Low back pain is incredibly common. In fact, in the United States alone, we spend about $90 BILLION annually on treatment, and it is the #1 cause of disability. There is a 70-84% chance you will experience low back pain at some point in your life. Although that may sound scary, the reality is that low back pain has a very favorable prognosis. About 70-80% of people will have a complete resolution of their symptoms within one year. Unfortunately for some people, low back pain can become a recurrent issue, and may even develop into chronic low back pain. With low back pain being such a common problem, let’s take a look at a few common questions surrounding it:
1. Do I need an x-ray or MRI to determine the cause of my back pain?
Usually, the answer to this question is NO. The actual structure of the spine may have little to do with the presence or intensity of low back pain. Studies have shown that as a person ages, the incidence of degenerative disc disease (DDD) increases. DDD is essentially back arthritis, where the discs lose water content and begin to shrink. Approximately 37% of people in their 20’s will show some type of disc degeneration on an MRI, and this continues to rise throughout their lifespan. In fact, a person in their late 30’s has OVER a 50% chance of having a degenerative disc. As there is a high prevalence of DDD in asymptomatic individuals, it is difficult to determine if the degenerative disc is actually the cause of pain or not. Another structural change that can happen to the spine is a bulging or herniated disc, sometimes referred to as a “slipped” disc. Interestingly, these also occur in completely asymptomatic individuals as well! The probability of a bulging disc spontaneously healing is very high, and in general, the larger the bulge, the MORE likely it will heal on its own!
2. So if the back often heals on its own, what causes some people to develop chronic low back pain while others don’t?
So what does all this mean? How can low back pain be treated if it is so hard to even determine the exact cause of it in the first place? Well, for once, there is a consensus here. EXERCISE is universally beneficial for the treatment of low back pain! All current research agrees that a gradual return to activity program is helpful during recovery. But what types of exercises are best, and how much should be done? The truth is, everyone is different, so it really depends on the individual. Taking short walks is a great place to start, and has been shown to reduce low back pain intensity. Finding a local physical therapist may also be beneficial, as they are experts in movement and exercise. Your physical therapist can help address faulty movement patterns, assist you in safely increasing your activity levels, and provide you with exercises to help improve strength and mobility. All of these have been shown to help reduce the intensity of low back pain. Your physical therapist may also provide hands-on treatment such as manual therapy, joint manipulation, or other modalities such as dry needling. The take home message here is that the vast majority of low back pain is not directly correlated to tissue damage, and usually does not require advanced medical treatment or imaging.
Disclaimer- For information and educational purposes only. The above content is not intended as medical advice.
Sources:
Henschke N, Maher CG, Refschauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008;337(7662):a171.
Romeo V, Covello M, Salvatore E, et al. High prevalence of spinal magnetic resonance imaging findings in asymptomatic young adults (18-22 yrs) candidate to air force flight. Spine (Phila PA 1976). 2019;44(12):872-878.
Kim SJ, Lee TH, Lim SM. Prevalence of disc degeneration in asymptomatic Korean subjects. Part 1. lumbar spine. J Korean Neurosug Soc. 2013;53(1):31-38.
Tsao H, Daniels LA, Hodges PW. ISSLS Prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine (Phila PA 1976). 2011; 36(21): 1721-1727.
