My doctor and the physical therapist who is treating me both think my low back pain is coming from the spinal joint. What's the best treatment for a problem like this?Low back pain can be caused by a wide range of problems. Nerves, muscles, ligaments, joints, and discs can all be either a direct or indirect cause of painful symptoms.
Identifying the involved anatomy can help direct treatment more specifically. The chances of recovery without recurrence may improve with treatment directed at the cause of the problems.
Joints in the spine are called facet or zygapophyseal joints. Lumbar zygapophyseal joints (LZJ) are a common cause of unilateral (on one side) pain in the low back area.
One way to both confirm and treat the source of problems from the LZJ is the use of facet joint injection. A numbing and an antiinflammatory agent are both injected into the joint. Pain relief is both diagnostic and curative for many patients.
Radiofrequency denervation called neurotomy is another treatment method. The nerve(s) to the joint are destroyed using heat generated by radiofrequency waves. Pain is prevented from occurring for up to 10 months. Once the nerve regenerates (grows back), the pain can return. At least half the people who have a neurotomy do not have a recurrence.
If you prefer something a little less invasive, then physical therapy may be a good choice. The therapist can apply manual techniques to help realign the joint and restore normal biomechanics. Decreased pain along with improved motion and function are possible.
Some people apply the wait-and-see approach. In many cases, doing nothing and letting the passage of time and natural healing take place is all that's required.
References:Victoria E. Wilde, et al. Indicators of Lumbar Zygapophyseal Joint Pain: Survey of an Expert Panel with the Delphi Technique. In Physical Therapy. October 2007. Vol. 87. No. 10. Pp. 1348-1361.
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