Mechanical Back Pain

In this article, you will find out everything you need to know about mechanical back pain and the most effective ways to treat it, including an advanced treatment called Prolotherapy.

Mechanical back pain is reported to affect one-third of the adult population living in the United Kingdom. 1 out of 15 individuals affected with lower back pain consults their local healthcare practitioner about their symptoms. This makes up 2.6 million of the UK population that consults a General Practitioner for their back pain every year. Experts claim mechanical lower back pain to be a leading cause of disability and increased healthcare expenses all over the world, as it may affect an individual of all ages and origins. (1)

What Is Mechanical Back Pain?

Mechanical back pain may be further classified into non-specific low back pain or mechanical lower back pain. While the non-specific lower back pain has no obvious cause, the mechanical lower back pain arises from intrinsic factors of the spine, intervertebral discs, and soft tissues. While most acute mechanical back pain cases are managed in through conservative treatments, the healthcare provider should still be on the lookout for red flags indicative of severe causes requiring immediate treatment. (2)

What are the Symptoms of Mechanical Back Pain?

The most common symptom of Mechanical Back Pain, as the name suggests, is a sensation of discomfort and pain in the lower back. This pain may radiate to the other parts of the body, including the buttocks and thighs. Many individuals also experience muscle spasms along with lower back pain. The symptoms usually worsen on flexion of the back, as seen while lifting heavy objects. Some individuals may also experience neck pain.

What Are The Common Causes Of Mechanical Back Pain?

In the past, mechanical back pain was also known as Lumbar strain or non-specific back pain; however, this is not commonly used anymore. These terms were used due to a lack of proper diagnostic methods which could help the physician identify the root cause of such pain. Recent advances in technology have allowed the invention of accurate diagnostic tools that help the physician understand the individual’s unique spinal anatomy and the factors that may be causing the pain.

The diagnosis of lower back pain is made according to the type of back pain and the etiological factors that are causing it. The most common causes of this condition include pathologies of the musculoskeletal system, which may be affecting the bone, spinal ligaments, facet joints, intervertebral discs, nerve roots, spinal cord, or surrounding musculature. (3) The common conditions that may bring about pathological changes in the musculoskeletal system include:

• Herniated Discs
• Spinal Stenosis
• Degeneration of Discs
• Facet Joint Syndrome
• Fractures Of Vertebrae
• Sciatica
• Spondylolisthesis
• Lumbar spondylosis
• Spondyloarthritis
• Osteoarthritis
• Ankylosing spondylitis
• Sprains
• Sacroiliac joint dysfunction

However, it is important to note that mechanical lower back pain may also be associated with psychosocial reasons with stress, depression, and anxiety. Hence, history taking should always contain questions regarding the individual’s habits, lifestyle, and substance use. (4)

How is Mechanical Back Pain Diagnosed?

The diagnosis of Mechanical Back Pain is concerned with finding out the root cause behind it. A detailed medical history and physical examination are essential for the diagnosis of mechanical back pain and ensuring no red flags are present. These kinds of pain can be triggered by physical and non-physical activity, out of which heavy lifting objects have been reported to be the most common. Some patients may also report no triggering event to have occurred for the back pain to develop. Recording the symptoms and type of pain is an essential part of the initial history as these are important indicators for the cause of back pain. For example, patients with herniated discs often a pain that radiates from the lower back to the spinal cord level S1. This pain may also be felt in the leg of the opposite side, especially on raising it. Back pain which is reported to worsen with the extension of the spine but is relieved with its flexion is often an indicator of Spinal Stenosis.

The Red Flags To Look Out For

The Red Flags that the physician should look out for during history and physical examination if a patient with lower back pain include:

1. Fracture: Patients with the fracture may report a history of trauma, a previous diagnosis of osteoporosis, or prolonged use of corticosteroids. Physical examination may show the presence of contusion, tenderness, and laceration around the spinous processes. (5)
2. Presence of Malignancy: Patients with Malignancy may report a sudden weight loss or a history of previous metastatic cancers. On physical examination, they may present with tenderness on palpation in the presence of the associated risk factors. (6)
3. Presence of Infection: Patients with infection often report a spinal procedure that may have been conducted in the past year or a history of lumbar spine surgery. They may also be intravenous drug users. These patients present with a fever and pain, and tenderness in the spinal region on physical examination.  (6)
4. Neurologic Disorders: Patients with Neurologic disorders may have a history of progressive loss of sensory or motor functions. They may also report fecal and urinary incontinence. In addition, on physical examination, they may show saddle anesthesia and motor deficits along the myotomes.

