Lower Back Pain That Won't Go Away
Lower back pain that won’t go away indicates a more serious underlying issue. If a known injury caused the pain, but is not resolving on its own, the injury may be more severe than initially thought. Similarly, if back pain arises without a known cause and it persists for days or weeks, it is time to seek the assistance of trained professionals such as physical therapists.
Ignoring or trying to self-treat lower back pain can exacerbate the symptoms or even cause a potentially serious condition to progressively worsen. If you’re unsure if you should visit a healthcare professional, there are a few warning signs that indicate the need for treatment.
Causes of Lower Back Pain That Won’t Go Away
Many adults in the United States and around the world experience some form of back pain at one time or another. The incidence rate is so high that back pain is one of the leading causes of absenteeism from work.
Lower back pain that is the result of an underlying health problem or injury rarely goes away completely without taking active steps to address the issue. Working with a physical therapist and engaging in regular modest exercise helps most people gain control of their back pain.
However, the cause of the pain needs to be identified in order for a therapist to offer a beneficial approach. Back pain may arise suddenly, and although it often originates in the lower back, the discomfort may gradually spread to other parts of the body.
Read on to learn about the different ways lower back pain may develop and possible reasons why , in some cases, it doesn’t go away.
Sudden Lower Back Pain
Back pain that arises suddenly may be due to stress, an awkward movement, an improper lifting maneuver, strenuous exercise, or an unexpected injury. If sudden pain is not the result of a serious problem, it should subside after a few days.
However, an event that causes significant trauma to one or more structures in the back may lead to pain that doesn't go away. In general, back pain that lasts longer than six weeks is described as chronic. Sudden lower back pain may also be sporadic, meaning that it comes and goes in an irregular manner. If this type of pain is recurrent, it is still considered chronic back pain.
If an individual experiences sudden, sharp lower back pain that persists for weeks or months, the ongoing issue may be linked to a new, unsuspected injury, an underlying condition that is progressing, muscle deconditioning, or even age-related degeneration of various structures in the back (e.g., spinal bones, discs, muscles). Any type of lower back pain that is problematic or reduces mobility should be evaluated by a physical therapist.
Middle Back Pain
Although lower back pain is most frequently reported by adults, some may also suffer from middle back pain. A health problem often linked to back aches is thoracic radiculopathy, which refers to a compressed (pinched) nerve root in the upper or middle part of the spine. This is the rarest location for a pinched nerve, as this issue usually develops in the cervical (neck) or lumbar (lower) spine following some form of nerve irritation.
The symptoms typically originate in the area where the compressed nerve root is located and include middle back pain, weakness, numbness, loss of reflexes, a sensation of pins, needles, tingling, and discomfort that spreads to the front of the body.
Radiculopathy typically develops due to abnormal changes in the tissues that surround nerve roots. This includes tendons, spinal discs, and bony structures located on vertebrae (spinal bones). When these structures shift, change in size, become inflamed, or are injured, they may reduce space in the spinal canal where nerve roots travel or decrease the size of the openings where nerves exit the spine.
For instance, small spinal openings between vertebrae where nerve roots exit are called foramina. The narrowing of these passages, which is known as foraminal stenosis, may lead to thoracic radiculopathy. This is a painful condition associated with middle back pain that may radiate toward the abdominal region and even the arms.
Another form of stenosis, called central canal stenosis, can lead to middle back pain as well. This condition refers to the narrowing of the spinal canal, which compresses (pinches) nerve roots and the spinal cord. The spinal canal is a protective, tube-like structure that encloses the spinal cord and nerve roots.
This form of stenosis decreases space around nerves and the spinal cord, leading to dysfunction and pain that corresponds to the region where the compression is occurring. Most cases of canal stenosis are observed in the lumbar (lower) or cervical spine (neck region), but it may also develop in the thoracic spine where it presents as middle back pain.
Additional causes of middle back pain include:
- Poor posture
- A herniated disc
- Muscle strains or sprains
- Falls or other injuries
Fractures that occur in vertebrae (spinal bones) following trauma from things like a car accident or sports injury can lead to middle back pain. The pain may be severe and worsen during movement. A serious fracture that impacts the spinal cord can also result in numbness, tingling, or incontinence. People who have decreased bone density or weak, brittle bones due to degenerative joint diseases, such as osteoarthritis, have a higher risk of experiencing spinal fractures.
Aging individuals are more likely to experience lower and middle back pain due to the natural aging process that involves gradual wear and tear on the body. This includes a loss of muscle mass and bone density (thinning bones) as well as decreased fluid between the spine and joints.
Obesity is linked to lower and middle back pain. This is because as weight increases, it puts more strain on the spine as well as spinal structures such as discs, tendons, and muscles that bear the body’s weight. Numerous medical reports indicate that the risk of experiencing back pain, including middle back aches, rises as weight increases.
