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What I Wish Everyone Knew About Low Back Pain

Dr Painkiller

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🔥 Join The Dark Room: Migraine School : https://www.skool.com/darkroom In this medical education video, double-boarded pain specialist and neurologist Dr Sader discusses the 3 main categories of chronic low back pain: disc pain, facet pain, and SI joint pain. For each one, he explains the symptoms, diagnosis, and treatment options.

Disc-related pain, which is the culprit in 40% of all cases of chronic low back pain, is in the back itself however it can also go down the leg (radicular pain) if the disc herniation worsens and irritates the nerve root. This kind of pain worsens upon flexion of the spine (sitting, bending over) and improves upon extension (walking, standing).

Facet-related pain accounts for 30% of all cases, and is usually described by patients as a dull aching bony pain and stiffness in their low back, however facets can also have a referral pattern in the thighs. If the facet arthritis worsens it can start compressing the exiting nerve root or the spinal canal, leading to spinal stenosis (which can manifest as pain, numbness, or weakness/heaviness in the legs). This kind of pain improves upon flexion of the spine (sitting, bending over) and worsens upon extension (walking, standing).

SI-joint (sacroiliac joint) related pain, accounts for 20% of cases, and the most common risk factors for it are a history of lumbar fusion, certain rheumatologic conditions, and ergonomics (sitting for long periods of time).

When a patient comes to my clinic, I use a combination of very specific questions on history, physical exam maneuvers, diagnostic testing (nerve conduction studies, MRI), to get to the right pain generator. A common issue we see with back pain patients is that they tend to be misdiagnosed and receive medications or even invasive procedures for the wrong pain generator unfortunately. That is why I like to take a step back and examine the facts before individualizing the treatment approach.

The general approach to back pain treatment is a spectrum, starting with more conservative measures (physical therapy for example), progressing to non-opioid medications (usually nerve medications and muscle relaxants), and if that fails, injection therapy (epidural steroid injections, facet injections, SI joint injections). The last resort is a referral to spine surgery for micro-discetomy, laminectomy, fusion or other surgery.

Footage from Storyblocks (licensed).

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Disclaimer: The information in this video is provided for general informational and educational purposes only and is not a substitute for medical advice. Before taking any actions based upon such information, we encourage you to consult with your own doctor.

Sader Consulting, LLC

#backpain #backpainrelief #medicaleducation #doctor #chronicpain

20 Comments

@Doctor.Painkiller Creator 1 year ago (edited) Pinned

Make sure to check out Part 2 of my back pain series, where I discuss the red flags that you don’t want to miss: https://youtu.be/lO7PMIzDPZU

@Djsexton25 1 year ago

I have all of this and more going on with my spine. I live with chronic pain 24/7.

@catleesie1235 1 year ago

In 2010 i was rushed into theatre and had a discectomy laminectomy decompression l5/s1 cauda equina my mri showed my disc on both sides of my spinal cord it just looks like it shot right through and i heard someone swear when he saw my scans , its been a hard journey it left me with one working leg and a badly working bowel , i went under anaesthetic in one pain and woke with new pain I've never really got rid of i have a bunched ball muscle pain around my scar area and my legs are heavy and getting weaker every year its like im wearing leggings made of pain and concrete and my hips knees and feet keep getting tendonitis's and bursitis . im trying to get better but its really hard when everything hurts .

@hasanyildiz9364 1 year ago

This is the most through video on what causes what and how to treat each of them!
Thanks brother!

@KurtSaturno 2 months ago

I am suffering from severe lower back strain/ muscle spasms. Im only 20yo, What I did was warm compress then massage and prayer, just don't lose hope, it's really hard, it hurts a lot even if you move slowly i cant even stand normal and walk even sit on chair but it will get better just rest and move as much as you can and Much better go to hospital❤

@richardgarcia2200 1 year ago

Good job. Clear descriptions, well-organized and no B.S. Thank you.

