Lower back pain is a common medical problem that, at some time, 80% of the population will experience at least one episode. Many individuals will experience recurrent episodes of pain in their lower back or suffer from persistent daily pain. Of those patients, one-third will have some degree of leg pain in one or both legs (sciatica). Most cases of back pain and leg pain do not originate from lumbar (lower back) spine. The main cause of lower back pain are the other pain fiber bearing structures in the lower back including: muscles, tendons, ligaments, vertebral joints and bone itself. Fortunately over 97% of all low back problems can be treated without surgery or invasive spinal procedures. Low back surgery is the most common overly performed surgical procedure in the United States. All too frequently the results are poor and even worse, makes the patient’s condition (back pain) more severe. We will look at the association of lower back pain and an MRI abnormality.
In examining patients with complaints of pain, a careful history and detailed physical exam is the basis for developing a comprehensive, conservative treatment plan. Physical exam with show significant back muscle spasm with tenderness. Some will have exquisite sacroiliac joint tenderness. The sacroiliac joint is where the tail bone meets the hip bone. This is called sacroiliitis. Piriformis syndrome can cause low back pain and leg pain. The piriformis muscle lays on top of the sciatic nerve. If this muscle is sprained, the sciatic nerve can be irritated, causing leg pains although there is no clinical findings to show spinal nerve compression – the proverbial “pinched nerve.”
In most clinical settings of low back pain, non-surgical treatment is indicated. Even in individuals who have evidence of a herniated disc need conservative therapy – physical therapy, massage and anti-inflammatory medication. The natural history of disc herniation is to heal without the need for surgery or other invasive procedures such as epidural spine injections. Physical therapy which involves direct hands on therapy combined with deep tissue massage therapy plus daily, self-administered back stretching exercises will result in relief the majority of the time.
Many patients will first undergo an MRI scan to look for the cause of their low back pain. This is where the common problem occurs in making the correct decision to use conservative therapy first versus the improper decision to go to with an invasive treatment route such as spine injections or worse, surgery. Studies have shown that the long term outcome of back pain patients treated surgically is no better than those treated with conservative medical therapy.
For patients who do get MRI studies, it is not uncommon to find spine MRI abnormalities. The important fact to remember is that an MRI abnormality does not necessarily explain the pain or symptoms that an individual is experiencing. The majority of the time, the MRI abnormality has nothing to do with the patient’s symptoms. To account for an individual’s back pain or sciatica (leg pain), the MRI findings must match exactly with the patient’s symptoms and neurological exam. MRI studies of normal individuals without back pain or sciatica have been done. The results show approximately 55% had bulging discs at one or more levels, 28% had disc herniation – with or without stenosis – on the MRI scans. Over 70% of MRI scans showed abnormalities and yet these patients had no symptoms. Conclusion: Just because there is an MRI abnormality does not mean that this is the cause of the patient’s symptoms.
With conservative treatment and patient cooperation to do the back exercises, most patients have significant pain relief within 4-6 weeks. Patients should continue to do their back exercises on a regular basis, as part of their daily exercise routine. Physical body reconditioning and core strengthening will also help a great deal. An MRI abnormality usually does not explain the patient’s low back pain. Back surgery (or neck surgery) can and should almost always be avoided.
With conservative treatment and patient cooperation to do back exercises, most patients have significant relief from their back pain within 4-6 weeks. It is then important to continue to perform back exercises on a regular basis. Physical body reconditioning and core strengthening will also help a great deal. If you have back or neck pain that is troubling you, contact Dr. Kassicieh now to avoid back surgery.
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