FAQ Category: Lumbar Spine

Studies have found that X-rays for low back pain tend not to be helpful. Although low back pain can be frustrating and debilitating, most causes of low back pain aren’t serious to the patient’s health. Recent studies have shown that as many as 50 percent of X-rays for low back pain don’t fit medical criteria for ordering an X-ray.

Often people tend to think they need X-rays when they don’t, and sometimes doctors prescribe them so that the patient feels everything possible is being done. That’s a problem because X-rays are costly and involve doses of radiation.

Your first step should be to talk more with your doctor. Explain your concerns to her. Make sure you understand all the reasons she thinks you don’t need X-rays.

Your doctor is probably only suggesting what seems appropriate for your particular case. As you probably know, the exact reasons for low back pain are often mysterious. It’s possible your friend had at least somewhat different circumstances. Your friend’s doctor may have been concerned about more serious problems, like a spinal infection.

You may be interested to learn, however, that X-rays often don’t help doctors determine the cause of low back pain, even when the X-rays are medically appropriate. Talk with your doctor about your concerns. You can never have too much information.

Absolutely. You should always talk with your doctor about your medical concerns and questions. However, you should know that X-rays are not typically very useful in helping doctors find a specific cause of low back pain. This is probably why neither doctor has suggested taking them. Regardless, get as much information as possible from your doctor about your condition, and don’t be shy about explaining your concerns and frustrations.

The sacroiliac joint does not usually move very much. The joint moves a different amount depending on whether you’re male or female and how old you are. Movement in the joint decreases slowly from birth to puberty. For males, the sacroiliac joint keeps losing movement after that. In females, however, movement in the joint increases after puberty, peaking around age 25. Overall, the movement in the sacroiliac joint is greater in women than men. 

People who’ve injured the ligaments that connect around the sacroiliac joint may end up with too much movement in the joint. This can be a source of pain and occasional popping or “clunking” in the joint. Try to avoid movements and activities that cause the pain or clunk. If your symptoms keep bothering you, consider seeing a physical therapist. A therapist can help you learn safe ways to lift and move and can train you in exercises to stabilize the joint.

The outlook is good. A recent study showed that physical therapy really makes a difference for people with sacroiliac joint dysfunction, or pain in the low back where the spine and pelvis meet. 

None of the patients studied had more pain after physical therapy. In fact, 95 percent of them rated their results as good or excellent two years later. Only 5 percent said their results were fair or poor. The patients who still had a lot of pain after physical therapy had chronic pain before treatment, meaning they had been in pain for at least 50 days. However, many patients who had chronic pain still saw some improvement. 

If you decide to have physical therapy, you’ll want to find a therapist who has experience treating the sacroiliac joint. He or she will work with you to create movement in the joint and strengthen the muscles around it. You’ll also learn bending and lifting techniques and find out which activities to avoid. Physical therapy may be just the key for helping you move more comfortably. 

The sacroiliac joint is the place where the low back meets the pelvis. It is the connection of the sacrum, the lowermost part of the spine, and the ilium, the wide set of bones that form the waist.

Your sacroiliac joint gets a workout whenever you bend forward from the trunk. You use your sacroiliac joint when you work over a counter, lean over a sink, make the bed, or wash the dishes.

From what you describe, the pain seems to be located in the sacroiliac joint, the joint formed where the lower spine meets the pelvis. This kind of pain can make it hard to do ordinary activities, like bending over to load the dishwasher or make the bed.

Fortunately, there are several ways to reduce sacroiliac joint pain. Physical therapy seems to work well, especially for people who have been in pain for relatively short periods of time. But people with chronic pain that’s been bothering them for a few months may also benefit from physical therapy. Other treatment options include wearing a brace or getting special injections. In rare cases, fusion surgery may be needed to keep the joint from moving. Talk with your doctor to discuss which treatment may work best for you.

Poor social relations don’t directly cause low back pain. But they can raise the risk of low back pain when combined with other risk factors. Such a combination happens often when there’s a poor social environment at work and when people feel they can’t make a difference in their work conditions.

It depends on your doctor’s definition of “lie low.” If your doctor is not suggesting surgery and you’re wearing your brace as prescribed, you are probably safe to get up and do some light activity. Most doctors prefer not to have their patients simply lie in bed for long periods of time. Muscles weaken, joints stiffen, and many complications can develop, such as pneumonia, bed sores, and other problems.

There has been some controversy over whether it’s safe to be mobile after having a fracture such as the one you’ve described. Some doctors suggest six weeks of bed rest; others want you up and moving wearing a brace. Recent research suggests that activity, including walking, is safe as early as the day of the injury, but only to the point of pain. At the very least, moving around prevents problems that sometimes come from long periods of bed rest. 

Make certain you understand your doctor’s definition of how much you can do. It’s possible you’re safe to get up and do tolerable activities now, but your doctor may want you to limit movement until he or she is certain your back is healing correctly.

If you were doing heavy labor, you’ve probably got a fifty-fifty chance of going back to your job. Your chances are slightly better if you had surgery that used screws to stabilize your spine. People doing light work have an easier time returning to their jobs after a fracturing a vertebra in their lower spine.

This is a serious type of injury, and you will want to take care of your back to ensure the best possible recovery. You may need to work with a physical therapist to make sure you’re safe to do construction work. A physical therapist can make suggestions about how to do your work safely. A  physical therapist can also be a resource for going in another direction if you simply can’t get back to your former type of work.

