Back Pain

Back Pain 

Low back pain

There are many causes of low back pain, the most common of which include: degenerative disc disease, lumbar facet-mediated pain from arthritis (see “facet joint blocks”) spinal stenosis, scoliosis, mechanical strain, and ligamentous injury.

While typical acute back pain episodes in an otherwise healthy person tend to resolve on their own, you should see a doctor if you have: a history of trauma, at least a month of back pain not getting better with rest, signs of illness (fever/night pain/cough, etc.), radiating symptoms (“sciatica,” hip, or leg pain), or neurological symptoms (weakness, numbness, bowel/bladder incontinence).

A good history and physical by an experienced practitioner can help give you the correct diagnosis and guide you to the right treatment plan.

Myofascial Pain

This category encompasses a large number of individuals who present with mostly non-localizable, diffuse, achy pain in an otherwise “normal” or age-appropriate spine. It may include: mid/upper back pain, back spasms, and various degrees of muscle-type pain. Sometimes there are more focal tender points or “trigger points,” which can reproduce one’s pain and pain referral patterns into nearby muscles. Although in itself a benign condition, myofascial pain can lead to severe, disabling pain if not treated.

Sacroiliac Pain (SI joint pain)

Sacroiliac pain or sacroiliac dysfunction arises from the joint between one’s pelvis and sacrum. It is usually very localized, and patients can point directly to this joint region when identifying their pain source. Sometimes one might feel “crooked” or “out of alignment,” like one leg or hip is shorter than the other. The sacroiliac joint is a very tough, fibrocartilaginous joint that involves many ligaments and nerve endings. It may result from a host of factors, including poor biomechanics, underlying predisposing conditions (i.e., pregnancy, Ankylosing Spondylitis), or simple deconditioning.

Sciatica/ Leg Pain

When people complain of “sciatic” pain, or pain radiating down one or both legs, medical professionals immediately think of causes for “lumbar radiculopathy,” which is the medical term for a problem or irritation of the lumbar spine nerve roots, which exit your spine out of tiny holes or “foramina” in the spinal column. 

 When nerve roots are suddenly irritated, usually by a disc herniation or obstructive lesion, the pain in one’s leg can be excruciating. It usually arises from the chemicals and inflammatory factors surrounding that nerve root rather than the actual disc itself. Sciatica or leg pain can also occur gradually over time, resulting from narrowing of the spinal canals (also called “stenosis”), which typically occurs from arthritis/bone spurs and degenerative disc disease as we get older. Most people over 50 will have some degree of degenerative disc disease and/or stenosis. These conditions can also cause numbness/tingling in the leg, and if severe enough, leg weakness and falls. One should definitely seek a clear diagnosis and medical attention if these symptoms arise. Besides herniated discs and spinal stenosis, there are other sources of sciatic or radicular leg pain, including: sciatic nerve entrapment, piriformis syndrome, sacroiliac pain, hamstring/muscle strains, hip/knee joint referral patterns, and others.

Common Medical Diagnoses

Lumbar radiculopathy, spinal stenosis, degenerative disc disease, arthritis, spondylosis/ spondylolisthesis, facet joint arthropathy, disc herniation, sacroiliac dysfunction, piriformis syndrome, myofascial pain, mechanical low back pain/ strain, scoliosis, compression fractures, osteoporosis.

Jennifer Kurz, MD Harvard Affiliated Physiatrist in Massachusetts