Dr Tom: Ouch, I've hurt my lower back. What now?

Most back pain resolves with rest, anti-inflammatory medication - and continuing to move. Sitting can make it worse.
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Most back pain resolves with rest, anti-inflammatory medication - and continuing to move. Sitting can make it worse.

The irony of a recent article I wrote about not falling was not lost on me as I slid down a mountain - my single snowboard edge tried desperately to grip as I hurtled over a series of icy judder bars before coming to an inglorious halt.

Once the relief passed, the pain kicked in. It was like a hot knife in my lower back, and my physician brain was self-diagnosing the signals to infer a diagnosis. 

Having had the pain before, I surmised it was the facet joints that link the vertebrae which had jammed up on each other causing the pain.

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Sure enough, the next morning I was stiff and sore and in need of some anti-inflammatories and pain relief just to get me mobilised. A snapped binding had caused the fall, which serves as a wakeup call that I should check my gear before  I ride. 

I would estimate low back pain to be the most common presentation I have seen in the Emergency Department over the past 25 years.

Most of it is traumatic: its causes can range from bending over to pick up a piece of paper to high-speed motor accidents or falls at home. The reality is that there is little we can do for acute back pain apart from analgesia (pain relief) and reassurance. The good news is that 90 per cent of back pain will resolve itself after about six weeks. 

One of the more common presentations of acute low back pain is what we call a disc prolapse. The disc is the shock absorber between your vertebrae which, in its centre, has a gelatinous core called the nucleus pulposis. This can herniate through a weakened part of the disc causing a prolapse that can press on a nerve. This pain is called sciatica as the irritated nerve sends pain down the leg, often into the foot. Sneezing or coughing can make the pain worse as raising the pressure in your abdomen squeezes the disc. 

The nerve fibres that control sensation are located closest to the disc. Worrying signs are weakness in muscle groups, a reduced reflex, or changes in bladder or bowel habits. This can mean the nerves are being compromised and surgery maybe needed to decompress the nerve before long-term damage is done. Most traumatic back pain from lifting or twisting is, however, what we call self-limiting: it will get better on its own. 

If your back is sore and you have not damaged it then we normally run blood tests to look for what we call "red flags". Infections such as an abscess can cause back pain so we look for a rise in white cells and inflammatory markers in the blood. If these are positive, imaging such as an MRI scan may be indicated. 

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As in my case, most back pain resolves with rest, maybe some anti-inflammatory medication, and continuing to move. Lying flat or walking upright is best. Sitting is not good for low back pain and can make it worse. 

As always, prevention is better than cure. Make sure bindings and other sports equipment are checked. Use correct techniques for lifting and protect your back from injury. Try managing it yourself if there are no red flags such as fevers or weakness. If it's not getting better seek medical attention for a diagnosis and treatment. 

Dr Tom Mulholland is an Emergency Department doctor and GP with more than 25 years' experience in New Zealand. He's currently on a mission, tackling health missions around the world.

 - Stuff

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