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Almost everyone gets back pain at some point. Although they cause a lot of pain, most back injuries are not serious and the pain usually goes away on its own. This newsletter will focus specifically on new back injuries, and not chronic back pain.

Back injuries can involve any of the following parts of the back (see image below):

  1. Bones or “vertebrae”. These sit on top of one another like a stack of coins.
  2. Intervertebral disks are rubbery and sit in between the bones. They function as cushions or shock absorbers.
  3. Spinal Cord and Nerves. The spinal cord connects the brain to the rest of the body. Nerves come off of the spinal cord and pass in between the vertebrae. From the lower back, the nerves travel to the lower abdomen and also down the legs. This is why a pinched nerve in the back can cause pain in the leg.
  4. Muscles, tendons, and ligaments – Together the muscles, tendons, and ligaments are called the “soft tissues” of the back. These soft tissues support the back and help hold it together.

Types of Injuries

Low Back Strain. The most common back injury is a “strain” of the muscles, tendons, and ligaments. These are usually not serious and will often improve in 1-2 weeks.
Vertebral Fractures. The soft tissues of the lower back help protect the bones from a fracture. In the average healthy adult, it takes a lot of force to cause a vertebral fracture. These are fairly uncommon unless you’ve been in a serious car accident or fallen off a ladder. However, in the elderly or those with osteoporosis, a fracture can occur from even a minor fall.
Herniated Disk. This occurs when a portion of the disk bulges or pushes out beyond its normal boundaries. Pain occurs because the disk pushes against the spinal nerve as it comes out between two vertebrae. (see image below)
Spinal Cord and Nerve Injuries are rare are usually caused by serious trauma. They will cause weakness and numbness in the legs.

Evaluation

Most back injuries can be diagnosed with a medical history and physical exam. Doctors usually do not order imaging tests such as Xrays unless there are signs of something unusual. If your doctor suspects a fracture, they may order an XRay or MRI. XRays are helpful if your doctor is looking only for a fracture, but they do not show soft tissues such as disks, muscles, tendons, and ligaments. If your doctor suspects a serious disk herniation or spinal cord injury, he may order an MRI.

Treatment

Keep in mind that most minor back injuries such as strains will get better regardless of the treatment. Vertebral fractures and spinal cord injuries are serious problems that usually require treatment in the ER, and sometimes require surgery. As back strains and herniated discs are the most common types of injuries, we will discuss treatment for these conditions here.

Most strains and herniated discs can be treated with a combination of rest and medication. Rest does not mean bed rest. Bed rest can actually worsen pain from spasm. It is fine to walk or move about, just avoid anything strenuous that may worsen your injury such as running, jumping, or climbing a lot of stairs. Try to get back to your normal routine, just don’t overdo it.

What medications should you use? In general, over the counter anti-inflammatories such as ibuprofen (Advil, Motrin) or naproxen (Aleve) work well for back injuries. If you are allergic or have a sensitivity to these types of medicine, then Tylenol may also help. If these do not help, your doctor can prescribe stronger pain medicines. Sometimes, doctors suggest a medicine to relax the muscles (called a “muscle relaxant”). But keep in mind that muscle relaxants have serious side effects, particularly in older patients.

After an injury, we do not recommend physical therapy or spinal manipulation unless the pain does not improve after one month.

When you start to feel better, ask your doctor or nurse about exercises that can help strengthen your back. These exercises can help you get better faster and might make it less likely that you will have pain again.

When should you see your doctor?

See your doctor or come to Access Now Urgent Care if you have any of the following:

  • Your pain is severe and not relieved with over the counter medication
  • Your pain does not improve after 2 weeks
  • Numbness or weakness in your legs
  • Sudden new problems with bladder or bowel control
  • Unexplained weight loss
  • Abdominal pain
  • Blood in your urine
  • You are on steroid medicine such as prednisone
  • You have serious medical problems such as cancer, diabetes or heart disease
  • You have osteoporosis
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Shobhit Arora