Poor posture places the spine under repeated pressure that can cause middle back pain. More specifically, slouching or even leaning forward for extended periods can overwork ligaments and muscles that try to maintain balance by counteracting poor posture. Continuing to overburden back muscles, tendons, and ligaments can lead to middle back pain.
A herniated disc develops when the gel-like fluid inside of a spinal disc distorts the outer cartilage, causing the disc to shift out of place and put pressure on spinal nerves. This form of nerve compression can result in numbness, tingling, or pain in the middle back and other areas the affected nerves travel to (e.g., arms, legs).
Muscle strains or sprains can occur anywhere in the back. Strains develop in muscles or tendons, while sprains refer to injured ligaments. Both types of injuries occur due to extensive stretching or tearing of the tissues. Lifting heavy objects repeatedly, especially without maintaining proper body posture, can cause an individual to strain or sprain the back. Rapidly moving the body in an awkward way can also strain a muscle or sprain a ligament. These types of accidents may result in immediate middle back pain. However, the pain may also appear a few hours or days following the injury and gradually worsen.
Falls or other injuries typically cause more damage to the cervical spine (neck region) and lumbar (lower) spine than the middle back. This is because structures in the middle of the back are more rigid and robust than structures in other parts of the back. Therefore, middle back pain due to falls or sudden injuries is rare, but not impossible.
Incidents that might lead to middle back pain include falling down a flight of stairs, a car crash, or falling from a high place (e.g., ladder, roof) onto the back. Older individuals are usually more susceptible to falls than younger individuals, but a spinal injury that causes middle back pain can happen to anyone. Serious injuries often necessitate immediate treatment that may involve seeing a physical therapist.
Treatment for Lower Back Pain That Won’t Go Away
One of the first strategies to consider when lower back pain arises is to rest for a short period of time. Resting the back is an ideal option for minor injuries and strains, but it is important to make sure that the pain does not intensify. This suggests that the problem may be getting worse. People who have strenuous lifestyles or jobs should consider resting the back for 1-2 days, if possible, to give the back pain a chance to subside before resuming regular activity.
If the back pain starts to linger, it is time to consider speaking with a spine specialist such as a physical therapist. This is especially the case if nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin only provide temporary relief from the pain.
Chronic lower back pain is an indication that a more serious issue might be causing the pain and ineffective treatment approaches could exacerbate the problem. Physical therapists have comprehensive knowledge about the spine that allows them to make an accurate diagnosis and provide an effective treatment plan.
While an individual is receiving physical therapy, the use of over-the-counter pain relievers may still be recommended because these types of medications help alleviate pain by reducing inflammation and swelling. If regular strength NSAIDs are not effective, prescription-strength pain relievers are another option that may be offered. Pain medicine can also be injected directly into the affected region for cases of severe lower back pain.
Corticosteroid injections are one of the most commonly used forms of injectable medications administered to treat intense back pain. The corticosteroid helps reduce pain and inflammation by suppressing an overactive immune system response to inflamed nerves or injured soft tissue.
This type of treatment is usually recommended for people suffering from severe, chronic back pain because it can offer pain relief for several weeks or months at a time. However, medication management in conjunction with physical therapy affords most individuals the best outcomes.
Physical therapy incorporates moderate exercise with therapeutic techniques that promote recovery. Exercise may sound counterintuitive after a back injury, but moderate exercise is particularly beneficial for an aching back. This is because modest exercise helps strengthen back muscles and other spinal structures (e.g., ligaments, tendons, discs).
Exercise also helps release endorphins — pain-relieving proteins that boost mood and reduce sensitivity to pain signals. Carefully executed exercises can also improve flexibility, enhance range of motion, and support healing.
Working closely with a physical therapist is an optimal way to ensure that useful exercises will be performed properly. Physical therapists also teach people the importance of appropriate body mechanics, like good posture. Good posture can take unnecessary pressure off of the spine, help prevent further injury, and give damaged soft tissue a chance to heal.
In addition, a physical therapist watches for signs of progress or regression that might lead to a necessary adjustment of the treatment plan.
Lower back pain that won’t go away is typically difficult to self-treat because the underlying cause may not be properly addressed. Without a comprehensive evaluation from a healthcare professional such as a physical therapist, the pain might become even worse.
A minor injury may initially be ignored or treated with over-the-counter pain relievers if an individual thinks the pain will quickly resolve on its own. If the lower back pain becomes persistent, it might be tempting to keep waiting for the discomfort to subside, but this may never happen.
People who are struggling with lower back pain that won’t go away can experience significant relief by working with the well-trained physical therapists at FYZICAL. Our team of experts perform thorough assessments to help pinpoint the main issue linked to the discomfort.
After identifying the problem, one of our highly skilled physical therapists will design an individualized treatment plan to offer effective pain management. Please contact our office today to schedule a consultation.