Low Back Pain Treatment
Jupiter and West Palm Beach Offices serving all of Florida
Low back pain that increases with movement like rolling over in bed, or getting out of a car or chair can be a result of significant lumbar arthritis or degenerative disc disease. Pain that originates in the back or buttocks and travels down the legs may can be a result of a herniated lumbar disc. The inability to stand in one spot, or walk for a minimal duration without having to sit down is most likely the result of lumbar central stenosis.
Break down (degeneration) of the lumbar disc occurs as we get older. Daily wear and tear, repetitive movement related to employment and sports, as well as injuries, and genetics also contribute to this process. Degeneration is the slow break down of the lumbar disc, which causes the disc to become thinner making the room for exiting nerves smaller, and cushion between bones less. This process causes symptoms of radiating pain, numbness, tingling, and/or weakness in the legs, and may also cause generalized low back pain and spasms.
Lumbar disc herniation is the rupture of the cushion (disc) that absorbs shock and allows for movement of the low back. Spinal discs are composed of an inner thick spongy like material (nucleus pulposus) and a leather like outer ring of tough, fibrous material (annulus fibrosis). If the outer fibrous material is acutely injured or develops a weak area, the potential for the inner material to express outward is greatly increased. When it does, it is called a herniation. A herniation can cause havoc to the central canal of nerves (spinal cord turns to nerve fibers at the 1st lumbar vertebrae) and exiting nerves depending upon size and location of the herniation. When a herniation causes pain, weakness, numbness, tingling, or burning it is referred to as radiculopathy.
Determining the health of your lumbar spine usually requires:
- A good history of your low back complaints.
- A good physical exam
- Diagnostic films – XR, CT, MRI
A conservative approach most times is the first line of treatment for lumbar spine pain. This includes: rest, ice, heat, anti-inflammatory medications, life style modifications, and a careful exercise based approach to health. Conservative treatments are directed at these symptoms and do not represent a cure for the degenerative process or disc herniation. Introduction of coordinated care with a physical therapist may be prescribed if self-directed conservative therapy does not improve the discomfort or radicular complaints.
Should your discomfort not improve with conservative therapy the spine surgery team may refer you to a pain management doctor for an injection of steroid medication into your low back. The pain doctor or spine surgeon will review your diagnostic films and your chief complaints of pain and then they will determine the best injection for you. Most common injections are epidural injections, transforaminal and facet injections, again depending on your lumbar spine pathology and pain.
Surgery is indicated for the lumbar spine in many scenarios, most commonly when pain, weakness, or parethesias (numbness / tingling) do not improve with conservative therapy and when pathology is present on imaging compressing the central lumbar canal of nerves or the exiting nerves. If the back pain is determined to be mechanical or axial pain, this is treated most times with PT and injections.