Parminder can’t remember exactly how or when her symptoms started, but they’ve been bothering her for several months. Her pain comes and then goes away completely, but when it strikes, it can be very unpleasant. She feels it mostly in her lower back, although the discomfort sometimes spreads into her buttocks and the top of both legs.
The pain increases when she stands still for any length of time—for example, waiting in line—or when she does anything that involves arching backward, such as putting things away in an overhead cupboard. Sitting is helpful, especially if she bends forward to rest her elbows on her knees. Lying curled up on her side in bed stops the pain, but lying on her stomach makes the pain intolerable. Parminder also feels stiffness and tightness when she first wakes up in the morning, but this goes away rapidly once she starts moving around.
“My back bothers me a lot of the time, especially when I’m standing. I can get relief if I bend forward. If I have to stand in one place for longer than 15 minutes, the pain in my back starts getting worse. I used to enjoy sleeping on my stomach, but that’s impossible now. I do the best I can at work during the week, but I have to keep stopping to bend forward in my chair. I feel really stupid.”
My pattern of symptoms is similar to Parminder’s. Tell me more.
Parminder’s pain is an uncommon pattern of mechanical back pain. It is pain aggravated by bending backward but never made worse by bending forward. In fact, flexing forward makes her feel better. This time the wear-and-tear seems to be in the structures in the back of the spine. Because it is back dominant it is referred pain and not the result of irritation to the nerves. She should try and remain as active as possible. When she does rest, she should choose a flexed lying or sitting position that makes her most comfortable.
For this pattern of back pain staying active is fairly easy. Most daily activities are done in flexion. But some things like working overhead will bring on the pain so she needs to make adjustments to her normal routine, using a step stool in the kitchen, for example, and walking around instead of standing still. Parminder should be able to control her pain but there will still be good and bad days.
If her symptoms change, for example if the back pain becomes constant, she should consult her family doctor or another health care provider. Surgery is almost never recommended for treating this pattern of back pain.