@oliviaforshay4346 4 days ago

I had low back pain after a car accident that was extreme. I went to a surgeon to find out that I needed a disc replacement. Got the disc replacement, and was still in agony. Come to find out I also had kidney stones on top of that. I think I would have rather have had the pain from the disc then kidney stones, but my mother has issues with all of those things in her back, and I wish I could take that pain from her.

@daphnematloa3727 1 year ago

Thanks for the clarification. Have had lower back pain . Occasionally get what I think are muscle spasms especially when doing house chores, causing difficulty of mobility due to severe pain lasting a week or two.

@sheliaporter6795 10 months ago

I have DDD, spinal stenosis and arthritis in my SI joints. I am in pain all the time and so far nothing has worked. Tylenol, Ibuprofen, and Naproxin do nothing. I was taking meloxicam and tramodol and they actually helped some. But when I had to change insurance and doctors, they started me back at square 1 with pain management and won't prescribe the meloxicam or tramadol. I am so frustrated with all the pain and physical limitations.

@614Lyfe 1 year ago

Doc this video was amazing. You deserve so many more view and subs. Keep it up

@barbiebush 1 year ago

Thank you so much for your help. I’ve been experiencing lower back pain for a couple of weeks now I have to talk to my primary care doctor. Your dog is absolutely beautiful. I see him in the background.

@CoachKarin-KEL 1 year ago

Well scoliosis and all 3. I have horrible time working yet I have a standing/sitting desk, use my vibration plate and/or treadmill but just can’t find myself without pain at anytime. Honestly I will say much has to do with my not being active enough in other ways because I am always working and my down time is yard work or recovery. I also am not one to take anything except Aleve at high pain levels. I drive very seldom because of numbness, shifting pain, and spasms.

@Bombay-ig7ss 1 year ago

Overall:
The MRI shows some issues with the discs in his lower back and a slight change in the natural curve of his spine.
Specific Findings at Each Level:
* L1-L2 Level: The disc between the first and second lumbar vertebrae is dried out and bulging, pushing backward into the spinal canal and slightly narrowing it.
* L3-L4 Level: There's a mild disc bulge here, pushing on the front of the spinal sac and causing some narrowing on both sides where nerves pass through, also pressing on the nerves.
* L4-L5 Level: Similar to L3-L4, there's a disc bulge that's slightly narrowing the spinal canal and the spaces where nerves exit, affecting the nerves on both sides.
* L5-S1 Level: This disc is also dried out and bulging, with a tear in the outer ring of the disc. It's pressing on the spinal sac and significantly narrowing the spinal canal and the nerve exits on both sides, compressing the nerves.

Other Observations:
* There's no sign of spondylolisthesis (where one vertebra slips over another) or lysis (a defect in the vertebra).
* The joints connecting the vertebrae (facet joints) and the ligamentum flavum (a ligament in the spine) are normal.
* The bones of the lumbar vertebrae (pedicles, laminae, spinous process, and transverse process) appear normal.
* The spinal cord, the end of the spinal cord (conus medullaris), the fluid-filled space around the spinal cord, and the nerves at the very end of the spinal cord (cauda equina) all appear normal.
* The soft tissues around the spine are normal.
* The sacroiliac joints (where the spine connects to the pelvis) are normal, with no erosions or swelling.
Canal Diameter Measurements (in mm):
* L1-L2: 9.2
* L2-L3: 1.04
* L3-L4: 11.4
* L4-L5: 9.5
* L5-S1: 7.8

Impression (Summary):
The MRI was done to check for disc prolapse or nerve compression. The report confirms disc bulges and protrusions at multiple levels (L1-L2, L3-L4, L4-L5, and L5-S1), leading to varying degrees of spinal canal narrowing and compression of the nerve roots.

Please advice or suggest the exercise
Also do I need the surgery which I want to avoid it
Thanks in advance for your help

@Toototabon.Toototabon 3 weeks ago

Thank you I have a sacroiliac old injury that is now inflamed so bad that it’s gone into a terrible situation. This is clear and simple. The last bit when you talked about the treatments for sacroiliac at least it’s a clear beginning. I’m gonna see what else you’ve got and I can go elsewhere and look now thank you very much Doctor appreciate this greatly.