Back Pain Causes and Conditions
Common Types of Back Pain We Treat
- Low Back Pain – Pain, pressure and stiffness across the lower back and buttock area. This is usually secondary to herniated discs or arthritis.
- Herniated Discs – Intense lower back pain. Patients typically have a hard time sitting down or getting up from a seated position. Pain into the leg is common.
- Sciatica – Herniated discs cause nerve irritation, resulting in lower back pain that radiates into the leg. Patients can experience weakness and numbness in the leg, and difficulty walking.
- Lumbar Facet Arthritis – Dull, constant low back pain that is usually worse in the morning. Patients describe a band like sensation across the lower back.
- Sacroiliac Joint Pain – Achy low back pain that spreads into the hip or buttocks. Tender points around the buttock. Common in athletes or after pregnancy.
- Tailbone Pain (Coccygodynia) – Sharp pain in tailbone (coccyx) that is usually exacerbated by sitting. There is usually history of trauma.
- Postpartum Back Pain – Low back pain that usually occurs within a few years after childbirth.
Back Pain – One of the most common reasons to see a doctor worldwide
Back pain is incredibly common. Almost everyone at some point in their lives suffers from back pain. Most back pain usually resolves on its own. When back pain is either severe, or has persisted for more than 4 weeks, it is time to see a physician. The goal is to properly diagnose the reason for persistent back pain, and to fix the issue. If left unaddressed, back pain can become a chronic condition.
- Near immediate pain relief and return to normal activities.
- Anti-inflammatory properties decrease swelling in the joint.
- No need to take oral medication which can have side effects.
- A great diagnostic tool for identifying the underlying source of pain.
- Restore range of motion.
- Restore function and allow for more effective Physical Therapy course.
- Avoidance of surgery.
Bulging/Herniated Discs and Sciatica
A bulging disc happens when a weakened or deteriorated disc shifts outside of its normal housing between the vertebra. Usually this occurs slowly over a long period of time as we age, or as a result of an acute injury. Bulging discs are common. When the disc is acutely displaced, nerves frequently become pinched and inflamed, causing pain. Patients typically experience low back pain that may radiate into the buttock or leg, a condition also known as Sciatica. Weakness and numbness of the leg can occur. It may be difficult to walk, sleep, or to stand from a seated position.
If bulging discs are causing symptoms, they require treatment. Once the bulging disc is identified, treatment is usually successful. Surgery is rarely warranted.
Depending on the size and a shape of a bulging disc the pain can be in the middle of the back, or the pain may radiate into one or both legs into the foot. The patient may also experience numbness and tingling.
Sciatica is a condition in which a herniated lumbar disc causes the nerves that are going into the leg to become “pinched” or inflamed. Patients will have a hard time sitting and walking, and will experience pain and numbness into the buttock and leg.
In most cases the bulging disc does not need “fixing”. The pain from a bulging disc, however, can be easily managed using physical therapy, anti-inflammatory medication or epidural injection therapy. Once the inflammation is controlled, symptoms will begin to subside.
Usually a bulging disc will not heal itself. However, most bulging discs do not cause symptoms and are of no clinical significance.
The bulging disc looks like a jelly doughnut with jelly leaking out. The jelly is the disc content.
If treated properly, sciatica from a bulging disc should resolve within 4-6 weeks. If you are suffering from sciatica for longer than 4 weeks, please see a pain management specialist.
While the x-ray itself does not show discs, some finding can allude to a disc change. The Gold Standard study for a disc evaluation is MRI.
Surgery is rarely warranted for a bulging disc. If all other treatment options fail, surgery may be an option. If treatment is promptly initiated, surgery can usually be avoided.
A bulging disc is not a life-threatening condition, but it can cause severe pain, immobility, and decreased quality of life.
Lumbar Facet Arthritis
Lumbar facet joint arthritis is a form of small joint arthritis that occurs along the lumbar spine. The facet joints hold the spine together. Over time or with strenuous physical activity, these joints can lose their cartilage and develop bone spurs, which causes inflammation of nearby nerves. Patients will typically complain of pain and stiffness in the low or mid back. The pain is usually described as a dull ache around the affected area. The pain does not to radiate into the legs. The pain and stiffness is usually worse first thing in the morning and at the end of the day, and is exacerbated with physical activity, bending and twisting. It can be painful to get up from a seated position. Once the correct diagnosis is made, treatment is usually highly successful.
