Chronic Back Pain: Causes, Treatments, and Next Steps

Unresolved back pain?

Dr.
Hsu: Hello, in February I experienced back pain.
Once, while helping a nurse lift a patient from the ground, I heard a slight cracking sound, but since I didn't feel much discomfort, I didn't think much of it.
However, I later developed back pain, which I suspect is an injury.
Pressing on the vertebrae is painful, but I don't feel much discomfort when standing upright.
Bending over, such as tying my shoes or picking something up, causes significant pain, and my muscles suddenly tighten, with a spreading stiffness that lessens after some movement.
I saw a doctor in February, and after an X-ray, they said my bones were fine and prescribed anti-inflammatory medication and muscle relaxants, which provided some relief.
However, the pain has recently returned, seemingly without a cure, as it fluctuates, and I feel warmth in the affected area when I touch it (please don’t say I’m sensitive; I previously had a knee ligament injury that caused inflammation and warmth for a whole year, and it was difficult to explain to doctors).
I would like to ask: 1.
Is it possible that the periosteum, muscles, or soft tissues (excluding bones) are injured and not healing properly, potentially leading to bone spur issues in the future? 2.
Should I see an orthopedic doctor or a rehabilitation specialist? 3.
Besides X-rays, what other tests can help determine if there is an injury to the spine? Would a CT scan or other imaging be appropriate? 4.
I used to do flexibility exercises and swim, but now both bending forward and backward at the lumbar spine are painful, and lying flat with my legs bent towards my chest also causes back pain.
Additionally, when I hula hoop, my right hand goes numb (which I never experienced before).
Now, I only swim and am hesitant to do exercises.
Should I continue to exercise or limit my activity? Thank you for your response.

Kunhuo, 40~49 year old female. Ask Date: 2004/06/01

Dr. Xu Xijing reply Orthopedics

Please visit the outpatient clinic for a consultation.

Reply Date: 2004/06/01

More Info

Chronic back pain can be a complex issue, often stemming from a variety of causes, including muscle strain, ligament sprains, or even underlying structural problems in the spine. Based on your description, it appears that your back pain began after a specific incident where you assisted a nurse in lifting a patient. The "crack" sound you heard could indicate a sudden movement that strained your back muscles or ligaments, leading to the pain you are experiencing now.

1. Potential Causes of Your Pain: Given that you have tenderness upon palpation of the spine and pain during certain movements, it is likely that you have sustained an injury to the soft tissues surrounding the spine, such as muscles or ligaments. Chronic inflammation in these areas can lead to muscle tightness and spasms, which may explain the sudden tightening and stiffness you feel. While bone spurs (osteophytes) can develop over time due to chronic strain or inflammation, they are typically associated with degenerative changes in the spine. Therefore, it is essential to address the underlying soft tissue issues to prevent further complications.

2. Next Steps in Medical Consultation: When seeking further medical advice, it would be beneficial to consult with a specialist in physical medicine and rehabilitation (physiatrist) or an orthopedic doctor. A physiatrist can provide a comprehensive approach to managing pain through physical therapy, medications, and lifestyle modifications. An orthopedic specialist can evaluate for any structural issues that may require intervention.
3. Diagnostic Imaging: While X-rays are useful for assessing bone integrity, they do not provide a complete picture of soft tissue injuries. A magnetic resonance imaging (MRI) scan would be more appropriate for evaluating soft tissue structures, including muscles, ligaments, and intervertebral discs. An MRI can help identify any herniated discs, muscle tears, or other abnormalities that may be contributing to your pain. A computed tomography (CT) scan can also be useful, particularly if there are concerns about bony structures, but it is less effective than an MRI for soft tissue evaluation.

4. Exercise Recommendations: It is crucial to maintain a balance between activity and rest. While it is essential to avoid movements that exacerbate your pain, complete inactivity can lead to muscle weakness and stiffness, worsening your condition. Gentle stretching and low-impact activities, such as swimming, can be beneficial. However, you should avoid exercises that involve bending or twisting motions until you have a clearer understanding of your injury. Consulting with a physical therapist can provide you with a tailored exercise program that focuses on strengthening your back and core muscles while ensuring that you do not aggravate your condition.

In summary, chronic back pain can arise from various factors, and addressing it requires a comprehensive approach. Consulting with appropriate specialists, obtaining advanced imaging studies, and engaging in a tailored exercise program can help you manage your symptoms effectively. Remember to listen to your body and avoid activities that trigger pain, while gradually reintroducing movement as tolerated.

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