Back Injuries: When To Seek Medical Care

June 23, 2008 · 270 views · Filed Under Chronic Pain

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Anthony Abbruzzese, a licensed chiropractor in Columbus, Ohio, explains that pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.Â

You may feel a variety of symptoms if you’ve hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet.

It won’t necessarily be one event that actually causes your pain. You may have been doing many things improperly — like standing, sitting, or lifting — for a long time. Dr. Anthony Abbruzzese states that “Then suddenly, one simple movement, like reaching for something in the shower or bending from your waist, leads to the feeling of pain.”

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body’s weight.

Low back pain is the #2 reason that Americans see their doctor — second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Dr. Abbruzzese explains that the key is to know when you need to seek medical help and when self-care measures alone will not allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not. Abbruzzese notes that “Just because it’s common, doesn’t mean it’s normal!”

You’ll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified unless an x-ray or MRI reveals the culprit. Whether identified or not, there are several possible sources of low back pain:

Small fractures to the spine from osteoporosis Muscle spasm (very tense muscles that remain contracted) Ruptured or herniated disk Degeneration of the disks Poor alignment of the vertebrae Spinal stenosis (narrowing of the spinal canal) Strain or tears to the muscles or ligaments supporting the back Spine curvatures (like scoliosis or kyphosis) Other medical conditions like fibromyalgia

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster, have bad posture, are pregnant, are over age 30 you moke, don’t exercise, or are overweight, have arthritis osteoporosis, have a low pain threshold, and feel stressed or depressed.

The tricky aspect of back pain, which can be very dangerous if untreated or diagnosed improperly, is if your back pain is coming from organs in the pelvis or elsewhere. Conditions stemming from an organ or elsewhere include; Bladder infection, kidney stone(s), endometriosis, ovarian cancer, ovarian cysts, testicular torsion (twisted testicle). If your back pain isn’t going away seek medical attention.

Many people will feel better within one week after the start of back pain, but not if the pain stems from an organ or elsewhere, as mentioned. To get better quickly, take the right steps when you first get pain.

A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended as reserach and clinical studies show that bed rest may actually worsen your symptoms. Bed rest used to be the standard of care but in modern day science, this is not the case any longer, unless there is a serious underlying condition indicated. Dr. Abbruzzese does indicate that there are a few common spinal conditions that may warrant “some” bed rest. “In some cases where a patient has spondylolisthesis, or other specific spinal condition, whether acute or chronic symptoms, bed rest is sometimes the only treatment, but not in the traditional sense of bed rest. Meaning, reduce activity, sit instead of stand - staying in bed for 18 hours a day will certainly make these types of conditions worse, namely, spondylolistesis. So be careful if you’ve been told to bed-rest yourself.”

If you have no indication of a serious underlying cause for your back pain (like loss of bowel or bladder control, weakness, weight loss, or fever), then reducing physical activity may be needed for the first couple of days and then gradually resuming your usual activities after that.

Additionally, instead of bed rest, medical experts recommend to reduce activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2-3 weeks, you should gradually resume exercise.

Over the years Dr. Anthony Abbruzzese has used protocols that are to treat back pain. He states, “In my opinion, light cardiovascular training such as walking, riding a stationary bicycle, and swimming, are among the best activities one can do that may rid your back pain.” Abbruzzese went on to say that such aerobic activities can help blood flow to your back and promote healing as well as strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A doctor such as a chiropractor or a provider such as a physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

When to contact a medical professional can be tricky because you may not be aware of some of the more serious conditions that mimic back pain. If you are unsure when to get medical help, call your doctor if you have; Unexplained fever with back pain, back pain after a severe blow or fall, redness or swelling on the back or spine, pain traveling down your legs below the knee, weakness or numbness in your buttocks, thigh, leg, or pelvis, burning with urination or blood in your urine, worse pain when you lie down or pain that awakens you at night, or very sharp pain.

Other indications that should cause you to consult your family doctor or chiropractor is if you have been losing weight unintentionally, you use steroids or intravenous drugs, if you have never had or been evaluated for back pain before, or if you have had back pain before but this episode is distinctly different. If this is the case, and this new episode of back pain has lasted longer than four weeks, then contact your doctor immediately. If any of these symptoms are present, your family doctor or chiropractor will carefully check for any sign of infection (like meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem. At that point, expect to have some testing done. For example, a urinalysis, x-ray, MRI, or blood test. These tests will depend on the questions asked about your back pain, including how often it occurs and how severe it is. Your family doctor or chiropractor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, manipulations, massage therapy, spinal decompression, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

Keep in mind that your family doctor or chiropractor orders special testing to be absolutely sure that they are ruling in or out all simple and complex complications.

You may not be thrilled about having blood taken, or getting an x-ray, or providing a urine sample, but expect these tests to be done for your better health. Again, blood, urine, x-ray exams are needed especially if your pain that has lasted longer than one month, you have numbness and muscle weakness with or without an accident or injury, fever, if you are over 65, if you have had cancer or have a strong family history of cancer, or unexplained weight loss. In these cases, your family doctor or chiropractor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present. The presence of a tumor, infection, fracture, or serious nerve disorder change how your back pain is treated. In fact, if any of the above red flags are found, your family doctor or chiropractor may refer you to a specialist depending on the positive findings.

Hospitalization, spinal decompression (traction), or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

Many people benefit from chiropractic manipulation, massage therapy, physical therapy, or medications. In fact, Dr. Abbruzzese notes that “Sometimes the key to a quick resolution may be to treat your condition physically, with manipulation, PT, massage, as well as chemically, with medicine.” Your family doctor or chiropractor will determine if you need to be referred out. In the event you choose chiropractic and physical therapy, your chiropractor will begin by using methods to reduce your pain. Then, the chiropractor will teach you ways to prevent getting back pain again.

If your pain lasts longer than one month, and your family doctor or chiropractor doesn’t think you will benefit from their scope of practice, then they may send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist). Or, your condition may require a team of specialists whereby your family doctor chiropractor and orthopedist may work hand in hand together and provide individual care as part of your complete care.

The bottom line when it comes to back pain is to contact your family doctor or chiropractor early on.

Dr. Anthony Abbruzzese is a licensed chiropractic physician in the state of Ohio. He obtained his doctorate and bachelor’s degree of science in human biology from National University of Health Sciences, Chicago, Ill. Dr. Abbruzzese is a member of the American Public Health Association, National Strength & Conditioning Association, Diabetes Exercise & Sports Association, American Chiropractic Association. Anthony Abbruzzese, DC, is a chiropractor

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