Lower back pain is a common complaint among adults around the world, and LBP is the most common cause globally of disability and days lost from work. A recent longitudinal study of world-wide incidence of low back pain from 1990-2017 revealed that lower back pain is the primary driver of adult disability, and closely correlates with the number of years lived with disability. The authors of the study called lower back pain a “major global public health problem.” If your lower back hurts when walking or standing, there could be many underlying causes, many of them treatable and reversible without medication or surgery.
Causes of Lower Back Pain When Walking or Standing
One of the most frustrating things about lower back pain is that the condition is often non-specific in nature, meaning there is no apparent structural cause of pain when examined by MRI. In fact, many medical practitioners do not prescribe MRI for their LBP patients in the early stages because it is expensive and time-consuming, and results often contribute little or nothing to the diagnosis. Nevertheless, there are some common structural causes of low back pain, including:
- Muscle, tendon and ligament strains from lifting or overuse
- Herniated discs that put pressure on nerves
- Spinal stenosis
However, osteoporosis, osteoarthritis and spinal stenosis are most often associated with older age, and do not explain lower back pain when walking in young or middle-aged adults. Strains to muscles or connective tissue, along with herniated discs, are temporary conditions that usually resolve themselves over time. If you have persistent non-specific lower back pain when standing or walking, there are a number of possible causes, and most of them are treatable and reversible. Common causes of non-specific lower back pain include:
- Excessive sitting without physical activity
- Poor posture when sitting and standing
- Poor sleep habits or awkward sleep position
- Being out of shape, overweight or obese
- Imbalanced muscle tone in the lumbopelvic region
- Deficient walking gait mechanics
- Neuromuscular impairments that cause instability
- Limited range of motion and impaired mobility
Non-specific low back pain can often be resolved with physical therapy and chiropractic care that centers on corrective therapy to restore pain-free movement.
Diagnosis of Lower Back Pain
Diagnosis of lower back pain begins with a detailed patient history followed by a physical exam. Your doctor will ask you about your symptoms, participation in physical activities, recent and past injuries, and sleep habits. The physical examination may include a postural analysis, palpation of the painful area, a neurological exam, range of motion testing, reflex testing and a leg raise test to identify disc herniation. If pain persists after two or three months of non-surgical treatment, your physician may prescribe a diagnostic imaging test by x ray, MRI or CT scan. They may also do injection studies to confirm the source of pain.
Lower Back Pain Treatment Options
Effective treatment for lower back pain is largely dependent on accurate diagnosis. Many doctors take a one-size-fits-all approach when prescribing exercises to alleviate non-specific lower back pain, often because they lack the tools or expertise to properly analyze patients and prescribe personalized treatment plans. One New York clinic uses advanced technologies to analyze patient motor patterns, to look for anomalies in movement. Their protocol includes 3D gait analysis to get to the source of lower back pain when walking, along with kinematic analysis of joint angles, postural alignment, range of motion, muscle firing patterns, and balance and stability. Using hard data, they are able to establish a baseline, prescribe a targeted progressive treatment plan, and measure the progress and effectiveness of treatment. A recent study (journals.plos.org/plosone/article?id=10.1371/journal.pone.0227423) found that sensorimotor training that targets motor control issues is highly effective in alleviating lower back pain when standing and walking. Motor control stabilization exercises can include resistance training, core strengthening and stabilization exercises, and perturbation and instability training. Other effective treatment options include:
- Ultrasound guided dry needling to release myofascial trigger points
- Shock wave therapy to promote cellular neogenesis
- Dynamic neuromuscular stabilization (DNS) to restore optimal motor patterns
- Gait retraining to restore efficient gait mechanics
- Physical therapy to optimize strength and range of motion
- Chiropractic care to enhance postural alignment
Getting the Lower Back Pain Treatment You Need
Conventional medicine often treats low back pain with treatment and steroids aimed at alleviating pain symptoms, without addressing the underlying cause of pain. If your lower back hurts when walking or standing, you may be able to reverse your symptoms with conservative care, like chiropractic and physical therapy. Surgery should only be a last resort for lower back pain, and only if lifestyle changes and alternative treatments have failed to alleviate your pain. Statistics (ncbi.nlm.nih.gov/pmc/articles/PMC5223716/) show that, over the long run, outcomes after surgery vs conservative care are similar for lower back pain patients. Look for a practitioner who specializes in holistic integrative treatment for low back pain, with a track record of success. This information is provided by New York Dynamic Neuromuscular Rehabilitation, the premier clinic for low back pain treatment in NYC. Follow this link to learn more about medication-free, non-invasive treatment options for low back pain in NYC.
Resources Gugliotta, Marinella, et al. “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.” BMJ open 6.12 (2016). Niederer, Daniel, and Juliane Mueller. “Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: a systematic review with meta-analysis and meta-regression.” PloS one 15.1 (2020): e0227423. Wu, Aimin, et al. “Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017.” Annals of translational medicine 8.6 (2020), https://www.wicz.com/story/44159240/unlocking-the-mystery-of-lower-back-pain-from-standing-and-back-pain-when-walking
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- Lev Kalika
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