Ben’s back started hurting after he helped a friend move some furniture. The pain started in his lower back—mostly on the right side—and it soon spread into his right buttock. When the pain is most intense, it spreads down his right leg toward the ankle but the back pain is still the major complaint. Ben also feels stiffness or tightness for a few minutes after waking or when he’s been sitting for a long time. This usually gets better once he starts moving around. Although it fluctuates a great deal, the back pain never disappears completely.
While his symptoms increase after making any sort of quick movement, the pain is especially bad when he bends forward or sits down for a while, particularly in a soft chair. For that reason, he finds driving very uncomfortable. He would rather stand up than sit down. He can’t bend down to lift up his three-year-old son without experiencing excruciating back pain. Lying on his stomach is the only thing that seems to help ease the pain.
"Until recently, my strategies for coping were just to stay active. I kept playing tennis and golf, but for the last few weeks I haven’t been able to do anything. My biggest concern was that I went from being this active guy to a couch potato. And the inactivity just seems to make things worse. I can’t go to sleep without sleeping pills, and I try to sleep on my stomach in a nest of pillows. It’s really taking a toll on my marriage."
My pattern of symptoms is similar to Ben’s. Tell me more.
Ben is experiencing the most common type of ‘mechanical’ back pain; back pain that is aggravated with forward bending. It probably comes from wear-and-tear on the structures in the front of his spine, perhaps the disc. It is referred pain arising from a physical structure in his back and not from pressure on the nerves. He should try to stay as active as possible, even though it hurts. When he does rest, he should lie on his stomach, since he’s most comfortable in that position.
Ben should think about ways to change what he’s doing, especially since certain activities or positions seem to increase his discomfort. For example, instead of lifting his three year-old son, he should get down on the floor to play with him. He should try and avoid doing things that make him bend forward because that is what gives him the most pain. But he must remember that the pain does not mean he is damaging his spine. Hurt is not harm. The goal is to stay active but to do it in a way that minimizes the pain. If his symptoms change, particularly if his leg pain should become worse than the back pain, he should consult his family doctor or another health care provider.
Ben has discovered that lying on his stomach reduces his pain. He could use that position as a way to control his symptoms and insert periods of lying face down between other activities that increase his discomfort. Constructing a daily schedule that mixes activity with pain controlling positions or manoeuvres can keep him in a productive daily routine. He’ll know he’s getting better when the symptoms become less intense, go from constant to intermittent and subside more quickly with movements that arch his back. Of course, even as he improves, he should still expect to have good and bad days. Surgery is rarely recommended for this pattern of back pain.