Lower back and leg pain since January

Dear Ask The Doctor: Starting sometime in late January I started feeling lower back pain and eventually it traveled into my right buttocks, now I can feel slight pain in the back side of my entire right leg. The pain started during a period when I had been lifting weights very heavily. The pain is worse when I've been laying for an extended period of time or sitting down at all, exercise tends to alleviate pain. I saw my family doctor about this a few weeks ago and he told me that I had pinched a disc/nerve in my lower back and that if I did some stretches he gave me the pain would go away in a few weeks. I've been doing the stretches (which are excruciating by the way) and the pain has only gotten worse, any ideas? Thank you

Dear Nick: The pain in the lower back is a common concern, and it affects roughly up to 90% of Americans at some point in their lifetime. According with the medical literature, up to 50% will have more than one episode. Back pain is not a specific disease but it is a symptom that may happen from a wide array of different processes. In up to 85% of people with back pain, despite a thorough medical examination and imaging tests (X rays, MRI, CT scans), no specific cause of the pain can be identified and we call it: mechanical back pain. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine as follows: disc herniation that produces irritation of the nerve (i.e.: sciatica), spinal stenosis, deformities of the spine (i.e.: scoliosis, kyphosis), fibromyalgia, amongst the most common.

The suggested strategy to treat a lower back pain that has persisted for more than 1 month is as follows: evaluation by a physician to rule out other possible causes than just mechanic or postural and start a physical therapy program aimed to control pain, stretching and strengthening exercises, correct posture, and teach you an exercise routine that you can follow at home, also the use of anti-inflammatory drugs (i.e: “motrin”, “advil”, “aleve”) can be beneficial to manage the pain. Pain from sciatica will probably limit your activities. Here are some ways to ease the pain at home or at work: Do not bend, lift, or sit in a soft, low chair because your pain will get worse. Unless you are allergic or should not take them for other reasons (if you take a blood thinner such as Coumadin, for example), over-the-counter pain medicines such as acetaminophen (Tylenol), or ibuprofen (Advil, Motrin ) will probably help ease the pain. Try a cold pack to see if it helps to ease the pain. If you don't have a cold pack, use a large bag of frozen vegetables; it makes a good first aid cold pack. Or have someone close to you massage you in a triangular pattern with an ice cube over the sore areas, no more than 15-20 minutes at the time.  After the cold massages, try alternating with heat from an electric heating pad to see if it helps the pain. If you don't have an electric heating pad, put a hand towel under hot water, wring it out, and place it on your back. Sometimes the moist heat penetrates more deeply and gives better relief of pain. You may feel better lying on your back on a firm surface with a pillow under your knees. Another option is lying on your side with a pillow between your knees to keep your back straight. Also, you might find that a recliner chair is helpful. Finally, take it easy, but do not lie in bed for longer than 2 days because this has been shown to worsen the condition. Try to do activities that you are able to tolerate, and the most important: be patient and do not expect to feel better overnight. Nearly everyone improves within a month following these conservative measures if it is a mechanical back pain. If, with all the above, there is poor or no improvement, I strongly recommend that you get an evaluation by an orthopedic surgeon.