Signs and Symptoms
Low back pain can feel like a dull ache, a sharp catch when you bend or twist, or a tight band across the lower back. You may notice:
- Stiffness in the morning or after sitting for a long time
- Pain that gets worse with bending, lifting or standing for long periods
- Muscle spasms or tightness on one or both sides of the spine
- Pain that spreads into the buttock or down one leg, which can point to an irritated nerve (sciatica)
- Trouble sleeping or finding a comfortable position
What Causes It?
Most low back pain is mechanical, meaning it comes from the muscles, ligaments, joints and discs of the spine rather than from a serious disease. Common causes include muscle or ligament strain, age-related wear of the discs (degenerative disc disease), arthritis of the small facet joints at the back of the spine, a herniated disc, and narrowing of the spinal canal (spinal stenosis).
Risk factors include heavy or repetitive lifting, long periods of sitting, weak core muscles, extra body weight, smoking and previous back injuries. In older adults with thin bones, a sudden onset of back pain can be a compression fracture of a vertebra.
How We Diagnose It at POPB
Dr. Baskin starts with a detailed history and a hands-on exam of your spine, hips and nerves, checking strength, reflexes and sensation in your legs. Many people with back pain do not need imaging right away. When it will change your care, X-ray and MRI are available in our office, so you do not need to schedule them somewhere else.
If a specific joint or nerve seems to be the source, a fluoroscopy-guided diagnostic injection (a small dose of numbing medicine placed with live X-ray guidance) can help confirm where the pain is coming from before planning further treatment.
Non-Surgical Treatment Options
Most people improve with non-surgical care. Your plan may include:
- Staying active with modified activity rather than bed rest
- Physical therapy in our office, focused on core strength, flexibility and safe movement. Our therapists share your chart with Dr. Baskin and adjust the plan together.
- Short courses of anti-inflammatory or other medications when appropriate
- Epidural steroid injections or facet joint injections, performed by Dr. Baskin with fluoroscopy guidance in our in-office procedure room
- Radiofrequency ablation, which uses heat to quiet the small nerves that carry pain signals from arthritic facet joints, when a diagnostic block has helped
Surgical Options
Surgery is rarely needed for low back pain alone. It may be considered when a nerve is badly compressed, when weakness is getting worse, or when pain has not responded to a thorough course of non-surgical care. Dr. Baskin does not perform spine surgery; if he thinks a surgical opinion makes sense, he will refer you to a spine surgeon and share your imaging and records.
For selected patients with long-standing pain that has not responded to other treatment, Dr. Baskin also offers advanced neuromodulation (spinal cord stimulation), which uses mild electrical signals to change how pain is felt.
Recovery
Many episodes of acute low back pain improve noticeably within two to six weeks. Relief after an injection often starts within a few days, although timing and how long it lasts vary. Physical therapy usually runs for several weeks, and a home exercise program helps lower the chance of flare-ups. Recovery varies from person to person.
Insurance and Cost
Office visits, imaging, physical therapy and spinal injections are generally covered by Medicare and most commercial PPO plans when medically necessary. Some plans require prior authorization or a trial of physical therapy before injections or radiofrequency ablation. If you have an HMO or managed-care plan, your referral must be in our office before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if your back pain lasts more than a few weeks, keeps coming back, wakes you at night, or spreads down your leg.
Call promptly, even without those red flags, if back pain comes with a history of cancer or unexplained weight loss.
Go to the emergency room or call 911 if back pain comes with any of these red flags:
- Loss of bladder or bowel control, or new trouble urinating
- Numbness in the groin, genitals, inner thighs or buttocks (saddle numbness)
- Leg weakness that is getting worse
- Fever or chills with back pain
- Back pain after a major trauma such as a car crash or a serious fall
