Back Pain +/- Sciatica

Back syndrome without radiating pain, often referred to as non-specific back pain, is a common condition characterized by discomfort in the back without the pain spreading (radiating) to other areas like the legs. 

Causes

  • Muscle or Ligament Strain: Due to heavy lifting or sudden awkward movements.
  • Degenerative Changes: Such as osteoarthritis or spinal disc degeneration.
  • Poor Posture: Prolonged sitting or standing in poor posture.
  • Obesity: Excess body weight puts extra stress on the back muscles and spine.
  • Sedentary Lifestyle: Lack of regular exercise can weaken back muscles.
  • Stress: Can cause muscle tension in the back.
  • Age: Risk increases with age.

Diagnosis

  • Medical History: Evaluation of symptoms, lifestyle, physical activity, and any history of injury.
  • Physical Examination: Assessing range of motion, muscle strength, nerve function, and areas of tenderness.
  • Imaging Tests: Generally not required initially but may include X-rays, MRI, or CT scans if symptoms persist or if specific conditions are suspected.

Red Flags

  • pain that lasts more than 6 weeks;
  • pain in persons younger than 18 years or older than 50 years;
  • pain that radiates below the knee;
  • a history of major trauma;
  • constitutional symptoms;
  • atypical pain (eg, that which occurs at night or that is unrelenting);
  • the presence of a severe or rapidly progressive neurologic deficit;
  • urinary and/or fecal incontinence;
  • poor rectal tone; and
  • a history of malignancy.

Differential Diagnosis

  • Sciatica: Characterized by lower back pain that radiates down the leg.
  • Herniated Disc: Can cause back pain, with or without leg pain.
  • Spinal Stenosis: Narrowing of the spinal canal, usually presents with leg pain upon walking.
  • Kidney Stones or Infections: Can cause back pain, usually on one side.
  • Inflammatory Diseases: Like ankylosing spondylitis.
  • Osteoporosis: Can lead to fractures that cause back pain.

Management

  • Self-Care Measures:
    • Rest: Short periods of rest but prolonged inactivity are not recommended.
    • Heat or Cold Therapy: For pain relief and to reduce inflammation.
    • TENS
    • Exercise: Low-impact activities like walking or swimming to strengthen back muscles.
    • Posture Correction: Ergonomic adjustments in daily activities.
  • Medications:
    • Pain Relievers: Over-the-counter pain relievers like NSAIDs or paracetamol.
    • Muscle Relaxants: In cases of severe muscle spasms.
  • Physiotherapy:
    • Tailored exercises to improve flexibility, strength, and posture.
    • Techniques to manage pain and prevent recurrence.
  • Alternative Therapies:
    • Acupuncture
    • Chiropractic Care
    • Massage Therapy: To relax tense muscles.
  • Lifestyle Changes:
    • Weight Management: To reduce stress on the back.
    • Stress Management Techniques: Like yoga or meditation.
    • Quit Smoking: Smoking can exacerbate back pain.
  • Surgery: Rarely needed for non-specific back pain but may be considered for persistent pain due to identifiable structural problems.

Conclusion

Most cases of back syndrome without radiating pain can be effectively managed with conservative treatments, including physical therapy, medications, and lifestyle changes. It’s important to stay active and avoid prolonged bed rest, which can worsen symptoms. If the pain persists despite these measures, or if there are signs of a more serious condition, further medical evaluation and possibly more advanced treatments may be necessary. Regular follow-ups are recommended to monitor progress and adjust treatments as needed.

Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg. It’s typically felt on only one side of the body.

Causes

  • Herniated Disk: The most common cause, where a disk in the spine presses on the sciatic nerve.
  • Bone Spur: On the spine that can press on the nerve.
  • Spinal Stenosis: Narrowing of the spinal canal, which compresses the nerve.
  • Piriformis Syndrome: When the piriformis muscle in the buttocks irritates the sciatic nerve.
  • Spondylolisthesis: A condition where a vertebra slips out of position.
  • Tumors or Infections: Rarely, these can affect the spine.
  • Pregnancy: Due to changes in weight and posture.

Diagnosis

  • Physical Exam: Includes checking muscle strength and reflexes. The doctor might ask the patient to perform activities like walking on their toes or heels, rising from a squatting position, or lifting their legs one at a time while lying on their back.
  • Straight Leg Raising Test: Lifting the leg induces sciatic pain, indicating sciatica.
  • Imaging Tests: MRI, CT scans, and X-rays to identify herniated disks, bone spurs, or other spinal abnormalities.
  • Nerve Tests: Electromyography (EMG) to check nerve conduction.

Differential Diagnosis

  • Muscle Strain: Can cause similar symptoms but lacks nerve pain.
  • Hip Arthritis: Causes pain in the hip or groin rather than radiating nerve pain.
  • Peripheral Neuropathy: Especially in diabetic patients, can mimic sciatica.
  • Deep Vein Thrombosis (DVT): Can cause leg pain but is more associated with swelling and warmth.

Management

  • Non-Surgical Treatments
    • Heat/Ice Therapy: For acute pain relief.
    • TENS: For acute pain relief.
    • Lifestyle Modifications: Weight management, ergonomics at the workplace, and regular exercise.
    • Physiotherapy: Exercises to improve posture, strengthen the muscles supporting the back, and increase flexibility.
  • Medications:
    • Pain Relievers: Over-the-counter pain relievers such as ibuprofen or naproxen.
    • Muscle Relaxants: For muscle spasms.
    • Nerve Pain Medications: Gabapentin, duloxetine.
    • Corticosteroid Injections: Reduce inflammation around the nerve root.
  • Surgical Treatments
    • Indicated when conservative treatments fail, or if there are signs of significant nerve compression, such as weakness or loss of bowel or bladder control.
    • Microdiscectomy: Removal of the herniated part of a disk.
    • Laminectomy: Widening of the spinal cord canal to relieve pressure.

Conclusion

Sciatica is typically resolved with non-surgical treatments, but a small percentage of patients may require surgery. A comprehensive approach, including physical therapy, medications, and lifestyle changes, often provides significant relief. Understanding the root cause is essential for targeted treatment, and regular follow-up is important to monitor progress and adjust treatments as needed.