Low back pain
Low back pain is one of the most common pain complaints, with an estimated 80% of people experiencing it at some point in their lives. Although one school of thought holds that most of these complaints fall under “non-specific low back pain”, another (which we share) argues that a thorough clinical examination correlated with imaging can lead us to the specific source of the pain, so that it can be treated properly.
Low back pain falls into two broad groups: axial (in the middle of the back) or radicular (radiating into the legs).
In axial pain, one of the most common causes is facet arthropathy, that is, osteoarthritis or inflammation of the small joints at the back of the spine. Inflammation of these structures is due to postural changes, particularly increased lumbar lordosis (a more pronounced curve in the lower back). Image-guided lumbar medial branch blocks or lumbar medial branch radiofrequency usually reduce pain dramatically, opening a pain-free window for proper postural correction.
In radicular pain, one of the most common causes is a herniated disc. These cases require rigorous correlation of clinical and imaging findings to define an individual plan. As conservative (non-surgical) measures, intradiscal or epidural injections usually allow good pain control.
There are also many other structures within the spectrum of low back pain, such as sacroiliitis (inflammation of the sacroiliac joint), inflammation of the many attachments of the thoracolumbar fascia and pain radiating from the buttock due to sciatic nerve compression there; each has different possible solutions depending on the case.
Postural correction is a cornerstone of treating low back pain, without which many other treatments may not make sense.
It is worth noting that all low back pain comes with associated muscular pain, a kind of “defence” by the body, which can sometimes be more intense than the pain from the originally injured structure and so must also be treated properly. Heat, massage and stretching are usually a universal formula that helps control the associated pain flare-ups.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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