Scott Webb (Host): Lower back pain is something that many of us suffer from, me included, and my guest today is here to discuss lower back pain and some of the surprising reasons why folks may be suffering. I'm joined today by Annare Loubser. She's a physical therapist with Franciscan Health

This is the Franciscan Health Doc Pod. I'm Scott Webb. Annare, it's nice to have you here today. We're going to talk about low back pain, and I'm one of those people who suffers from lower back pain. And maybe we'll get into here, you know, some of the surprising reasons why folks have low back pain. And I know that so many Americans experience it at some point in their life, if not, for long periods of time. So, how often is pain in the lower back actually a back issue?

Annare L. Loubser: It most likely is because the work we do and the postures we're in on a daily basis. A large portion of Americans have low back pain. There are a few patients that come in where the back pain is from other reasons, or it can be caused by a stiff hip, osteoporosis, or some other medical condition that physical therapists, when you see us, will rule it out.

Host: Yeah, as you say, you know, it's one of those things where, yeah, when my back hurts, it's probably my back, but possibly it could be something else, right? So, let's talk about that, like are there some other common issues in the body that could cause lower back pain? 

Annare L. Loubser: Yes. A very stiff hip joint can cause increased mobility in your back. Since the hip won't move, it'll cause your back to become hypermobile, that can cause back pain. Something like hypermobility can cause back pain. In females, we can often see where they have maybe a cyst in the ovary or uterus that can cause back pain. Osteoporosis can cause back pain. Something like low vitamin B12 or vitamin D can cause back pain. And then, also, you can have back pain because you're busy having a kidney stone. So, there's many different reasons. So, we will ask you lots of questions when you come to therapy to find out what's causing your back pain.

Host: Right. Lots of questions. Good patient history. In fact, when you mentioned the kidney thing, and I actually know someone, it was my mom who thought she was having, you know, back pain or some issue with her back, and it turned out to be a kidney infection, which sounds like that's not that uncommon apparently.

Annare L. Loubser: Yes. So, especially in the summer when people dehydrate a lot, and then we can also see it in the winter time when air's really dry, and in elderly people, we can see it often as well, where it's a bladder infection or a kidney infection, a bladder infection that progressed to the kidney.

Host: Sure. Yeah. And obviously, at some point here, most folks will probably end up reaching out to someone like yourself for physical therapy. But let's just say they're experiencing low back pain and maybe they, you know, sort of assume that it is their back and not something else. What can we do at home to try to get some relief before we reach out to someone like yourself?

Annare L. Loubser: Okay. So some of ,the things is, it depends on what caused the pain. You know, the first thing we'll always ask is, "What did you do when the pain started?" Because if, for example, you were lifting something heavy and you felt something pop in your back and you felt the pain go down your leg right away, the first thing that you should do then is try to lay on your stomach and maybe lay on your elbows for a little bit. So, you want to do the opposite position of the position you were in that caused the pain at that time. So, because the worst thing you can do at that time, which you see it on a lot of social media, they say to stretch the hamstring, well, that if you do have a bulging or herniated disc, at that point, that'll actually aggravate your symptoms because it's straining the nerve over that bulge.

Host: Sure. Yeah, I'm guessing, Annare, that a lot of folks sort of maybe kind of self-medicate a little bit, right? So, we all think that because we're on social media, that we're doctors, you know, now, and physical therapists. So, we go to the pharmacy. We buy pain medications, things like that. What are your thoughts about that? Like, I guess what I'm asking is when is it time to reach out, right? So, maybe we have some back pain. Maybe it's caused from the back, maybe it's from something else. We try to do some things at home for some relief, and maybe we buy these OTCs, but when do we know that it's time to reach out? 

Annare L. Loubser: I feel like personally that this is best to reach out as quick as possible to prevent you from getting complications. Because many times by the time the patient comes to physical therapy, they have already done so many things that just aggravated the symptoms. Well, the first acute thing to do is to maybe use ice. And a lot of times if you go to emergency, they'll give you anti-inflammatories and muscle relaxers, but, there's a version of that over-the-counter.