If the history and examination show the presence of no red flags, there is often no need for further radiographic and laboratory tests. However, more advanced imaging tools may be recommended if the patient comes with a history of trauma, failure of previous pain treatment, worsening of symptoms, and new neurological problems. For example, imaging tools are highly advised when there is a suspicion of Cauda Equina Syndrome, Fracture, Malignancy, or Infection. These may include:

• Plain radiography of the lumbar spine – when there is a suspicion of bony abnormality or fracture.
• Magnetic Resonance Imaging – when there is a suspicion of soft tissue abnormalities and neurologic disorders.

What Are The Complications Associated with Mechanical Back Pain?

The complication associated with Mechanical Back Pain depends on patient factors like their health and medical history and also the etiology of the condition. Some patients may experience persistent symptoms of pain and disability even after treatment attempts. A very low percentage of people have reported complications like Cauda Equina Syndrome and associated physical deformities. However, the majority of the complications are associated with the interventions for the mechanical back pain rather than the condition itself. This may include ulcers caused by prolonged use of NSAIDS, gastrointestinal bleeding, breathing difficulties, and even kidney injuries. (7)

Treatment of Mechanical Back Pain

The treatment for mechanical back pain depends on the etiology of the symptoms, their severity, their duration, and the patient’s medical health. Most commonly opted treatments for Mechanical Back Pain include physical therapy, pain and anti-inflammatory medication, and surgery.

Physical Therapy

Physical Therapy is considered the primary non-pharmacological treatment option for Chronic Low Back Pain. This is because using pain killers in the long term can lead to side effects on the individual’s health, and physical therapy can bring about more long-term benefits. This may include spinal manipulation, acupuncture, massage, and healing therapies. The physical therapist may also recommend at-home exercises for the patient and changes in posture, which may help with the lower back pain in the long term. (8)

Medication

Medication is considered the first-line treatment for acute low back pain as it can provide immediate relief to the patient. The initially recommended drugs for the patient include Anti-inflammatory drugs like NSAIDs, Ibuprofen, and Muscle Relaxants. However, if the pain is severe, and the patient may not be able to find relief from these drugs, the doctor may then move on to second-line treatment, which includes pain killers like Tramadol and Duloxetine. Individuals with severe back pain may also be given epidural steroid injections that may also provide short-term pain relief.

Surgery

Persistent Radiculopathy and herniated disc diseases may require a standard open surgical procedure to provide short-term benefits. The procedure commonly conducted for these conditions include open discectomy and microdiscectomy. Moreover, individuals with lower back pain caused by spinal stenosis may require a decompressive laminectomy, which also fount exhibit short-term benefits. Individuals who have previously undergone surgery for disc herniation without an improvement in Radiculopathy may be recommended spinal cord stimulation. (9)

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat back pain.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help back pain.

As prolotherapy is helping to treat the root cause of back pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

How Can the Occurrence of Mechanical Back Pain Be Prevented?

There are a number of recommendations that can be made for the prevention of mechanical back pain. These include:

• Strenuous physical activity should be reduced, as the load caused by such activity on the back is a common triggering factor for lower back pain.
• Introduction of light stretching exercises in the workplace. This promotion of physical activity would allow the employees to take breaks from sitting in the same position all day and promote healthy movement of the spine and associated structures.
• Patient Education about proper posture and the lifting techniques that may be used to prevent the onset of mechanical back pain. (10)
• Weight Loss is one of the most common recommendations for treating and preventing Lower back pain. Studies have shown the increase in weight directly related to chronic lower back pain; hence, the greater the weight, the more the chances of lower back pain. (11)

Frequently Asked Questions:

Is mechanical back pain serious?

