Low Back Pain: Q&A with Steven Agabegi, MD

Are you living with acute or chronic back pain? Steven Agabegi, MD, an orthopaedic spine surgeon, discusses the general causes of low back pain and treatment options, below.

Why Is Low Back Pain So Common?

As a physician, I notice that many people neglect their back health, mostly due to poor physical conditioning and a sedentary lifestyle, which can cause weakness in the core muscles. Excessive sitting at work or in a car can also wreak havoc on the lumbar spine.

When you sit in a chair, your pelvic muscles and your legs are doing absolutely nothing, and all of the weight of your upper body is shifted to your lumbar spine. But when you are standing and walking, your pelvic muscles, legs, and quadriceps muscles are contributing to maintaining that upright position. There is a lot less stress on your lower back when you are standing and walking as opposed to sitting.

Obesity is another contributing factor to low back pain because if you are overweight, there is going to be more stress on the lower back.

One of the main goals in treating low back pain is to take the stress off the lumbar spine. There are three things I recommend: sit less, exercise more, and try to lose weight. Try to avoid sitting as much as possible. Maintaining a healthy weight can help as well because the less you weigh, the less stress there will be on your lumbar spine. It’s also important to exercise and strengthen your core and the muscles around your spine. Doing so will help take the stress off of the lumbar spine.

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Can Stress Cause Low Back Pain?

Yes, stress can be a source of low back pain. The central part of the nervous system is typically affected by stress. When feeling stress, people generally have headaches, neck pain, and low back pain. Some people even develop tailbone pain when they are in severe stress.

What Are the General Causes of Low Back Pain?

There are many causes of low back pain. Some people have a structural problem, which is identified by taking x-rays and an MRI. If these tests do not show a source of pain, it may just be a case of weak core muscles and we recommend physical therapy. Genetics also play a role, as low back problems and disc degeneration tend to run in families.

How Does Spine Alignment Affect Back Pain?

Two terms that you should be familiar with are lordosis and kyphosis. The lordosis is the arch that you have in the lumbar spine and in your neck. In the mid-back, which is also called the thoracic spine, you have a reverse curve called kyphosis.

Your spine is essentially maintained in an upright posture because of these curves. It’s very important to understand these terms because they have a lot of relevance to the long-term health of your back. If you do not have an arch in your lumbar spine, then you potentially could have problems with alignment and poor posture. Poor posture, in turn, can contribute to additional stress on the low back.

How Can Low Back Pain Be Treated?

Low back pain can be treated in a variety of ways. Treatment options may include:

  • Physical therapy. Physical therapy is the mainstay of treating low back pain. This is usually the first treatment option that we recommend when we see a new patient with either acute low back pain or chronic low back pain.
  • Chiropractic treatment. Chiropractic treatment can be helpful, especially for acute low back pain.
  • Massage. Massage is another treatment option that can be very helpful for a lot of patients. But keep in mind that it’s probably not going to be a long-lasting treatment. Everybody feels better after a massage, but if you don’t address the underlying problems, which are usually muscle weakness and inactivity, massage is probably not going to give you long-term relief.
  • Pain management and steroid injections. There are a lot of different types of injections that pain management doctors can administer, including trigger point injections and epidural steroid injections. Injections can be very helpful for those who have a pinched nerve, which can cause pain radiating to the leg or legs. If you’ve tried everything to manage your lower back pain and nothing has helped, you may want to consult a pain management specialist about injections.
  • Exercise and weight loss. The stress on your lower back and other weight-bearing joints like your hips, ankles, and knees is significantly increased if you are overweight. Aerobic exercise helps to improve blood flow and add oxygen to your tissues, including your lumbar muscles and lumbar spine in general. Brisk walking is a great form of aerobic exercise, as well as swimming and using elliptical machines and exercise bikes. Keep in mind that consistency is the key. Just a few minutes of exercise each day goes a long way.
  • Change your mattress. If you have back pain only in the morning, you may want to look at your mattress. Buy a mattress that contours to your body or a memory foam cover to put over your current mattress. Avoid sleeping on couches and futons. But keep in mind that stiffness in the low back in the morning is common with arthritis. So, your mattress may not necessarily be the problem.
  • Surgery. Spine surgery may be an option for someone who has a pinched nerve that causes radiating pain into the legs, especially if that pain has not responded to conservative treatment such as physical therapy and injections. We generally advise against surgery for low back pain unless there is clear pathology on imaging studies that is likely to be the source of back pain.

Dr. Agabegi sees patients at the UPMC Outpatient Center on Pellis Road in Greensburg, UPMC 600 Oxford Drive in Monroeville, UPMC Somerset, and in Johnstown.

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC Orthopaedic Care

When you are dealing with bone, muscle, or joint pain, it can affect your daily life. UPMC Orthopaedic Care can help. As a national leader in advanced orthopaedic care, we diagnose and treat a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. We provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. Our multidisciplinary team of experts will work with you to develop the treatment plan that works best for you. Our care team uses the most innovative tools and techniques to provide better outcomes. We also are leaders in research and clinical trials, striving to find better ways to provide our patients care. With locations throughout our communities, you can find a provider near you.