While it’s true that, like any surgery, spine surgery can lead to other problems, paraplegia–or paralysis of the body’s lower half–usually isn’t one of them. Complications such as infection are far more common.

If the fracture has caused an injury to the nearby nerves, you could end up having muscle weakness or numbness whether you have surgery or not. And if the fracture is putting the nerves at even more risk, surgery may be the best option.

Still, if you’re reluctant to have surgery, you should know that you have options. Research has shown that patients who have screws surgically implanted in their spines for a fracture like yours recover more quickly than those who do not, but this difference goes away after a year. Two years after injury, patients who do or don’t have surgery feel about the same.

Talk with your doctor about your alternatives. While spine surgery probably won’t lead to paralysis, it is serious business. It’s important to make the best decision for your needs and condition.

Saying back pain is “all in your head” is one way our society brushes serious issues aside, like the challenges workplaces can put on workers’ health. People prefer to think that your backache makes it hard for you to handle your work. But some doctors have suggested the very opposite–that your workplace makes it hard for you to handle your backache.

Research has shown that if you take time off for chronic, disabling back pain, you are less likely to return to work as you get older. There’s a reason for this. Studies have shown that stress in the workplace can potentially lead to poor general health among workers. A stressful or unstable work setting can also make back pain even less tolerable. When you already suffer from back pain, a difficult workplace can be like “the straw that breaks the camel’s back.”

Heavy labor or not, the personality of your workplace can take a toll on your back. You may want to consider other job options. You may also want to work with a physical therapist who can suggest stress-reducing exercises and help you cope with your back pain if the stresses at the workplace stay high.
 

It is common for medical people to describe discectomies as “removing a disc.” But usually only a small piece is removed from the outer ring of the disc (the annulus) or from the middle of the disc (the nucleus pulposus). Scar tissues then fills that area.

In some fusion surgeries, the disc is completely removed. It is usually replaced by a bone graft or a metal cage.

The ultrasound that lets doctors look at organs inside the body is different than therapeutic ultrasound. Therapeutic ultrasound uses much lower frequencies, and it could harm a developing fetus. No one really knows what effects therapeutic ultrasound has on a fetus. Some doctors think that the fetus is protected from ultrasound waves by the mother’s pelvic bones for about four months into pregnancy. But most doctors would rather be cautious.

There are many other treatments you can try to ease your low back pain. Ask your doctor or therapist about massage, posture training, positioning, or support belts.

Good physical conditioning is best in any situation. However, some types of exercises for the back and pelvis, such as lying face down and lifting one leg, have actually been shown to worsen pain and fatigue in women with back pain after pregnancy. Learning how to move and lift safely and how to use a pelvic belt are two things that can help. It might also help to know that a “tincture of time” (usually about six months) may be needed before symptoms go away. If your pain is getting worse, is too much to bear, or is not going away after about six months, talk to your health care advisor.

Unfortunately, back pain is very common in pregnancy. Usually it will go away on its own within the first year after delivery. If it doesn’t get better in that time, you may have a more chronic problem. It’s estimated that about one-fourth of all women with chronic back pain develop the condition during pregnancy. There are many ways to approach chronic back pain. See your health care provider if your back pain feels like it is getting worse, is severe, or doesn’t go away with time.

Women in their last couple months of pregnancy sometimes walk with a waddle. Your body is releasing a hormone called relaxin, which loosens the joints in your pelvis (and everywhere else in your body). Also, the weight of the pregnancy stretches and puts a lot of pressure on the groin area. Those two factors can affect how you walk and are likely causing the ache in your groin.

If your ache turns into pain, or if it becomes unusually difficult to get around, consult your health care provider. Otherwise, wait for it to go away on its own after delivery. But be patient! It may take up to six months for pelvic pain to go away after pregnancy.

Ideally, surgery will help lessen your pain. The main goals of spine fusion surgery are to prevent movement between the section of your spine that is causing your pain and to stop your problems from progressing. After surgery, your doctor and a physical therapist can help you pinpoint the source of your remaining pain and find ways to manage it.

That would probably be a good idea. The sacroiliac (SI) joint is where the pelvis meets the bottom part of the spine. Pain in the SI joint is common in the last trimester of pregnancy. At this time, your body produces a hormone called relaxin that helps loosen ligaments of the pelvis. This helps the baby fit through the birth canal. The problem is, relaxin makes all the ligaments in your body looser, putting them at risk for injuries. If you strained your hips while your joints were affected by relaxin, you might have stretched the SI ligaments too far.

Your doctor will have some recommendations for ways to get rid of the pain. You might need to work with a physical or occupational therapist. A therapist can help you manage the pain and design an exercise program that will strengthen your SI joint.

Not necessarily. Doctors have found that people who have back injuries do better when they go back to normal activities as soon as possible. This is true even if the pain has not gone away completely.  

The pain of lower back injuries takes time to go away. You will need to be patient. Continue with your rehabilitation exercises, and try to do your normal activities as much as possible. Follow the guidelines given to you by your doctor and physical therapist. They can help you modify your activities so you don’t re-injure your back. Let them know if a particular task aggravates your condition. They can help you find ways to change your job or change the way you do the task so that you don’t hurt yourself again.