Back Pain

Ask our expert about when to see a doctor

About Our Expert

Joshua Krassen, D.O., is a physiatrist at Lehigh Valley Health Network.

• My back hurts. What should I do?
• Why does my back hurt?
• How do I know when back pain is serious?
• When should I go to the doctor?
• What kind of doctor do I need?
• How do doctors diagnose back problems?
• How is back pain treated?
• When is surgery needed?
• What type of surgery is available?
• How can I prevent back pain?

Q: My back hurts. What should I do?

A: Most back pain is due to a muscle sprain or strain. These problems are not usually serious and clear up quickly. If you experience back pain, rest for a day or two, take an anti-inflammatory medicine like ibuprofen and change any daily activities that would aggravate it. If the pain persists, call your primary care doctor.

Q: Why does my back hurt?

A: The two main causes of back pain are muscle sprains or strains and disc problems. Discs are located between your vertebrae and serve as shock absorbers for your spine. There are several types of disc problems:

• A herniated disc is a protruding disc fragment that presses against the nerves within the spine. If it hits the sciatic nerve,(the nerve that runs down the leg into the foot), severe pain and numbness can result.
• A degenerative disc is one that has worn away. This condition may be caused by injury, but more often results from the normal wear and tear of aging. Sometimes it causes no pain and sometimes it does.

Other conditions include spinal stenosis, a narrowing of the spine that pinches the spinal cord and nerves, causing pain and numbness in the legs. Osteoporosis, a weakening of the bones, can weaken the spine, causing instability and pain in the back.

Q: How do I know when back pain is serious?

A: It may be serious if the pain persists or travels down one or both legs, if you have numbness and weakness in one or both legs, or if you have severe back pain along with bowel and bladder problems.

Q: When should I go to the doctor?

A: That depends on the type and location of the pain and what caused it.

• If you are in a traumatic accident and have severe back pain, go to an emergency department or call your primary care doctor right away.
• If the pain is due to a lifting or twisting injury or another strenuous or overuse injury, try a few days of rest and anti-inflammatory medication. If it does not improve, call your primary care doctor.
• If you have an accident that causes back pain and leg weakness or incontinence, go to an emergency department or call your primary care doctor right away.
• If you have severe back pain along with bowel and bladder problems, go to an emergency department or call your primary care doctor right away.
• If the pain extends down one leg, you may have a herniated disc that is pinching a nerve. You should have a doctor evaluate your condition.

Q: What kind of doctor do I need?

A: Your primary care doctor may be able to diagnose and treat less serious back problems. You also may see a physiatrist, a doctor that specializes in physical medicine and rehabilitation. Physiatrists treat a wide range of problems, from sore neck, back and shoulders to spinal cord injuries, and focus on restoring function. If you have severe pain or immobility that does not get better, you may need to see an orthopedic surgeon or neurosurgeon who specializes in spinal surgeries.

Q: How do doctors diagnose back problems?

A: To make a precise diagnosis, the doctor will want a complete medical history and physical examination. If necessary, they may order an X-ray, CT scan or MRI to get a detailed picture of your spine.

Q: How is back pain treated?

A: Treatment is based on your age, overall health and medical history, the cause of your back pain, your ability to tolerate specific medications and your preference for care.

Treatment usually begins with rest, changing your activity and taking anti-inflammatory medication. Your doctor may refer you to a chiropractor, a specialist in adjusting the vertebrae of your spine. Your doctor may suggest physical therapy or acupuncture as other treatment alternatives. You may have to wear back supports, take medication or have an injection of steroids along the spine (epidural). Your doctor may ask you to lose weight or change your activity level.

Q: When is surgery needed?

A: When more conservative treatments do not work for at least six months or there is significant neurological loss, weakness and pain, your doctor may ask you to consider surgery.

Q: What type of surgery is available?

A: There are several types of surgery, depending on your specific condition and overall health:

• A micro-discectomy is surgery done through small incisions (minimally invasive) to remove disc fragments pressing against nerves in the spine. This may help if you have a herniated disc.
• Spinal fusion uses rods and screws to connect vertebrae, removing pressure on the spinal cord and nerves, thereby relieving pain.
• Cervical spine surgery removes pressure on the spinal cord or nerves due to degenerative disorders, trauma or instability in the neck.
• Disc replacement surgery replaces a damaged disc with an artificial disc. This surgery is approved for specific discs in the lower back (lumbar) and the cervical (neck) spine as well.

Q: How can I prevent back pain?

A: Practice good posture while walking and sitting. Lift heavy objects by bending at the knees, not at the waist. Exercise regularly and put an emphasis on strengthening abdominal muscles. Stretching techniques used in yoga are also a great way to prevent back pain. Avoid smoking and reduce emotional stress, which may cause muscle tension and lead to back pain.

This page last updated 5/27/09 02:22 PM