Lower back pain (LBP) occurs in 84% of adults during their lifetime. Back pain duration can be classified as:
Acute < 4-6 weeks
Subacute 4-12 weeks
Chronic >12 weeks
If you have an acute episode of LBP that goes away, there is still a 70% chance that you will experience another episode within a year, and some individuals go on to have chronic pain. Those with herniated discs with nerve pain have a good chance of experiencing disc resorption and recovery. Studies have shown that seeking care with a Physical Medicine and Rehabilitation specialist like Dr. Bainbridge or Dr. Trainor within 48 hours of an acute event, or within 10 days of seeking care, can potentially help you avoid surgery and increase your satisfaction with care. In most cases, surgery is not required and you can get back to the lifestyle you enjoy.
The Denver Spine & Pain Institute has the diagnostic, therapeutic, and prevention education tools to help reduce your pain so you can get back to the activities you enjoy.
What Are Some of the Causes of Lower Back Pain?
Low back pain can occur for a variety of reasons, including:
Simple bending, twisting, missteps, or the lifting of items (both heavy and light)
Trauma to the back, including falls or the sheer forces of motor vehicle collisions
Prolonged, forced position sitting, such as during car travel
Anatomy and Sources of Back Pain
The spine can be thought of as containing the following components, each of which can be a source of pain.
Discs (Intervertebral Discs)
Discs are made up of the:
Nucleus – This structure serves as a load bearing cushion
Annulus — A network of circularly arranged fibers that provide structural support
The nerve and blood supply of the discs come from adjacent edges of vertebral bone (end-plates) and the outer layers of the annulus. Disc pain can occur when small, inner tears of the annulus reach these nerve fibers, also called discogenic pain, or with “microfractures” of the end-plates, also called vertebrogenic pain.
These painful conditions can occur due to trauma. They can also be caused by degenerative changes. Disc degeneration and herniation are also heavily influenced by genetics. Keep in mind that visible imaging (MRI) findings aren’t always associated with pain. In addition, your pain can often be significantly reduced or even eliminated with proper treatment.
Disc herniations associated with a tear in the annulus can cause both back pain and the pain of pinched or inflamed nerves. Disc herniations fall into three different categories:
Sequestration (free disc fragment)
These disc protrusions cause pain in the nerve root, also known as sciatica/radiculitis, by compressing the nerve root or causing inflammation. Fortunately, disc protrusions resorb in many cases. In addition, treatment can significantly reduce pain and restore the ability to function by reducing nerve inflammation as the condition resolves. Surgery may be required if:
The pain of a pinched nerve doesn’t improve
You experience significant weakness
The situation becomes worse
The Denver Spine & Pain Institute works closely with the best surgeons in the area, and we can counsel you regarding indications for surgery to make your decision an informed one. We can also provide you with post-operative care and rehabilitation.
Facet Joints (Zygapophysial Joints)
There are two facet joints at each level of the spine. They work with the disc to create a weight bearing “tripod.” The facet joints allow spinal motion. They can be injured from a twisting motion or due to trauma. In many instances, the onset of pain can occur gradually.
The disc is responsible for supporting most of your weight. However, as the discs degenerate and become thin, more of your weight load shifts to the facet joints. This can cause degeneration in the joints, which may result in pain.
Sacroiliac Joints (SIJ)
The sacroiliac joints (SIJs) are complex, boomerang shaped joints that are supported by strong ligaments and muscles. There is normally slight torsional motion at the joints while walking and moving. The joint surfaces can, however, shift out of position or become locked. This can cause pain, and the surrounding muscles can become dysfunctional.
Some muscles will become tight and painful, while others stop doing their job in order to maintain normal stability and movement of the SIJ. This is why sacroiliac joint problems often cause piriformis muscle problems.
Degenerate and lead to bone spurs that can pinch nerves
Fractures can develop after trauma to the region. The most common type of spinal fracture is a compression fracture of the vertebral body. These cause wedging of the body of the vertebra. While trauma is the most common cause, compression fractures can also occur with a simple bend or lift if you have thin bones (osteoporosis/osteopenia).
