What is a Back Pain?
A chronic or acute pain stemming from the muscles, nerves or discs of the lower back.
Quickcare or ER?
Most back aches can be seen in the clinic.
Red flags that will send you to the ER include:
- Numbness into the legs
- Paralysis of the legs
- Severe pain
- Inability to walk
- A history of cancer
What will your doctor ask?
Your doctor will want to know your Symptoms. Remember, a symptom is your description of your aches and pains. It is your story.
Your doctor will want to know the following..
- Where is your aching back pain?
- What is the pain like? Is it a dull ache in the lower back? Is it sharp like a knife?
- When did it start?
- Did you have a fall or trauma?
- What makes it better?
- What makes it worse?
- Does your back pain make the back of your legs ache?
- Do you have associated symptoms such as fever, or paralysis?
What will your doctor look for?
Your doctor will look for Signs. A sign is a an objective finding that a doctor discovers during examination.
First , your doctor will observe how you walk. Is it stiff gait? Are you leaning to one side while walking?
Then , your doctor will observe your movements; The most obvious movement to observe is the motion of going from a standing to a sitting position and vice versa
So much information is obtained with just those two observations.
When I examine persons with back pain, I palpate (push) on the back. I notice if the pain in on the vertebrae or on the sides. I notice if the there are any bruises, rashes or swelling at the back.
I want to determine range of motion. So, I then have persons stand up and touch their toes. I look at forward/backward movement, side-to-side, and rotation.
A good neurological exam is to include a test of reflexes and sensation.
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
Lower back ache causes are many. A routine cause is a muscle strain. Before jumping to this diagnosis, your doctor will want to consider the path of the pain.
Pain radiates. It shoots from its origin and goes to other parts of the body. From the back, pain may go forward to cause stomach ache and back pain. This may be seen with intestinal illness such as gallbladder illness, diverticular disease, or ischemia. Pain may go down into the legs suggesting sciatica.
Severe pain going into the genitals suggests a kidney stone or infection.
A ripping or tearing pain suggests a more serious illness such as an aneurysm.
Another differential diagnosis is shingles. A classic presentation of a shingles rash is preceded by low back pain.
What is the treatment of Back Aches?
If my patients do not have emergent signs and symptoms such as paralysis, loss of bowel or bladder control or fever, then I like to prescribe Naproxen (500 mg twice a day for 7-10 days).
Many times I add on a muscle relaxer such as Soma (350 2-3 times per day) or Flexeril (10 mg 2-3 times per day). I try to avoid the opioids but realize their usefulness in the acute setting.
If lower back pain is work related, I place them on light duties such as no heavy lifting, and no bending .
The vast majority improve with this regimen alone.
How long will you be sick with Back Aches?
Most of my patients will suffer though a typical bout of back ache from muscle strain for about a week.
The worst part is the first 2-3 days.
If they are not better with anti-inflammatories and muscle relaxers such as Soma or Flexural, then I like to try Physical Therapy.
Another alternative is chiropractic care. More and more persons are turning to acupuncture therapy.
Let me tell you a Story………
As a doctor, I will many times start to help my patients with one problem and then it leads to a whole new issue.
Vicente came to my clinic after he hurt his back. In his words, he “didn’t do anything.” That is, in the early morning, before doing any stretching exercises, he bent over to change a tire at his daddy’s auto mechanics store. He must have done this a million times over the past decade.
Like so many persons with back strain, he walked slowly;Slightly leaning to one side. His face grimaced with each step.
I could not help but notice how overweight he was. His shirt barely covered his belly. So young and so out of shape.
After my normal exam, I stated, “You know….you will have a better chance of recovery if you lose some weight.”
I must have hit him at the right time. He got real quiet.
“When I got married 1o years ago, I was rail thin,” he said.
“What do people say to you if they had not seen you in a while?,” I asked.
“They say, ‘ Dude, what happened to your neck?'” With the gained pounds, his face had become melded into one with his shoulders.
“And look right here.” He pointed to his scalp. The extra fat produced thick grooves. Waves of fat.
“See this one here?” he asked as he pointed to the top of his head. “It looks like a sausage. My kids say, “‘Dad, why do you have a sausage on your head?'”
He went on to say, “Like, every weekend, I get together with my cousins. One of my cousins is disabled so he doesn’t work. Man, I drink until I’m all buzzed…It takes me a 12 pack to get wasted.”
He got quiet. He knew that his habit was not to boast about. Maybe in front of his friends, his drunkeness was a badge of honor but not as a father of small children. He went on, “Now when I tell my kids stuff (discipline them) they say, ‘Hey dad Don’t tell me anything. You drink.’ ”
I told to him lose weight, cut out the liquor, strengthen his core via Pilates exercises…..blah blah blah. Advice that I know was going to pass in and out of his pudgy ears.
At least I did my part