the small joints in the spine. Rarely is surgery indicated. X-rays may be useful to diagnosis this condition, but MRI is usually not required.
Sacroiliac Joint Dysfunction
The third most common cause of back pain is sacroiliac joint (SIJ) dysfunction. This joint is located on each side of our lower back where our sacrum (also known as tailbone or sit bone), meets the back of our hip bone, or ileium. The joint that forms here can become irritated due to instability of the ligaments that surround the joint which can lead to inflammation and pain. Sometimes the joint can also get locked into or stuck in place which will lead to pain. In rare cases, the joint can become severely arthritic. Typically this type of back pain presents as pain on one side of your lower back. In this case, the pain can also move all the way down your thigh to your knee and mimic “sciatica”. Normally this condition can be diagnosed without any imaging. It is often treated conservatively with physical therapy, ice or heat, and NSAIDs. If these treatments aren’t helpful, then a steroid injection at the site of the SIJ on the affected side can be very useful in reducing your pain and getting you moving like normal again.
Sciatica is a commonly used term to describe various symptoms you may experience down your leg including pain, numbness, and tingling. Although sciatica has become commonplace in our language and culture today, it is actually more useful as a descriptive term for the symptoms rather than a diagnosis for this painful condition.
The nerves from the lower part of our spines supply the muscles and sensation in our legs. These nerves originate as nerve roots just outside the spinal cord. When these nerve roots get pinched or irritated in some way they will send signals down to our legs that result in pain, numbness, tingling, and possibly even weakness if it is prolonged and severe enough. On the other hand, the sciatic nerve is a large bundle of other smaller nerves that forms outside of our spine farther down from the nerve roots and much closer to our buttocks than our spine. These smaller nerves eventually branch out to supply the muscles and sensation in our lower legs, feet, and toes. Although the nerve roots and the sciatic nerve are related in a way, typically the nerve roots are what gets affected in sciatic, not the sciatic nerve itself. The nerve roots may be pinched by a herniated disc or arthritis in the spine where the nerve roots exit. Regardless of what it’s called, the painful symptoms of “sciatica” can be diagnosed and treated in the following ways.
Once sciatica is suspected, a physical exam may clue the doctor into which nerve roots may be affected. A couple different tests can then be ordered to better diagnose exactly which nerve roots are involved. MRI gives an excellent picture of the anatomy of the spine and may not only help to reveal which nerves are injured, but also why, such as a herniated disc or arthritis of the spine. EMG is a nerve test that helps isolate which nerves are injured by looking at the physiology of each nerve and seeing if there is any damage present to the nerve or nerves. Combining these three key components - the physical exam, EMG, and MRI - can help diagnose specifically which nerve roots are the cause of the pain. The L5 and S1 nerve roots are by far the most commonly involved.
Treatment for sciatica can include more conservative options such as physical therapy, NSAIDs, oral steroids, and neuropathic medications (to treat nerve pain). If these treatments do not help, then epidural steroid injections may be helpful to reduce the inflammation around the nerve root. Finally, if all else fails then surgery can be considered to take pressure off the pinched nerve in order to reduce the symptoms of this painful condition.