Ligaments are bands of fibrous material that hold the vertebrae in place and keep the spine stable, while also allowing normal motion. They can be torn by trauma or loosened through degeneration, resulting in spinal instability. This can cause shifting and muscle spasms in the back, which is often painful.
Muscles (Movers and Stabilizers)
Muscles can become bruised, torn or overstressed. All of these issues can be quite painful. More commonly, pain from other structures in the spine cause a reaction in the muscles such as:
Pain in muscles “on-guard”
A lack of supportive activity and protection from other muscles
This can result in both inactive and spastic muscles at the same time, requiring physical therapy (PT) to retrain them. This muscle dysfunction can happen even after a brief episode of back pain. Formal PT is often needed to restore proper muscle function. Correction of muscle length and activity is crucial for protecting you from future back pain and getting you back to life.
Inflammatory Rheumatological Conditions
Rheumatologic conditions can cause low back pain. The team at The Denver Spine & Pain Institute has extensive experience identifying symptoms associated with these conditions. When these symptoms are present, our team will order labs and refer you to a rheumatologist to ensure you receive the proper treatment plan.
Infections of the spine are rare but can occur, especially when you have a compromised immune system. Infection can also spread to the spine from other areas of the body. Severe, focused, spine pain while being sick or feverish would potentially be a sign of an infection, and immediate treatment is required in these situations.
Neoplasm (Benign Tumors, Cancer)
Tumors of the spine are extremely rare, occurring in less than 1/1000 spine images. When they do develop, it is most commonly associated with metastatic disease. Often, these tumors will have spread to the spine from the following types of cancer:
Lymphoma and myeloma can be found on occasion. However, primary tumors arising from the structures of the spine are the least likely to develop.
Non-Spine (Referred Pain) Causes of Back Pain
Medical problems in the chest or abdomen can refer pain to the spine. These include:
Kidney or bladder stones or infection
Ulcer or pancreatitis
Cardiac, lung/pleura, and pelvic or abdominal organ disease
Please let your doctor know about any symptoms that you are experiencing so that they can determine whether it is related to your back pain.
Diagnosing the Cause of Your Back Pain
The Denver Spine & Pain Institute will conduct a thorough diagnostic evaluation to determine the cause of your back pain. This process includes:
Review history of onset, prior treatment, and symptoms
There are certain patterns of pain that help identify the source. This information can be combined with physical exam findings to assist our team in making your specific spinal diagnosis.
A detailed spine and neurological exam will be conducted to determine the cause of your pain, and to help with further diagnostic testing and treatment planning.
Imaging, including x-ray, MRI, CT scans and others
Our team will recommend specific imaging studies and the proper timing for these scans based on your specific situation and medical best practices.
Most commonly, x-rays are ordered after one month of pain or when a fracture has potentially occurred.
MRI is scheduled at 4-6 weeks when neurological signs and symptoms are detected, other spine diagnoses must be ruled out, or when spinal procedures are being considered.
CT scans may be necessary when bone needs to be examined or you are unable to undergo MR imaging.
Diagnostic ultrasound is performed to examine soft tissue structures.
Less commonly used imaging such as bone scans will be ordered when indicated.
EMG studies are electrical studies that Dr. Bainbridge or Dr. Trainor may perform on your legs to help to determine the cause of your pain in these areas. We can evaluate the health of your nerves to determine whether you have peripheral neuropathy; conduct testing to identify the presence of an “entrapped nerve” at the knee, ankle or other sites; and look for signs of specific spinal (or plexus) nerve injury that may be related to radicular pain (sciatica). The EMG diagnosis may be helpful in determining the appropriate conservative treatment plan, and it can help us evaluate whether surgery is necessary.
