Low Back Pain

An Independent Licensee of the Blue Cross and Blue Shield Association

 Spinal Anatomy Overview
• The spine consists of four
main areas

– Cervical
– Thoracic
– Lumbar
– Sacrum/coccyx
 Spinal Anatomy

• The spine is a remarkable combination

of strong bones, flexible ligaments and
tendons, large muscles and highly
sensitive nerves. It is designed to be
incredibly strong, protecting the highly
sensitive nerve roots yet being highly
flexible providing for mobility on many
different planes.
If This Is You, You Are Not Alone
 Quick Back Facts
• 80% of Americans will experience back
pain in their lives
• Second most common reason for
doctors visit
• Total cost exceeds $100 billion per year
• 90% of people will recover within 6
weeks with conservative care
• Second only to the common cold for
work sick days
 Symptoms

• Depending on the cause, symptoms

can vary
– Dull, sharp or burning
– Felt at a single point or over a broad area
– Occurs suddenly or comes on gradually
– Occurs with spasms or stiffness
– Associated leg symptoms such as pain,
numbness or tingling
 Red Flag Symptoms

• History of cancer • Bilateral leg

• Progressive motor weakness
or sensory deficit • Fever and chills
• Prolonged steroid • Unrelenting severe
use, IV drug use pain with rest
• Major trauma • Loss of bowel or
• Numbness in bladder function
groin/saddle
 Cauda Equina
• A serious problem that can occur if the nerves
at the end of the spinal cord are squeezed
• Seek emergency treatment if you experience
any red flag Symptoms
 Causes of Back Injuries

• Most back injuries can be attributed to

one of these five causes
– Poor posture
– Improper body mechanics/work habits
– Stressful living
– Loss of flexibility
– Poor conditioning/overweight
“Your back went out because your
front went out.”
 Obesity
• World Health Organization (WHO)
– Overweight: BMI 25-29
– Obese: BMI 30 and above
• By 2015: 700 million will be obese
• Overweight and obesity lead to serious health
consequence
– Cardiovascular disease
– Diabetes
– Musculoskeletal disorders
– Some cancers
Body Types
 Diagnostic Testing

• Physicians will not generally order

diagnostic tests in the first six weeks of
low back pain
• Most of the time, the causes for back
pain cannot be found by x-ray, CT scan
or MRI
 “I’m the one with the medical
degree, I’ll determine if your back
is bothering you or not.”
The intensity of the pain does not
equal the severity of the injury

An Independent Licensee of the Blue Cross and Blue Shield Association

 Intervertebral Disks
• Acts like a cushion
between the bony
vertebrae that make
up the spine
• 90% water
• Wears with age
 Potential Disk Problems
• Degenerated disks
• Thinning disks
• Bulging disks
• Herniated disks
• Osteophyte (bone
spur) formation
 Why does back pain seem
to always come back?
• The disks between our vertebrae act
like shock absorbers
• When disks are injured from either wear
and tear or a sudden force, they are
unable to repair themselves very well
because they lack the rich blood supply
needed for healing
 Sciatica
• Set of symptoms - not a disease in itself
• When the sciatic nerve is irritated or
compressed
• Causes shock like or burning low back
pain that can extend down to the foot
• Extreme cases can cause loss of motor
control
Sciatica
 Sciatica Treatment

• Self care under a doctor’s care

• Chiropractic
• Prescription medications
• Epidural steroid injections
• Physical therapy program
 Piriformis Syndrome

• Muscle that runs

above the sciatic
nerve.
• When the muscle
becomes tight,
causes sciatica like
pain down the leg
• Prolonged sitting,
car accidents, falls
 Piriformis Syndrome Treatment
• Stretching- #1 treatment
• Physical therapy
• Massage therapy
• Anti-inflammatory medications
• Temperature treatments
 Spinal Stenosis
• Congenital or age related narrowing of
the spinal canal
 Spinal Stenosis
• Risk of developing increases after 50
years of age, severity can increase with
age
• Treatments include
– Pilates or yoga to stretch and strengthen
the spine.
– Physical therapy
– Epidural steroid Injections
 Spondylosis

• Spinal arthritis
• Can allow for a
forward slippage of
the vertebrae onto the
vertebrae below it
 Helping prevent spinal
osteoarthritis
• Stay ahead of the • Save those joints
game! • Only eat the good
• Get up and go! stuff
• Cut the fat! • Kick the habit, don’t
• Sit smart smoke!
• Stand smart too! • No pain, all gain!
• Be good to yourself
 Muscle Strains
• The majority of back pain is caused by
muscle strains
• Usually heals with conservative
treatments and time
• Muscles in the lower back have an
excellent blood supply bringing it the
necessary nutrients for healing to occur
 Exercise and Low Back Pain
• The natural stimulus for healing process
is active exercise
• The majority of people do not get
enough exercise from daily activities to
support their lower back muscles.
• While some of these muscles are used
in everyday life, a complete exercise
program for optimal lower back health is
needed
 Treatment Options

• Exercise
• Temperature treatments
• Physical therapy
• Chiropractic
• Acupuncture
• Massage therapy
• Water therapy
 Medications

• Over the counter

- Acetaminophen, ibuprofen, aspirin
• Narcotic pain relievers
- Not recommended for long term use
• Muscle relaxants
- Treats muscle spasms
Did you notice surgery was not included?

An Independent Licensee of the Blue Cross and Blue Shield Association

 Healthy Living

• Exercise regularly
• Maintain or achieve a healthy weight
• Regular core strengthening exercises
• Eat healthy, drink plenty of water
• Practice good body mechanics
• Good quality sleep
 Sleeping Easier with Back Pain

• No perfect position for everyone –

Listen to your body
• Pillow between your legs
• Firmer mattress
• Egg crate or pillow top if it helps
• Good sleep routine
 Four things to take away

• Chances are you will experience back

pain at some point in your life
• Expensive diagnostic tests cannot
always identify the cause of your pain
• There is no quick fix
• Establish a healthy lifestyle
 Resources

• www.bcidaho.com
• www.spine-health.com
• www.spineuniverse.com
www.bcidaho.com