We may not always be successful in identifying the cause of back pain, but it hardly proves to be serious. Mostly, it is a temporary ailment that resolves in a few days and sometimes, even before that. So, it is not a problematic issue.

What does mechanical back pain feel like?

The key characteristic of mechanical back pain is acute pain. You may also feel pain in the lower back that might emanate to different body regions, like the legs, and may include lower back convulsions.

What causes mechanical low back pain?

Mechanical back pain is most commonly caused by straining muscles of the lower back. It may also be the cause of poor posture and inaccurate lifting movements. About 70% of cases are due to lumber strains, and 10% are due to degenerative changes associated with old age.

How long can mechanical back pain last?

Mechanical back pain comes in the category of acute pain that lasts less than 4 to 6 weeks. Most people quickly respond to treatment which further reduces the period of illness. About fourteen days, around 90% of individuals are free from side effects. A large number of the leftover assessed 10% recuperate in three months or less. The incidence of pain may be recurrent.

How can you tell the difference between inflammatory and mechanical back pain?

Inflammatory pain is more likely to be a modest beginning and last longer (for example, over 90 days). In contrast, mechanical pain will generally be more intense and can frequently be connected to a physical issue. Moreover, inflammatory pain improves with movement and exercise, while mechanical pain does not.

Can mechanical inflammatory back pain be cured?

There is no single remedy for mechanical inflammatory back pain brought about by spondyloarthritis; however, side effects can be overseen through a blend of activity, exercise-based recovery, medicine, and elective medicines. So, the symptoms can be reduced, and the pain can be relieved.

References:

1. National Collaborating Centre for Primary Care (UK). Low Back Pain: Early Management of Persistent Non-specific Low Back Pain [Internet]. London: Royal College of General Practitioners (UK); 2009 May. (NICE Clinical Guidelines, No. 88.) 2, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11709/
2. Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. (2022). Back Pain. In StatPearls. StatPearls Publishing.
3. Chien, J. J., & Bajwa, Z. H. (2008). What is mechanical back pain and how best to treat it?. Current pain and headache reports, 12(6), 406–411. https://doi.org/10.1007/s11916-008-0069-3
4. Besen, E., Young, A. E., & Shaw, W. S. (2015). Returning to work following low back pain: towards a model of individual psychosocial factors. Journal of occupational rehabilitation, 25(1), 25–37. https://doi.org/10.1007/s10926-014-9522-9
5. Casazza B. A. (2012). Diagnosis and treatment of acute low back pain. American family physician, 85(4), 343–350.
6. Downie, A., Williams, C. M., Henschke, N., Hancock, M. J., Ostelo, R. W., de Vet, H. C., Macaskill, P., Irwig, L., van Tulder, M. W., Koes, B. W., & Maher, C. G. (2013). Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ (Clinical research ed.), 347, f7095. https://doi.org/10.1136/bmj.f7095
7. Roshi, Dajana et al. “Users’ Knowledge About Adverse Effects of Non-steroidal Anti-inflammatory Drugs in Tirana, Albania.” Materia socio-medica vol. 29,2 (2017): 138-142. doi:10.5455/msm.2017.29.138-142
8. Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., Clinical Guidelines Committee of the American College of Physicians, Denberg, T. D., Barry, M. J., Boyd, C., Chow, R. D., Fitterman, N., Harris, R. P., Humphrey, L. L., & Vijan, S. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
9. Chou, R., Loeser, J. D., Owens, D. K., Rosenquist, R. W., Atlas, S. J., Baisden, J., Carragee, E. J., Grabois, M., Murphy, D. R., Resnick, D. K., Stanos, S. P., Shaffer, W. O., Wall, E. M., & American Pain Society Low Back Pain Guideline Panel (2009). Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10), 1066–1077. https://doi.org/10.1097/BRS.0b013e3181a1390d
10. El Sayed M, Callahan AL. Mechanical Back Strain. [Updated 2022 Jan 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542314/
11. Lee CA, Jang HD, Moon JE, Han S. The Relationship between Change of Weight and Chronic Low Back Pain in Population over 50 Years of Age: A Nationwide Cross-Sectional Study. Int J Environ Res Public Health. 2021;18(8):3969. Published 2021 Apr 9. doi:10.3390/ijerph18083969