<>Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter will review many of the causes of back pain and proper evaluation and diagnosis. Please be sure to discuss your individual symptoms as well as the suggested treatments with your health-care professional to determine the appropriate diagnostic and treatment plan for your circumstances.
<>Save a bundle on a bundle! The boxed set is a 50% discounted bundle of all 8 book-length tutorials for sale on this website, about 8 different common injuries and pain problems. It’s ideal for professionals, keen patients, and anyone who wants more for less. Purchased individually, all the tutorials would cost $160, but the set price is only $79.50. More information and purchase options.
<>In some cases, it’s difficult to pinpoint the cause of chronic back pain. “If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist,” recommends Nava. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse, warns Nava.
<>Paget's disease of the bone is a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget's disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.
<>Spines haven’t changed in the last century,21 and yet modern civilization suffers from a great plague of low back pain.2223 Yet the real causes of most back pain are obscured by medical mythology and misunderstanding.24 Before I discuss what does cause most low back pain, it’s important to talk about what does not cause it. In this section, I will challenge the mythology in just a few paragraphs, supported by over thirty references to the best scientific information available — references you can check for yourself. This is quite different than most sources of patient-focused low back pain information, which tend to avoid discussing the evidence.
<>There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
<>Exercise methods: The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help you become more aware of your movements and may help relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is also good for stress reduction and can help with the psychological aspects of pain. Core exercises strengthen the muscles that support the back and help reduce pain. These non-medical and conservative therapies empower patients. This empowerment with a self-help plan may reduce feelings of helplessness and pain separate from any effect on body tissues and structures. More research is needed to see how these exercise techniques affect back pain.
<>A physiatrist or interventional pain management doctor may help you avoid more invasive treatments. “These can include medications delivered to the spine such as epidural steroid injections to reduce inflammation, or radiofrequency nerve ablations to reduce transmission of neck or back pain,” explains Koser. The expert you meet with will go over all of the options available to you.
<>Save a bundle on a bundle! The boxed set is a 50% discounted bundle of all 8 book-length tutorials for sale on this website, about 8 different common injuries and pain problems. It’s ideal for professionals, keen patients, and anyone who wants more for less. Purchased individually, all the tutorials would cost $160, but the set price is only $79.50. More information and purchase options.
<>An accurate history and physical examination are essential for evaluating acute low back pain. Often, patients awaken with morning pain or develop pain after minor forward bending, twisting, or lifting. It is also important to note whether it is a first episode or a recurrent episode. Recurrent episodes usually are more painful with increased symptoms. Red flags are often used to distinguish a common, benign episode from a more significant problem that requires urgent workup and treatment (Table 2).5,6,8 A recent study shows that some red flags are more important than others, and that red flags overall are poor at ruling in more serious causes of low back pain.8 Patients with back pain in the primary care setting (80 percent) tend to have one or more red flags, but rarely have a serious condition.8  However, physicians should be aware of the signs and symptoms of cauda equina syndrome, major intra-abdominal pathology, infections, malignancy, and fractures (Tables 15,6  and 25,6,8). Cauda equina syndrome and infections require immediate referral. Family physicians should rely on a comprehensive clinical approach rather than solely on a checklist of red flags.
<>A doctor may recommend a spinal injection to help reduce your back pain. There are different types of injections that doctors specializing in pain relief may use. For example, an injection of a corticosteroid can help relieve inflammation that is causing the pain. Depending on the kind of injection, your doctor may limit your number of doses per year to avoid possible side effects.

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Medical Disclaimer: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any exercise program.

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