But for me, I would like to see acute back patients into the therapy clinic as soon as possible, because we can stop all the complications from the injury that then cause the problem to prolong. You know, so acute injuries, a lot of times if you have an acute back injury, you know, we'll do a taping technique to prevent that from happening, to prevent you from actually doing the incorrect motion that'll actually aggravate the symptom. But typically, if you sprain and you don't have ability to get somewhere, you know, I would say it depends on the position you sprain yourself and say you were lifting something heavy, the first thing I would do probably is ice and lay on your stomach, maybe some anti-inflammatories if that's something that you can buy over-the-counter until you can get in to see the therapist.

I would also make sure you keep your spine straight as possible, bend from your knees. Try not to flex too much if you don't have to until there's time until you can get to the physician or the physical therapist. And now in Indiana, you can come to the physical therapist right away for 42 calendar days without a doctor's order. So if you sprain yourself, try and access that system as soon as you can.

Host: Yeah, right. As you say, you know, there's many of us who suffer from chronic back pain, and that's maybe a different conversation. But when we're talking about acute pain, especially one that, you know, we can draw a line back and say, "I was doing this when I hurt myself," that's a great time to reach out, right?

Annare L. Loubser: Yes, absolutely. Because you really want to do the right thing at that point to prevent you from exacerbating your symptoms. Say for example, you are a patient that you didn't know that you had osteoporosis, you bent forward, you had excruciating pain, you might have a compression fracture and you don't know that. That's something you come into physical therapy. We can rule out if you have a bulging disc, if you continue to do what you're doing, you can cause it to herniate. Now, that's when they start talking about surgeries, but if it's at a stage where the disc is just bulging, that's something that's very treatable with physical therapy.

Host: Yeah. Yeah. This is good stuff. I want to finish up today and just talk about what you all, you know, experts like yourself, what do you do to help folks? We talked about what we can do for ourselves a little bit at home, but what do you do once we get there? How does that work? How do you help us?

Annare L. Loubser: Okay. We'll do the full assessment, determine what we find is causing the problem, whether it's trigger points, those we can treat with trigger point release techniques, or we can do dry needling. We do a lot of exercises specific to your condition, depending on what we determine your condition is, whether it needs to be stretches, whether it needs to be core strengthening or also stabilization exercises. Because you might have an instability in your spine that will benefit from stabilization exercises.

So, the main thing is that we do the assessment and really take your history and find out what caused the problem. And then, our test that we do to determine what is the best course of therapy for you. With exercises, we can do stuff with pain relief. We have different machines we use, but something that works really, really good that we use a lot nowadays is dry needling and then a lot of stretching and stabilization exercises for the spine.

Host: Sure. Yeah. Well, as we've learned today from you, back pain may be caused by your back, could be caused by something else. And especially if we're talking about something that's sort of a flare up or acute kind of thing, best to get in, best to be evaluated. Because again, it could be your back, it could be something else. But in most cases, physical therapist like yourself could help, right?

Annare L. Loubser: Yes, most of the times. There's a few situations that what we do is called differential diagnosis. We decide whether it's musculoskeletal, which is physical therapy can help you, but if it's something systemic or chemical, then we'll refer you back to your primary care physician with a recommendation that, "We suspect it might be osteoporosis. Would you please evaluate further?" or something like that.

Host: Right. That's perfect. Well, appreciate your time today. It's always good to learn about things. And as I said, I'm somebody who suffers from chronic back pain, which is something I should have done something about a long time ago, you know, osteoarthritis, whatever it might be. but great to have your time and expertise today. Thank you so much. 

Annare L. Loubser: Thank you. Appreciate it. Have a good day. 

Host: And for more information about physical therapy services, visit franciscanhealth.org/rehab. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.