- OFFICES IN 16 COUNTIES IN PENNSYLVANIA - Berks, Bradford, Bucks, Centre, Chester, Delaware, Lackawanna, Lancaster, Lehigh,  Luzerne, Lycoming, Monroe, Montgomery, Northampton, Wayne, Wyoming

Low back pain continues to be a diagnostic and therapeutic dilemma in our society. Despite the boom in technology over the last several decades in medicine, our jobs and in our daily lives, the rate of disability due to low back pain continues to escalate. Up to 80% of Americans will have had a low back problem of some type at least once by age 50. Low back problems are second only to the common cold and are primary reasons for visits to family or other primary care doctors. While this number is staggering, it pales in comparison to the fact that 50-70% of these people will go on to have recurrences and may become disabled as a result. Low back pain is the number one cause of disability in patients younger than 45 years of age, and the number three cause for those older than 45 years old.

What is low back pain and what are its causes? This is the question, the problems is that the answer, while many times easy, can become complicated. Low back pain is characterized by pain or discomfort in the low back, which can be accompanied by pain or numbness that moves down the leg (sciatica). It can be associated with weakness and other neurological conditions, but usually is treated easily. Some causes may be a herniated disc (slipped disc), spinal stenosis (arthritis of the spine), muscle or ligament strain/sprain or other causes that may not necessarily be related to the structures of the spine.

Most patients can have quick and relatively simple treatment regiments that include activity modifications, over-the-counter medications, and simple low stress exercises. There are times, however, that the treatment becomes more extensive (usually those individuals with a herniated disc or other non-spinal related causes for back pain), requires more extensive medical treatment and may even require surgery. While most patients still do not require surgery even in this classification, they often at times require special radiological testing (MRI), invasive diagnostic and treatment measures, such as EMG or spinal injections, physical therapy, prescription medication and pain management. While there are many different types of specialists that are called upon to aid the family doctor when low back pain gets to this point, it is the physiatrist who can offer the broadest range of diagnostic and treatment options. Physical medicine and rehabilitation physicians have received special training and education in musculoskeletal medicine and pain management and can distinguish pain and disability. They are often able to exhaust those conservative treatment options before surgery has to be contemplated. It should be remembered that this disease process remains greater than 90% non-surgical.

The Agency of Health Care Policy and Research recently published it recommendations for the treatment of acute, painful low back problems. They suggested non-prescription painkillers, mild exercises such as walking or swimming followed by conditioning exercises for approximately two weeks. It is these conditioning exercises, if done compliantly, which can help prevent long term low back problems and disability. Rehabilitation medicine specialists are experts in this type of treatment. Because their emphasis is non-surgical, they have many options available to help hasten the acute pain and are the most knowledgeable at prescribing this long term exercise program with the aid of specialized therapists to help reduce recurrence and disability of this condition.

Physiatrists can also be an excellent resource to ask the question which all of us have – How will this impact my future lifestyle, occupation or health in general and what steps can I take to minimize any untoward effects? Physicians who choose to see low back pain must have the skills to coordinate many types of treatment. Physiatrists have this broad range that can be very specific and focused by virtue of their expertise in these treatments, exercises that have been proven to be most effective in both the short and long term to reduce pain, suffering and disability and allow the patient to achieve a successful outcome.

Click to return