Chronic Low back Pain: What can I do about it?

Patient

Q: I have a bad back. I've had back pain for at least 25 years. Nothing horrible but it's almost always there. Four days ago, I bent over to pick something up off the floor and I felt my lower back "pop." Right at the small of my back, I felt a "pop." This has happened before so I didn't think much of it. However, I've been in horrible pain ever since. The first day wasn't so bad but ever since it has felt like someone's taken a baseball bat to my lower back. I'm okay when I'm sitting. Once I'm standing, I'm sore but I can get by. The pain is at its worst when I'm in the process of standing up or sitting down and also when I try to walk (if I'm just standing there I'm okay). Pretty much any kind of movement is killing me. I've also noticed that when I try to bend my head down and try to touch my chin to my chest, my lower back starts to hurt. However, when I touch my lower back, I don't feel any pain. It's not like I'm sore to the touch. The problem is standing up, sitting down and walking around. If I stay seated, I'm okay. What did I do to my back? What can I do about it?

Doctor

A:   Lumbar facet arthropathy is one of the causes of chronic low back pain, but is usually not considered until conservative measures for treating low back pain (LBP) have been tried without success or an MRI confirm the diagnosis. The symptoms that you described, you feel more pain in some positions because in those positions the intervertebral space gets smaller and compress the correspondent nerve. When you bend your head down and try to touch your chin to your chest, your lower back starts to hurt because the para spinal muscles act as an unit from cervical to lumbar.
Basically the conservative treatment of the Lumbar Facet Arthropathy is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-educating you, teaching you a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: sleeping with a pillow between the knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above, with the objective to keep you as far as possible from episodes of acute low back pain, and also to preserve your quality of life. If the conservative measures do not seem to work, the local corticosteroid injection may be considered.

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