Dear Ask The Doctor: Hello, about 4 months ago, i started getting back pain, and i do not know where it came from, it was not too bad so i decided to wait and see what happened and about a month later, it was gone, another month after that, it came back, only this time it was a lot worse. I went to an orthopedic specialist and my doctor diagnosed it as a lower lumbar strain and recommended physical therapy and put me on pain killers. I have now been in physical therapy for over a month and a half and i am not seeing much improvement, if any at all. The pain is in my lower back, and it does not go away even when i am sitting in a comfortable chair or lying in bed (because of this i am unable to sleep). The pain gets worse during physical activity, or anything that involves bending or crouching, and occasionally when i bend over or lean forward while sitting i get a very sharp pain shooting through my back, then it goes away, and when i am sitting up right i cannot extend my legs out in front of me without pain, it also gets worse when i touch my chin to my chest. The reason i ask is that my doctor is trying to take me off the pain killers without even seeing me or knowing whether or not i am still in pain, and the soonest appointment i could get is not for several weeks. Could this be something other than a simple muscle strain, is it normal that it takes this long to go away, is there anything else i can do for the pain since my doctor is intent on taking me off the pain medication? I would also like to add that he tried putting me on muscle relaxants (amrix) and it made the pain worse.
Dear Nicholas: Mechanical low back pain (LBP) is the second most common reason for seeing a physician in the United States. Of the US population, 85% will experience an episode of mechanical LBP at some point during their lifetime. Fortunately, the LBP resolves for the vast majority within 2-4 weeks. Sometimes it may complicate with a sciatic nerve inflammation. The suggested strategy would be: using a physical therapy program aimed to: keep your weight under control, because the overweight suppose additional stress to the lumbar spine, control the pain and the inflammatory process, anti-inflammatory medication (“Motrin”, “Aleve”), relative rest, flexion and extension exercises of the spine to reduce the nerve tension, exercises that improve the muscular strength and endurance of lumbar muscles, also follow these general recommendations: sleeping with a pillow between the knees while lying on one side may increase comfort, lying on his back with a pillow under the knees. If the pain episode persists for more than 2 months, it is strongly recommended that you get an evaluation by a physician to rule out more serious conditions as a disc hernia.