Back Pain

Post provided by Ai Mukai, MD

What can cause back pain?

There are many structures in the back area that can cause pain. Some of those structures are:
• Muscle – muscle strain and sprain – usually achy, may have spasms
• Disc – usually sudden pain, can pinch nerve, twisting and bending makes it worse
• Bone – fracture of the back bone or smaller bony structure in back – usually constant, may be sharp or achy
• Ligament – strain or sprain, usually worse with movement
• Nerve – pinched nerve – can shoot pain to one side or another, feels like burning, shooting, tingling pain
• Joint – sacroiliac joint – near the base of spine and buttock area, worse with transitional movements like sit to stand
• Joint – facet joints – “knuckles” of the back, pain with bending backward or twisting.
• Coccyx – tailbone pain- worse with prolonged sitting, feels achy and inflamed

How do you figure out what is causing the pain?

X-rays can show broken bones or alignment issues. MRI is usually needed if soft tissue injury or cause is suspected like disks, pinched nerves, and ligaments. Information about how the symptom started, what it feels like, what makes it better or worse and physical examination can help narrow down the possibilities. Sometimes, there are multiple causes for the pain and one pain can cause another. Lab work can diagnose issues that may be preventing you from healing or causing more widespread pain and inflammation.

What are some possible treatment options?

Physical therapy is the key to improving alignment, taking pressure off areas of pain, and preventing future injuries. For the spine, McKenzie method and looking at the stabilizing the pelvis seems to give the best long term results. To help with the symptom relief of pain, different types of medications aimed at the different causes of pain (nerve pain medicine, muscle relaxers, anti-inflammatories) can be taken short term while undergoing physical therapy. For more severe pain or long term issues, non-surgical procedures such as injections into joints, epidural space (space where discs and nerves live), and muscles may help. There are more specialized procedures geared towards specific structures like radiofrequency ablation (burn the small nerves that supply joints) and spinal cord stimulators. Sometimes, the procedure can help diagnose the cause of the pain. Lastly, if all options fail, or there is something that needs to be addressed surgically, spine surgery is an option.