Gradual Onset Low Back Pain
Mild or moderate low back pain can be from a chronic or long term back problem or can follow a bout of acute low back pain.
It may be difficult to diagnose a specific cause of long term low back pain as a number of structures can cause or contribute to the pain.
Below we outline a step by step process for reducing, curing and managing chronic or long term back pain based on identifying possible causes, reducing pain and restoring mobility and strength.
Treatment of moderate low back pain
Chronic back pain is usually caused initially by an injury, usually to the joints in the back but over time other structures in particular soft tissue such as muscles contribute to the pain. Muscles tighten up and go into spasm in response to a back injury and if left they can tighten, weaken or adaptively shorten causing changes in posture or movement which then also make the condition worse.
Moderate low back pain can also following an episode of acute low back pain. After 24 hours the initial severe back pain often eases leaving a less severe pain. Symptoms include aching in the lower back which may be constant or can come and go. It can be on one side of the back or all the way across and may radiate into the buttocks and back of the thigh. The patient is likely to have a reduced range of motion with tenderness over parts of the spine.
Treatment of chronic or long term back pain involves identifying the possible causes which can include various back injuries conditions as well as postural or work related causes, reducing pain and inflammation, restoring full pain free mobility, increasing strength and returning to full fitness.
Identifying possible causes
A number of back injuries and conditions can contribute to chronic low back pain. An outline of these can be see on our low back pain page. More often than not it will not be possible to diagnose the exact cause of back pain. MRI scans and other assessment techniques have not been proven to be accurate enough in many cases. However where a condition such as disc problems, facet joint pain, stress fractures, sacroiliac joint pain and hip joint injuries are present it may be possible to make a diagnosis. A chiropractor or Osteopath will have a great deal of experience in diagnosing possible mechanical causes of back pain and offer appropriate treatment.
Postural problems include hyperlordosis which is an increased lumbar curve in the spine and scoliosis which is an S or C shaped curve in the spine when viewed from behind. Poor posture when sitting or standing is a very common factor contributing to back pain as is poor pelvic or core stability and weak muscles of the back and trunk. Sleeping in a bed which offers poor support can also be a contributing factor to chronic low back pain. Spending too long sitting a desk or driving in a car can cause adaptive muscle shortening and put pressure on the structures of the lower back.
Reducing back pain
A doctor may prescribe pain killers of NSAID's which are non steroidal anti inflammatory drugs which can reduce pain, inflammation and muscle spasm. If the muscle spasm is removed often pain is significantly reduced so the drug can help to cure the problem and not just masking it. Always check with a doctor before taking medication and do not take Ibuprofen if you have asthma. NSAID's should always been a short term measure and not relied on long term as they are not likely to be affective and can cause other side effects.
Back massage can help with back pain by relaxing muscles and reducing muscles spasm. Often with chronic back pain muscles have gone into spasm which prevents blood supplying the nutrients the muscles need which makes them weak, tight and a viscous circle of pain continues. Deep tissue massage flushes blood and nutrients through the muscle, stretches them, warms them and relaxes them easing muscle spasm and allowing the muscle to work more efficiently. See benefits of sports massage for more details.
Chiropractors and Osteopaths can be very effective in relieving back pain through mobilization and manipulation of the spine. By restoring the spine to its normal position pressure on nerves is released reducing pain and tension in the muscles. Many practitioners will also use soft tissue massage and electrotherapy as part of their treatment approach.
Dry needling or acupuncture can help reduce long term back pain. Sterile needles are inserted into the muscle at specific trigger points or tiny localized knots. By deactivating or neutralizing the trigger points back pain is reduced. If there is tension in the sciatic nerve which would be identified via the slump test which puts the sciatic nerve on stretch then suitable exercises which help stretch the sciatic nerve can also help to reduce moderate back pain.
No specific treatment method for low back pain has been proved to be effective so a number of approaches should be tried. The effectiveness of them may vary from patient to patient. Different treatment methods may be more effective for some people than others.
Restoring strength and mobility
Once pain allows, back mobility and stretching exercises should be done to restore normal movement in the spine. A normal functioning spine is much less likely to be painful. If an exercise is painful then it should not be done. Rotational back mobility exercises as well as flexion and extension may be required. However, it is important to get professional advice when beginning a back mobility program because some joints may have too much movement and some may have too little and the wrong exercises can make back pain worse.
Back strengthening exercises are very important and should also begin as soon as pain allows. In particular core strengthening exercises will provide a firm support and strong base for the back and are likely to improve sports performance at the same time. Pilates exercises are often prescribed for rehabilitation and prevention of long term back pain.