To say that low back pain is common would be an understatement. It is the second most common reason that people see their primary care physician. Most people, about 60 to 90%, will experience at least one episode of low back pain in their lifetime. This often resolves on its own without medical treatment, but up to 90% will have a recurrence of their pain, and about half go on to develop chronic pain. Low back pain not only causes “pain”, but also frequently decreases the function of the person. A vicious cycle can develop where decreased function can lead to increased pain, and so on. One can obviously see the importance of treating people early in their course of low back pain with a program that focuses on functional restoration before they go on to develop chronic pain.
What is a physiatrist?
A physiatrist is a physician with specialty training in Physical Medicine and Rehabilitation. The goal of this specialty is to help people with various musculoskeletal conditions that cause acute and chronic pain. The focus is to decrease their pain and increase their functional status by using non-surgical methods.
Common Low Back Pain Causes
Common conditions known to cause low back pain include degenerative arthritis, spinal stenosis, and disc herniation. Degenerative arthritis is a common cause of low back pain and stiffness. Degenerative changes affecting the disc often cause low back pain that is worse with flexion of the lumbar spine, such as when sitting or standing. Arthritis affecting the facet joints, the joints in the back of the spine, often causes low back pain that is worse with extension or rotation. Spinal stenosis often causes leg pain that is worse with walking, and better with sitting. Disorders of the sacroiliac joint can cause buttock and thigh pain. Hip arthritis can cause pain in the groin and thigh. Often patients present with “hip” pain that is actually referred from the lumbar spine, as both structures can cause similar referred pain into the lower extremity.
Injections as a Diagnostic Tool
Injections can be useful diagnostically to determine which structure is causing the patient’s pain. Corticosteroids are often used to decrease inflammation and provide pain relief. Common spinal injections include lumbar epidural steroid injections, spinal nerve blocks, and facet joint blocks. These are performed under fluoroscopic guidance to allow specific placement of the medication at the intended target. If a specific cause of low back pain can be found, the disc, facet joint, or sacroiliac joint for instance, then a functional restoration program using physical therapy can be directed at this structure to correct any imbalances that may be contributing to the pain and hopefully decrease the number of exacerbations of pain in the future.
Of course, there are certain spinal conditions that require surgery, but often people have surgery because nothing else has helped and they are tired of hurting. It is the physiatrist’s goal to help the patient find ways to decrease their pain and increase their functional status using non-surgical means.
By Daniel Hankley, MD