Understanding Lower Back Pain

Lower back pain is very common, with most people experiencing a strained or pulled back muscle at some point in their life. The U.S. Department of Health and Human Services estimates that at least 39 percent of adults have had back pain in the past three months.

While lifting a heavy box incorrectly, or taking a long car ride, might cause pain, people can take precautions to prevent injury and protect themselves.

Rajiv Saigal, MD, PhD, a neurosurgeon with the Bell Neuroscience Institute at Washington Hospital, advised people to have an exercise plan, practice good work ergonomics and proper posture, maintain a healthy weight, and be mindful of body mechanics.

Dr. Saigal, who is certified by the American Board of Neurological Surgery, and a member of the UCSF Health faculty, said: "Almost everyone will suffer with lower back pain at some point, and there are a lot of simple things we can do to prevent problems, treat pain easily, and stay out of trouble."

"I’d like people to have more knowledge about the causes of lower back pain, and to know when they can manage it themselves and when they need to see a doctor," he said. "It’s best to recognize the red flags for more serious problems."

Most Pain is Caused by Musculoskeletal Strain

The No. 1 cause of lower back pain is musculoskeletal strain, more commonly referred to as a pulled muscle, according to Dr. Saigal, occurring most often when people lift or bend incorrectly, or have a minor injury from sports or an activity they aren’t accustomed to.

To avoid musculoskeletal problems, he recommended using one’s legs when bending to avoid straining the back. "Make your legs do the work," he said.

When sitting at a desk working or doing an activity for long periods of time, he suggested an ergonomic work space and sitting straight, with hips pulled as far back on the chair as possible. He also advised having a laptop or other device at eye level to avoid pulling your neck and head forward.

Most cases of minor musculoskeletal injury can be managed at home with rest, application of heat or cold, and over-the-counter medications, he explained. People usually get better within a few weeks. "Listen to your body. Consider what makes the pain worse and what makes it better." Heat can relax muscles and cold can numb the pain, he added. Applying either is fine.

Knowing When to See the Doctor

Some conditions, however, require a visit to the doctor, according to Dr. Saigal, who noted that it’s best to start with your primary care provider (PCP). Sometimes the PCP can prescribe non-surgical measures to help, including physical therapy, acupuncture, oral anti-inflammatories, topical gels and creams, injections and neuropathic pain medications. The PCP can also make a referral to a spine specialist.

"Back pain alone is less concerning than back pain with extremity pain," he noted, "especially pain that shoots down the leg and arm. That can mean a nerve is pinched."

Some conditions, including spinal stenosis, car accident injuries, cancer, spinal deformity, degenerative and congenital problems may require surgery, but he assured people that there are many minimally invasive procedures that provide easier recovery and excellent outcomes.

"My philosophy is to first try non-surgical measures, and to give patients the best chance at a good outcome."

Dr. Saigal listed the red flags of when to see a doctor because the back pain isn’t resolving and may be more serious than a pulled muscle:

• Back pain that radiates down the legs or arms which could indicate a pinched nerve.
• Weakness or numbness in the legs or arms.
• Imbalance issues or difficulty walking.
• Difficulty going to the bathroom or an inability to fully empty one’s bladder.

Minimally Invasive Surgery

If surgery is indicated and a patient needs to see a spinal surgeon, he urged people not to be overly concerned. Many new options for minimally invasive surgery and same-day procedures have made the process much easier. New advanced procedures minimize blood loss, reduce length of hospitalization, facilitate a quicker recovery, and provide excellent outcomes.

In addition to Dr. Saigal, the Bell Neuroscience Institute includes a team of talented neurologists and neurosurgeons who are fellowship trained and provide the highest quality of care. Patients can get the specialized care they need right in Fremont without having to travel.

Dr. Saigal will discuss this topic during an online seminar, Understanding Lower Back Pain, on Jan. 22, at 5 p.m. You can view his presentation on:

• Facebook.com/WashingtonHosp
• YouTube.com/whhsInHealth

Tune in to watch the seminar debut on the above date or at your convenience beginning the following day.

For more information about Dr. Saigal and the Institute, visit the Washington Hospital website.