When to Get Help for Low Back Pain

Pain resulting from ruptured discs and arthritis doesn’t have to incapacitate you. There are various methods to alleviate lower back discomfort and decrease disability, often without resorting to pharmaceuticals.

The challenges associated with spinal issues are an inherent consequence of our upright posture. The wear and tear on our backbones, coupled with the constant gravitational pull on our vertebrae, take a toll over time. Virtually every adult has experienced stiffness or soreness in the back at some point.

Sciatica, a term commonly used to describe pain in the lower back radiating to the buttocks and down one or both legs, may be indicative of one of two conditions—either a leaking disc or spinal stenosis (narrowing of the spinal canal), according to Dr. Steven Atlas, Associate Professor of Medicine at Harvard Medical School. These conditions can exert pressure on the sciatic nerve, which originates in the lumbar (lower) spine, separates just above the buttocks, and extends down each leg.=

Understanding your spine

The spine constitutes a bony column composed of 24 vertebrae, forming an open central channel or canal for the spinal cord. Gel-filled, fibrous-ringed discs, situated between the vertebrae, act as cushions to absorb the forces exerted on the spine. Nerves emanate from the spinal cord at each vertebral space.

When a disc or bone compresses a nerve as it exits the spinal cord, typically occurring between the 4th and 5th lumbar vertebrae, it can lead to lower back pain radiating into the leg. Among individuals aged 30 to 60, a ruptured disc is often the culprit, while those over 60 are more likely to experience such pain due to spinal stenosis. In the latter condition, a reduction in the size of the spinal canal, often caused by excessive bone growth, exerts pressure on the nerves.

Ruptured disc

Damage to discs can result from injuries or the regular activities of daily life. When a disc swells or shifts out of place, it can exert pressure on a nerve, and if it ruptures, the leaking gel may inflame the nerves. Dr. Atlas notes that almost everyone experiences a ruptured disc at some point, but not everyone exhibits symptoms.

While the term “sciatica” is commonly used to describe the pain, doctors may refer to it as radicular leg pain—a pain that radiates due to a compressed nerve. Typically, the pain emerges suddenly after a disc ruptures. Sitting often exacerbates the pain, while standing and walking may provide relief.

Initial treatment typically involves over-the-counter pain medication and exercise. Exercise is beneficial because standing and movement can alleviate pressure on the disc.

Despite the initial discomfort, it’s important to recognize that the pain will likely subside without medical intervention once the body has absorbed the disc material—usually within a few days or weeks. In most cases, once the episode concludes, further treatment is unnecessary. Dr. Atlas emphasizes the need to reassure individuals seeking immediate relief that surgery is often unnecessary.

However, Dr. Atlas highlights rare exceptions. If there is weakness or numbness in the leg, or if bowel or bladder function is affected, seeking immediate medical attention is crucial to prevent permanent nerve damage.

Spinal stenosis

This condition becomes more prevalent with advancing age. The cumulative effects of gravity gradually bring the vertebrae closer together, and the discs, over time, tend to dry out and become thinner. With diminished cushioning between them, the vertebrae can rub against each other, leading to the development of arthritis. Arthritic bone deposits may further narrow the channels through which nerves pass, placing pressure on them and causing pain.

Pain arising from spinal stenosis is termed neurogenic claudication, signifying “difficulty walking originating in the nerves.” It is typically more subtle than pain caused by a damaged disc. Symptoms may manifest in the back, buttocks, or upper thighs, and the pain might not necessarily radiate all the way down the leg. Moreover, it is likely to affect both sides of the body. Individuals with spinal stenosis may experience pain in their upper thighs or legs when standing.

Alleviating pain from spinal stenosis often involves sitting down to reduce stress on the lower spine. Additionally, slight bending over can help by creating space between the vertebrae, thereby reducing pressure on the nerves. Interestingly, activities such as pushing a shopping cart while at the grocery store may bring relief to those who have endured the pain, providing a welcomed respite.

Treating spinal stenosis

In contrast to disc herniation, spinal stenosis is a chronic condition that cannot be cured, but effective pain management can be achieved through a combination of the following approaches:

1. Oral analgesics: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or acetaminophen, can be used for occasional flares. However, they come with potential side effects, and the choice of medication and dosage should be discussed with your doctor.

2. Spinal injections: Lidocaine injections for pain relief and corticosteroids to reduce inflammation are commonly administered to the affected spinal area. While steroid use has been questioned in controlled clinical trials, lidocaine alone has shown comparable pain relief and functional improvement with fewer side effects.

3. Physical therapy: Exercise is a key long-term strategy for managing spinal stenosis. A physical therapist can guide you through exercises to strengthen back muscles, providing better support for the spine and compensating for pain. Massage and manipulation may not be as effective since the problem originates in the bones, not muscles or tendons. Acupuncture may offer some relief but may require repeated sessions.

4. Walkers: Using walkers can facilitate exercise without causing pain. Bending slightly to grip the handles of a walker can open the spine, providing relief. Wheeled walkers with a seat can be particularly beneficial for allowing breaks during walks.

5. Laminectomy: When conservative treatments are ineffective, laminectomy may be considered. This procedure involves removing the bony overgrowth that puts pressure on the nerve. Recovery typically involves one to three days of hospitalization, with a return to work within a couple of weeks. The surgery may be performed through a traditional incision or minimally invasive methods guided by a miniaturized camera.

6. Spinal fusion: This procedure, which includes laminectomy, involves removing the discs between affected vertebrae and filling the spaces with bone-like material. Instrumented spinal fusion uses metal plates, rods, or screws to hold vertebrae together. While spinal fusion can be helpful, it’s recommended for only a small percentage of people, primarily those with degenerative spondylolisthesis and severe arthritis. Most patients with spinal stenosis find relief with a laminectomy, and spinal fusion is suggested sparingly due to drawbacks such as a longer recovery time, reduced mobility, and potential stress on adjacent vertebrae.

Dr. Atlas emphasizes that spinal fusion is generally recommended for a very specific subset of individuals, while the majority of patients with spinal stenosis can find effective relief with a laminectomy.