This depends on the degree of the degenerative changes. The condition is not life-threatening and typically does not result in neurological compromise. However, it can cause pain and greatly decrease mobility and quality of life.
Treatment options for facet joint arthritis include:
- Physical Therapy
- Anti-inflammatory medication
- Medial branch block / Facet joint injection – local anesthetic injected around the facet joints. This stops the pain almost immediately.
- Radiofrequency ablation (RFA) – heat applied to the facet joints. This usually alleviates pain for 9 months to 1.5 years or more.
Sacroiliac Joint Pain
Sacroiliac joint pain is a dull, achy pain that is felt in the low back and buttock area. It can sometimes radiate to the groin. The pain is usually felt on one side, but can be bilateral. The pain is usually worse when running or climbing stairs. The cause is Sacroiliac Dysfunction, which can occurs secondary to prolonged sitting, sports injuries, pregnancy, child birth and prior low back surgery.
The sacroiliac joint itself connects the spine to the pelvis, so when it becomes irritated or misaligned, it can affect the way a person walks or bears weight. This can lead to muscle imbalances in the hips and lower back, which further aggravate the condition.
Treatment typically includes a combination of physical therapy, stretching, and strengthening exercises focused on stabilizing the pelvis and improving core strength. Anti-inflammatory medications, SI joint belts, and targeted injections can also provide relief by reducing inflammation and restoring normal joint mechanics. Early treatment helps prevent chronic flare-ups and promotes better long-term function.
This depends on the degree of the degenerative changes. The condition is not life-threatening and typically does not result in neurological compromise. However, it can cause pain and greatly decrease mobility and quality of life.
Most of the time the pain can be well controlled with medications and injections. In very rare cases, however surgery might be required.
Physical Therapy, anti inflammatory medication, and sacroiliac joint injections are common treatments.
These injections are generally not painful and very well tolerated. If you have a fear of needles and would rather not feel the injection, we do offer IV sedation as an option.
Tailbone Pain (Coccygodynia)
Coccygodynia is characterized by pain and tenderness localized to the tail bone. The pain is usually describe as sharp and stabbing. It can be quite severe and disabling. Pain is generally exacerbated by sitting, or by changing position from standing to sitting. The cause of the pain is usually trauma or fall, but it can happen spontaneously without an injury.
This usually occurs secondary to injury, fall or trauma.
Conservative measures such as physical therapy, anti-inflammatory medication and sitting on a cushion should be attempted. If the pain persists after these measures, a trial of a ganglion impar block ( local anesthetic injection around the coccyx) will usually resolve the inflammatory response.
Tailbone pain can last from weeks to years depending on the severity of the problem. It can potentially become a chronic condition.
You should see a doctor if the pain is severe, lasts more than two weeks, and if you develop fever/chills or any other signs of infection.
Treatments options include:
- Ganglion Impar Block – injection of local anesthetic around the tailbone. This breaks the pain cycle and allows healing to begin. Pain relief is almost immediate.
- Rest and physical therapy
- Anti-inflammatory medication
Postpartum Back Pain
Back pain after childbirth is extremely common. It can occur from a few months to several years after a baby is born. The pain is usually dull and achy and typically occurs in the lower back and can radiate into the buttocks or legs. There are multiple causes, with the most common being rapid weight changes, excessive pressure on the back during vaginal delivery or c-section, pregnancy hormones that weaken ligaments, and progression of a disc herniation. Proper diagnosis and treatment is essential to prevent further disease progression. Once treatment is initiated, back pain is easily managed and usually resolves.
Depending on the individual and the anatomical changes during pregnancy, pain can last from weeks to years.
Core strengthening and proper rehabilitation is very important. If pain persists, an epidural injection can be attempted.
While usually not life-threatening, postpartum back pain can be debilitating. Proper treatment should resolve this condition.
You should see a doctor if the pain is severe, lasts more than two weeks, and if you develop fever/chills or any other signs of infection.
Treatments options include:
- Physical therapy and yoga
- Anti-inflammatory medication
- Epidural steroid injection
- Sacroiliac Joint Injection
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