Lower back pain

Pain in the low back is the most common musculoskeletal complaint of people over age 40, with almost everyone experiencing an episode of low back pain (LBP) at some time in their life. Many people suffer LBP for years on end, after efforts to resolve it medically, including surgery, have proven futile. However, most cases of LBP can be resolved with appropriate conservative treatment.

Anatomy of the Lumbar Spine

Contrary to what many people think, your low back is not fragile. It is designed to twist and bend, bear weight, transfer force loads between your upper and lower body during physical activity, and provide stability when lifting. Your lumbar spine is both flexible and powerful, enabling you to perform physical work and engage is challenging physical activities.

The five vertebrae of your low back that make up your lumbar spine are the largest non-fused vertebrae in your spinal column. The lumbar vertebrae are numbered L-1 to L-5 in descending order, with the lower vertebrae bearing the most weight. The two lower segments where L-4 meets L-5, and where L-5 meets S-1 (the first vertebra of the sacrum) are the most vulnerable to injury because they bear the greatest loads.

Most cases of low back pain occur at the L-4/L-5 and L-5/S-1 junctions, often due to pressure on the nerve roots of the sciatic nerve that exit the spinal column in the lumbar region. Muscle strains associated with lifting are a common cause of low back and sciatic nerve pain.

Symptoms of LBP

Low back pain can be debilitating at times, keeping you from performing even simple daily tasks.

LBP symptoms may include:

• Dull aching pain in the low back
• Stinging or burning pain that descends from the low back to the lower extremity
• Numbness or tingling in the legs or feet
• Muscle tightness and spasms in the low back
• Pain when standing or walking

Common Causes of LBP

Low back pain falls under one of two categories:

• Mechanical pain is the most common source of LBP, and involves injury or overuse of the mechanical structure of the low back, including muscles, tendons, ligaments and bones. Mechanical pain often resolves itself with rest, and abstaining from the activity that caused it.
• Radicular pain is cause by an impinged or entrapped nerve root in the low back. It may accompany mechanical pain, if inflamed tissues or misaligned bones exert pressure on a nerve. Radicular pain is often described as sharp or burning, and may be accompanied by weakness, tingling or numbness in the buttocks and lower extremities.

Several lifestyle and behavioral factors can contribute to and increase the risk of LBP, including:

• Sedentary lifestyle with excessive sitting
• Poor physical conditioning with lax muscle tone
• Weak core and low back muscles
• Imbalances in muscle and connective tissue tension that cause joint misalignment
• Poor postural habits
• Faulty gait and movement mechanics
• Poor lifting technique
• Obesity
• Overuse and injury from sports and exercise

LBP Diagnosis

As with most musculoskeletal conditions, diagnosis of LBP begins with a detailed patient history and physical exam. The patient may be asked about recent and older injuries, sleep postures, lifestyle behaviors, activity level and athletic participation. A postural assessment may be performed. The physical exam may include palpation of the painful area, tests for range of motion and reflexes, and other motor assessments. A neurological exam may also be performed.

Imaging via MRI, X-ray or CT scan is often prescribed in hopes of revealing abnormalities in the low spine, but in many cases traditional static imaging scans are unable to identify the precise cause of pain, and some consider those diagnostic methods to be obsolete.

Traditional Treatment for LBP

Medical treatment for LBP mainly focuses on eliminating pain to ease the patient’s discomfort. Treatments may include:

• Narcotic pain medication
• Muscle relaxants
• Corticosteroid injections
• Bracing

However, because most back pain is mechanical in nature, treating pain alone does not resolve the underlying issues that caused it, and back pain often returns once treatment is discontinued.

LBP Diagnosis and Treatment at NYDNR

At NYDNRehab, we use the most advanced technologies and innovative therapies to diagnose and treat your low back pain. Many of our diagnostic and treatment tools are unique to our midtown Manhattan clinic, and cannot be found elsewhere.

Some of the diagnostic and treatment approaches that set NYDNR apart include:

• Diagnostic Ultrasound: Unlike traditional imaging methods, ultrasound imaging allows both the clinician and patient to see the inner structures of the low back in real time, including muscles, tendons, ligaments, bones and neural bodies. During the diagnostic session, the patient is able participate in the diagnostic process through movement and feedback. Ultrasound also provides important information about the patient’s progress following treatment.
• 3D Video and Force Plate Technology, with EMG systems: This sophisticated technology enables us to analyze gait and biomechanics, to identify deficient movement patterns that are often at the source of pain.
• Dynamic Neuromuscular Stabilization (DNS): This unique treatment approach helps patients to activate and coordinate intrinsic spinal stabilizers for optimal control of the lumbar spine and pelvic region.
• Computer Assisted Rehabilitation Environment (C.A.R.E.N): NYDNR is first among a handful of private clinics to incorporate virtual reality technology into our treatment toolbox. Patients interact with a virtual reality environment while 12 infrared cameras capture their motion and provide real-time feedback to correct faulty movement patterns and improve performance.

Dr. Kalika and his team are dedicated to getting to the sources of low back pain, and devising individualized treatment plans to eliminate them, with the end goal of improving our patients’ quality of life.