Fluoroscopically-guided spine, nerve and joint injections
Diagnoses are often confirmed or “tested” through the use of diagnostic injections. During this process, specific nerves or joints can be numbed to see if your pain temporarily goes away, helping to confirm your diagnosis. These diagnostic blocks are sometimes combined with corticosteroid to add a therapeutic effect.
During discography, needles are placed into the discs and pressure-monitored contrast is injected to identify any internal disc tears. This will also evaluate whether your specific pain pattern is reproduced at a specific disc or discs. Discography can be beneficial for surgical decision making, and it can be used to direct other therapies such as regenerative medicine treatments.
Physical therapy joint and muscle function evaluation
The physical therapy assessment includes a detailed examination to detect restrictions of joint motion, joint instability/hypermobility, impaired neurological function, and muscle imbalance. Muscles that are short and tight or less active than they should be are identified, and specific therapies or exercise programs are employed to bring function of the spine back towards normal. The best function possible is the goal so that you can get back to life.
Assessment of insomnia, depression, or other aggravators of pain
We are interested in knowing if, along with your pain, you are struggling with sleep, depression, anxiety, substance use, or other issues. These are known to both result from as well as aggravate pain. These issues will be treated as part of our comprehensive pain management Connected Care Approach™.
Your low back pain treatment plan will be created with the following goals in mind:
Reducing inflammation through medications, supplements and diet
Restoring normal levels of spine joint motion and muscle function through physical therapy and independent exercise
Promoting quality sleep and ability to function at home, work, or play
You can learn more about the specific treatments we offer by viewing our Pain Management page.
Conservative Treatment of Low Back Pain (Pain Management)
We will recommend a customized treatment plan to address your unique needs and goals. This plan will often utilize multiple modalities (a core component of our Connected Care Approach™) to deliver maximum pain relief and restore a good quality of life.
Depending on the specifics of your condition, your treatment plan may include:
Non-opioid pain medication, topical pain relievers and safe use of opioids when appropriate
Lifestyle guidance for pain management
Pain psychology services to address pain control options including mindfulness
Office-based injections such as trigger point injections
Interventional Treatment of Low Back Pain (Pain Management)
The team at The Denver Spine & Pain Institute will provide you with all the education you need to make informed decisions about the use of injections, highly specialized procedures, or surgical solutions that can alleviate your low back pain. Some options include:
Indirect decompression of stenosis with interspinous device
Sacroiliac joint distraction/fusion
We also have close working relationships with the area’s top spine, neuro and orthopedic surgeons, and radiologists. We can connect you with the proper specialists to provide any necessary treatments.
We have been conducting pain research since we opened in 2012, and this allows us to offer you the option of receiving state-of-the-art research treatments through our many clinical trials. Ask your provider if one of our trials might benefit you, or call our Research Department at 303-327-5511, extension 319, to learn more.
Our current studies include:
FAST and SOLIS studies – Interventional Treatment for Chronic Low Back and/or Leg Pain (spinal cord stimulation)
Eliem Study of ETX-018810 (Oral Drug) for Treatment of Leg and Low Back Pain
Discovery 6603 – Interventional Treatment for Leg Pain Due to Disc Protrusion (enzyme injection into protruded disc)
Helping You Restore Your Quality of Life
At the Denver Spine and Pain Institute, we understand the ways that debilitating pain can derail your quality of life. Our team will recommend the ideal treatment plan to alleviate your pain so that you can enjoy your favorite activities and perform routine daily activities with greater ease.
Our exclusive Connected Care Approach™ has helped countless individuals get back to enjoying life, and we can help you overcome the many challenges that arise when you experience debilitating chronic back pain. This unique approach involves:
A full spectrum of care options, including physician treatments, physical therapy, massage, diet and lifestyle coaching, behavioral health services and other state-of-the-art treatments
Customized treatment plans based on your specific pain needs
Caring and therapeutic relationships with our team to ensure the best possible treatment
A thorough explanation of all your treatment options so that you have the knowledge to make an informed decision
Schedule an Appointment
Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.