Back Pain

Lower back pain is second only to the common cold for why people seek medical care. Back pain may be mild or extreme and cause lost job time, lost personal time and can significantly decrease quality of life.

Causes of Back Pain

Causes of lower back pain can be caused by many different factors. Three factors that frequently are associated with lower back pain are the muscles of the lower back, the skeletal system and the nervous system.

Muscular low back pain is the most common type of back pain and often results when a person performs an activity that requires more strength or more endurance than the muscles of the lower back can provide. When muscles are forced to contract harder than they are able, then microscopic tears result causing significant inflammation. This is commonly called a back spasm or back strain.  One should not underestimate how much pain muscles can cause. Treating muscular low back pain first involves reducing the pain and inflammation so that one can move more freely.  Initial treatment is typically in the form of medications that decreased pain and inflammation.  The goal of this treatment is to encourage comfort and normal activity.  In some cases muscle spasm may be severe enough to require more aggressive treatment.  On occasion, small trigger point injections are used to reduce pain and spasm so that a person can sleep more effectively.  Trigger point injections actually have lower risks then giving narcotic pain medications. Once pain is manageable then a combination of massage therapy, then physical therapy combined with either acupuncture or medication management, can allow person to return to normal activity.  Once the pain level has decreased to a low enough level the treatment should be centered on strengthening the core muscles to prevent reoccurrence of the muscle pain.

Bone and joint problems are a common cause of chronic back pain. Unfortunately, disorders of the bones and joints can be difficult to diagnose.  The first step in determining bone or joint related back pain is a careful physical examination. The causes of pain can range from trauma or arthritis of the small joints called facets, tears in the discs of the spine or fractures of the bones of the spine.  Frequently, x-rays or MRIs are used to assist in diagnosing the exact cause of pain.  Rarely, carefully performed injections using x-ray guidance may be used to clarify the cause of pain if a physical exam and imaging are not enough.  These injections are frequently helpful in decreasing pain and allow other treatments to be more effective.  The mainstay of long term treatment and prevention of reoccurrence is to restore proper posture and strength to the spine and hip.  Sometimes injections or medications are required to reduce that pain so person move and sleep so they can participate in physical therapy.

Pinched nerves of the low back are often the most painful source of lower back pain and require the more urgent attention. Pinched nerves can cause pain into the leg, numbness, weakness or all the above.   Very rarely, pinched nerves can cause bowel or bladder incontinence and this requires immediate evaluation by a medical provider.  It is a common belief that all pinched nerves require surgery.  However, the majority of pinched nerves can be treated without surgery.  If a pinched nerve only involves pain and numbness, physical therapy to reduce compression on the nerves combined with either steroid pills or steroid injections can be used to effectively manage a pinched nerve and support the body while it heals.  If there is weakness then this needed to be closely evaluated with repeat physical exams and potentially a study to evaluate the heath of the nerves called an EMG.  One can follow a pinched nerve with mild weakness for 2 to 3 months before a discussion about surgery is needed. A pinched nerve that causes weakness that is functionally impairing that does not improve with steroid injection, physical therapy or medications, often require surgical consultation. Generally nerves can be compressed mildly for 2 to 3 months without permanent damage. After this time, increasing risk of permanent damage results.   Is often valuable to see a rehabilitation physician such as those at ROI first, to help diagnose and provide supportive treatments for a pinched nerve prior to referral to a surgeon. Most surgeons require at least some conservative management, that is, massage therapy, medication management, injections and physical therapy before even considering surgery for pinched nerve in the back.


Our Clinic provides comprehensive diagnostic and treatment options for Back Pain.  These include physicians to evaluate the cause of pain with physical exams, imaging review, EMG’s and injections.  Additionally, ROI has skilled providers from physical therapy, massage, acupuncture, and athletic training that work as a team to address your specific needs to improve your pain and restore your health. Our Clinic provides an integrated approach to resolve your back pain. We first confer with our specialist and then create a unique program specific to each patient for their back pain.

Contact us or call us for an appointment at 425-394-1200 to start you on a path to a pain free and healthier life.

 Back Pain

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