Low Back Pain

Daily exercise will increase your fitness and health in many ways, including decreasing your risk for developing a back strain or sprain.

Low back strain is one of the most frequent problems seen by health care providers. Four out of five adults will experience significant low back pain at some point during their lifetime.

The lower or lumbar spine is a complex structure that connects your upper body (including your chest and arms) to your lower body (including your pelvis and legs). This important part of your spine provides you with both mobility and strength. The mobility allows movements such as turning, twisting or bending, and the strength allows you to stand, walk and lift. Most low back problems are easily treated on a short-term basis. Preventing recurrence and gradual worsening of back problems, however, requires patient education and compliance with basic exercise programs.

• Low Back Strain
  The muscles of the low back provide power and strength for activities such as standing, walking and lifting. A low back strain is an injury to the muscles in the lumbar area of the back. It is more likely to occur in a poorly conditioned or overworked muscle. These injuries are the most common causes of low back pain.
   
• Low Back Sprain
  The ligaments of the low back connect the five vertebral bones and provide support or stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament. This also happens more often when the low back muscles are weakened and do not "protect" the ligaments, and in people who have stiff back muscles, which can be overstretched more easily than conditioned muscles.

Diagnosis
Your health care provider can accurately diagnose and effectively treat most types of low back pain in the office. Examination will focus on the nature of your symptoms, and may include both your spine and legs. For most types of low back pain, no costly tests are needed for initial diagnosis and treatment.

If pain is severe and not responding to treatment, or if you have significant leg pain, some imaging tests may be required. X-rays will show changes in the bone such as arthritis. X-rays will not show changes in other structures such as the lumbar discs or nerves, however. For conditions or injuries that involve these soft tissues, myelography, computerized tomography (CT scan) or magnetic resonance imaging (MRI) may be needed. Occasionally, a bone scan will be taken to assess bone activity. Electrical tests, such as electromyography (EMG), may be needed to determine if the spine condition has caused nerve or muscle damage.

Risk Factors
Factors known to increase the likelihood of low back strain and sprain include:

• Muscle weakness . Weakness in the supportive muscles of the back, as well as weakness of the abdominal muscles, may contribute to low back strain and/or sprain.
• Improper use of back muscles. This includes sustained sitting, repeated or improper lifting techniques, or poor posturing of the low back.
• Poor flexibility of the spine and its supporting ligaments
• Obesity
• Smoking

Treatment
Low back strains and sprains can be safely and effectively treated following an examination by your health care provider. Treatment often includes a prescribed period of activity modification and medication to reduce pain and inflammation. Although a brief period of rest may be helpful, most studies show that light activity speeds healing and recovery. It may not be necessary for you to discontinue all activities, including work. Instead, you may adjust your activity under your doctor's guidance.

Once your initial pain has eased, a rehabilitation program may be suggested in order to help you return to regular activities as quickly and safely as possible. Your doctor may refer you for physical therapy to help increase muscle strength and flexibility in the lower back and abdomen. Also, you can decrease your chances of recurring low back pain by losing excess weight and quitting smoking. The best long-term treatment is an active program of physical conditioning and using proper posture during all daily activities.

Prevention
Low back strain and sprain are largely preventable by doing the following:

• exercising regularly to keep the muscles that support the back strong and flexible
• using correct lifting and moving techniques and getting help when needed
• maintaining proper body weight to avoid straining the back muscles
• avoiding smoking
• maintaining a proper posture when standing and sitting (don't slouch).