Treatment for back pain is based on its presentation. Presentations are often mixed, but you can match pain to 1 of 4 patterns. An important note, matching a pattern does not mean you need medical intervention (that’s reserved for the Red Flags we discussed earlier). But, if you go and see a medical provider, you will 100% get a medical diagnosis, and they will potentially offer you a medical treatment.
Let’s dig into these patterns.
Pain - Is it constant or intermittent? Location of pain is also important. Patterns 1/2 are BACK PAIN dominant, 3/4 are LEG pain dominant. The medical world considers the back to be from the bottom of the butt check and up.
Cause of Pain - usually positional. Pattern 1 increases pain with bending forward/sitting - so FLEXION based. Pattern 2 increase pain with leaning back/walking, so EXTENSION based.
Pattern 3 is your standard herniated disc. An acute disc injury can take 2-6 months to fully heal. There is evidence that the disc material can reabsorb. Pain can be because of local inflammation or disc material pressing on the nerve root. A steroid dose pack is usually the first line of defense for this, and they are usually effective.
Pattern 4 is stenosis, usually reserved in older people, and typically in BOTH legs. A common report is “I can walk for exactly 12 minutes before my legs hurt, then I have to sit down. Once I sit, the pain stops immediately.”
The thought with stenosis is the arthrtic changes to the spine cause compression to the actual nerves when you are upright. Since the nerves are compressed, they don’t get the nutrients they need for activity. Similar to how kinking a water house disrupts the flow of water. Walking increases the demand for energy to the nerves, but the kink in the hose limits nutrients. Sitting down reduces the compression (unkinks the hose), so the flow is restored.
Summary
So that is what back pain looks like. As long as you don’t have any Red Flags, treatment is just finding out what movements/positions increase your pain, trying to limit or avoid those to reduce irritability, then slowly RE-INTRODUCING those movements to build your tolerance to them. Sounds easy, but honestly, when you look at back pain stats, no one has figured it out.