Do I have a serious back problem?

Fortunately, most low back pain episodes fall under the category of non specific low back pain. As our previously blog post discussed there is a very good chance that you’ll experience back pain at some point in your life.

Some conditions can produce back pain that are more urgent to medically assess and treat. While statistically they don’t occur frequently, they fall into one of these categories:

Spinal Cord compression

In most people the spinal cord ends just above your low back. A group of peripheral nerves continue down through the rest of your spine known as the cauda equina for their resemblance to a horse’s tail. If either the spinal cord or the cauda equina are being compromised your symptoms will include:

• Loss of sensation in your “saddle” the area that you wipe after going to the bathroom
• A new change in your ability to hold in your feces or urine. Specifically, the inability to properly empty your bladder or a bowel and bladder that spontaneous empties when full without you being able to control it
• Loss of sensation of both legs
• Inability to control the muscles of your legs

Infections

Spinal infections are another potential serious source of low back pain. These symptoms will generally be associated with a fever and a history of infection. They are more common if you are immune compromised or use intravenous medication.

Cancer

Cancer of the spine can cause pain. The cancer can cause destruction of bone leading to bone pain. Cancer causing back pain can be ruled out if you’ve had no past medical history of cancer.  If you have had a history of cancer, are experiencing a new episode of low back, are experiencing a significant amount of unintended weight loss and pain that wakes you up at night, your doctor will refer you for an MRI to rule this out as a source of back pain.

Fracture

If you are a healthy adult a spinal fracture requires significant traumatic force.  This can occur with a fall from a significant height or a motor vehicle accident.  If you have osteoporosis then large amount of forces are not required to fracture your spine.  In either of these cases your doctor will order an X-ray to rule out a fracture.

I don’t have those

That’s a good thing! Just because you don’t have the above, or if they’ve been ruled out, it doesn’t minimize the back symptoms you have. The first step is to give back pain some time to improve. Try and keep moving as much as you are able to pain free.

Most episodes of back pain will have a direction if preference. Some structures, like the spinal facet joints, when aggravated, become more painful when standing and feel better with sitting. Exercises such as biking would become a good way to maintain your fitness while respecting your pain.

Other areas like the muscles of the back, discs and ligaments often prefer positions of standing. Exercise that maintain back extension would be the best start and could include walking or swimming.

Shouldn’t I get an MRI to see what’s going on?

Numerous studies have shown that in early stages, MRIs become important to rule out the above emergencies and urgent problems. The amount of “problems” found on X-Rays and MRIs increase as we age, but that doesn’t mean that these discovered problems are the source of your symptoms.  MRIs also become necessary if the worst pain is leg pain and not improving with conservative management. At that point an MRI will determine if you are a candidate for back surgery to take pressure off of the affected nerves.

Studies show that early imaging increases the number of surgeries performed but in the long term shows no benefit over those in a conservative treatment program.

I don’t want surgery but the pain isn’t going away

If your pain is continuing for more than 2 weeks then conservative management becomes the next strategy. With social distancing, this will likely involve a video consultation. If you’ve ever used the internet then you have the tools for a video consultation.

Your physiotherapist will take a detailed history to determine what factors may need to be addressed including past injuries and limitations. Various movement tests, nerve tests and joint tests can be performed without hands on touch to determine the best way to reduce your pain and get you back to normal. You will be taught exercises to reduce the pain and improve your function.

During social distancing these sessions may be done online. A tailored program to address your pain, core strength and areas contributing to your symptoms will be prescribed.

References

Chou R. et al. “Diagnosis and Treatment of Low Back Pain: A joint Clinical Guideline from the American College of Physicians and the Pain Society” Annals of Internal Medicine 2007; 147: 478-91

Health Care Guideline: Adult Acute and Subacute Low Back Pain Institute for Clinical Systems Improvement January 2012 (15th ed.)

Jacobs W. et al “Surgery vs conservative management of sciatica due to a lumbar herniated disc: a systematic review” European Spine Journal 2011; 20: 513-22