|
One complaint that has
extensive speciality crossover is low back pain (LBP). Just
about anyone can suffer from low back pain and reports have
indicated that the average person has an 80% chance of having
significant low back pain at some point in their life. Athletes
in particular are at significant risk for developing low back
pain.
Fortuntely, most low
back pain is transient and responds to conservative measures
over a relatively short period of time. That said, it is very
important to maximize conservative therapy in the athletic
population in order to effect a rapid return to sports
activities. Also, the more serious causes of back pain and those
whose treatment may be less amenable to conservative therapy
must be screened for in every patient.
The anatomy of the back
is fairly complicated and its discussion will be limited. As
most people are aware, the spinal cord descends within the
veterbral canal and gives off nerve roots at different levels
throughout its course.
Between the vertebrae
that house the spinal cord and provide the skeletal framework
for the body there are non-bony structures called intervertebral
discs which serve a biomechanical purpose. The inner, softer
portion of the disc is called the nucleus pulposus.
Muscles, tendons, and
ligaments attach to the vertebral column at various places on
the bones. These serve both structural and functional purposes.
The lower spine (lumbar
spine) is subjected to very intense forces both in daily life
and especially in athletics. These forces can occasionally cause
an acute injury or, more commonly, may produce a more chronic
pain picture.
In most people, the
intervertebral disc begins to degenerate in the fourth or fifth
decade and can predispose them to experience LPB.
The vast majority of
LBP in sports is due to injured structures that support the
spine (i.e. the muscles, tendons and ligaments). These are
generally termed lumbar strains or mechanical back pain and may
be acute or chronic. In these cases, the spinal cord or its
nerve roots are not effected. While the pain may indeed be
severe, it is generally localized to the back and does not
effect the buttocks or legs.
The treatment strategy
for this mechanical back pain is usually conservative. Those
without contraindications may be placed on an oral anti-inflamatory
medicine, may be sent to physical therapy, and may be required
to make sports or exercise modifications that decrease the
workload of the low back. This therapy is usually very
successful.
People with what
doctors call radiculopathic pain generally have a different
pathology that produces their low back pain. Patients who
complain of back pain that radiates into their buttocks or leg
may have a herniated disc or other problem.
Symptoms of a disc
herniation may come on suddenly through direct trauma or
movement or may begin gradually.
The positive exam
findings that are strongly associated with lumbar disc
herniation include radiating lower extremity pain; any evidence
of motor weakness in the leg; a side to side reflex change; a
positive straight leg raise test; decreased sensation in the
leg. Many or most of these findings can be directly correlated
with the level of the disc herniation.
In evaluating low back
pain, your doctor will conduct a thorough history and physical
examination. Additionally, he or she may order plain Xrays of
the back to evaluate its bony structure. However, if they are
considering the diagnosis of lumbar disc herniation, the
definitive imaging study has become MRI.
Patients with disc
herniation are almost always treated conservatively in much the
same way that patients with mechanical back pain are treated. It
is very important for patients with radiculopathic pain to rest
until the radiating pain has resolved significantly.
Occasionally, the placment of a steroid injection into the
pathological area is warranted as is a short course of oral
steroids.
For most patients,
lumbar disc herniations heal well with the above conservative
measures. However, in a small subset of patients these
treatments are unsuccessful. These are difficult and intricate
surgeries that are performed by orthopaedic surgeons or
neurosurgeons who are specially trained to operate on the back.
The good news is that
the vast majority of low back pain, especially in the athletic
population, will get better with conservative therapy reasonably
quickly. However, don't delay evaluation of low back pain. There
are some entities that, though not discussed here, are much more
serious and demand immediate attention. When in doubt, talk to
your doctor about your back pain.
|
