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Low Back Pain
Low back pain is an ache or discomfort in the area of the lower part of the spinal column that may radiate down into one or both legs. The lower spinal column consists of small, stacked bones (the vertebrae) that surround and protect the spinal cord and nerves.
Cross-section of Vertebral Canal with Spinal Cord in the Center |
There are many possible causes for low back pain, including:
- Sprain or strain of muscles or ligaments in the area
- Herniated disc or ruptured disc—the cushions between the bones of the spine bulge out of place as a result of age-related changes or trauma.
- Disc degeneration—caused by arthritis or by the wear and tear of living plus aging
- Lumbar spinal stenosis —bony narrowing of the spinal canal in the low back area
- Spondylolisthesis —slippage of one bone over another, causing stretching or pinching of nerves
- Fractures due to trauma or osteoporosis
- Fibromyalgia —a condition that causes muscle aches and fatigue
- Ankylosing spondylitis —a disorder that causes spine stiffness and arthritis (believed to be hereditary)
- In rare cases,
- Benign or malignant tumors
- Infections
- Arterial problems, such as hardening of the arteries
Herniated Lumbar Disk |
What is Sciatica?
Sciatica is irritation of the sciatic nerve, which passes from the spinal cord to the buttocks down the back of each thigh. The sciatic nerve is composed of several nerve roots that arise from the lower spine on each side of the spinal column. These nerve bundles travel deep in the pelvis to the lower buttocks. From there, the nerve passes along the back of each upper leg and divides at the knee into branches that go to the feet.
Sciatica typically causes pain that shoots down the back of one thigh or buttock. Anything that causes irritation or puts pressure on the sciatic nerve can cause sciatica, including:
- Herniated disc (ruptured or slipped disc)
- Disc degeneration
- Spinal stenosis
- Spondylolisthesis
- In rare cases:
- Benign or malignant tumors
- Infections
Low back pain is very common, it is estimated that over the course of a lifetime 80% of Americans will suffer from at least one episode of back pain. Every year, about 15%-20% of the adults in the United States will report back pain. Most back pain gets better with time; about 5% to 10% of patients will continue to have pain for longer than three months.
What are the risk factors for low back pain and sciatica?
[What are the symptoms of low back pain and sciatica?
[How are low back pain and sciatica diagnosed?
What are the treatments for low back pain and sciatica?
Are there screening tests for low back pain and sciatica?
[How can I reduce my risk of low back pain and sciatica?
[What questions should I ask my doctor?
Where can I get more information about low back pain and sciatica?
Most back pain is usually localized in the low back. Stress on the muscles and ligaments that support the spine produces strain in these tissues, and this is the usual cause of lower back pain, although there can be other, more serious causes. There exist many treatments for low back pain.
If a nerve is irritated, the pain may extend into the buttock or leg on the affected side, and weakness or numbness may be present. Other symptoms include burning, tingling or a shooting pain down the back of one leg. This is often called “sciatica.” However, the nerve involved is usually a spinal nerve, and not the sciatic nerve. Sciatica is known by many other medical terms, such as lumbosacral radicular pain or radiculopathy.
Sciatic Nerve Pain |
More serious symptoms associated with low back pain that may require immediate medical attention include:
- Pain that doesn't subside or worsens with rest
- Pain that is worse when you are reclined
- Pain that is sudden, severe, or that has gotten dramatically worse
- Progressive weakness or numbness in a leg or foot
- Difficulty walking, standing, or moving
- Numbness in the genital or rectal area
- Loss of bowel or bladder control
- Burning or difficulty with urination
- Fever, unexplained weight loss, or other signs of illness
- If there has been any trauma, fall or impact
- If you have a history of cancer, back pain should be evaluated
Sources:
Conn's Current Therapy 2001. 53rd edition. W.B. Saunders Company; 2001.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd edition. Mosby, Inc.; 2001.
Low Back Pain
Low back pain is an ache or discomfort in the area of the lower part of the spinal column that may radiate down into one or both legs. The lower spinal column consists of small, stacked bones (the vertebrae) that surround and protect the spinal cord and nerves.
Cross-section of Vertebral Canal with Spinal Cord in the Center |
There are many possible causes for low back pain, including:
- Sprain or strain of muscles or ligaments in the area
- Herniated disc or ruptured disc—the cushions between the bones of the spine bulge out of place as a result of age-related changes or trauma.
- Disc degeneration—caused by arthritis or by the wear and tear of living plus aging
- Lumbar spinal stenosis —bony narrowing of the spinal canal in the low back area
- Spondylolisthesis —slippage of one bone over another, causing stretching or pinching of nerves
- Fractures due to trauma or osteoporosis
- Fibromyalgia —a condition that causes muscle aches and fatigue
- Ankylosing spondylitis —a disorder that causes spine stiffness and arthritis (believed to be hereditary)
- In rare cases,
- Benign or malignant tumors
- Infections
- Arterial problems, such as hardening of the arteries
Herniated Lumbar Disk |
What is Sciatica?
Sciatica is irritation of the sciatic nerve, which passes from the spinal cord to the buttocks down the back of each thigh. The sciatic nerve is composed of several nerve roots that arise from the lower spine on each side of the spinal column. These nerve bundles travel deep in the pelvis to the lower buttocks. From there, the nerve passes along the back of each upper leg and divides at the knee into branches that go to the feet.
Sciatica typically causes pain that shoots down the back of one thigh or buttock. Anything that causes irritation or puts pressure on the sciatic nerve can cause sciatica, including:
- Herniated disc (ruptured or slipped disc)
- Disc degeneration
- Spinal stenosis
- Spondylolisthesis
- In rare cases:
- Benign or malignant tumors
- Infections
Low back pain is very common, it is estimated that over the course of a lifetime 80% of Americans will suffer from at least one episode of back pain. Every year, about 15%-20% of the adults in the United States will report back pain. Most back pain gets better with time; about 5% to 10% of patients will continue to have pain for longer than three months.
What are the risk factors for low back pain and sciatica?
What are the symptoms of low back pain and sciatica?
How are low back pain and sciatica diagnosed?
What are the treatments for low back pain and sciatica?
Are there screening tests for low back pain and sciatica?
How can I reduce my risk of low back pain and sciatica?
What questions should I ask my doctor?
Where can I get more information about low back pain and sciatica?
References:
Conn's Current Therapy 2001. 53rd edition. W.B. Saunders Company; 2001.
Freedman MK. Saulino MF. Overton EA. Holding MY. Kornbluth ID. Interventions in chronic pain management. 5. Approaches to medication and lifestyle in chronic pain syndromes. Archives of Physical Medicine & Rehabilitation.89(3 Suppl 1):S56-60, 2008 Mar.
Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine.25(2):226-37, 2000 Jan 15.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd edition. Mosby, Inc.; 2001.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop low back pain or sciatica with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing low back pain or sciatica. If you have a number of risk factors, ask your doctor what you can do to reduce your risk. Some back pain treatments can be helpful in preventing the onset of low back pain.
Risk factors include:
Sedentary Job or Lifestyle
Muscles that support the back can become weak with lack of exercise.
Occupation
Work that requires the following motions puts additional stress on the back:
- Heavy lifting
- Bending or twisting
- Exposure to vibrations, such as riding in a car or operating heavy machinery
Participating in Strenuous or Contact Sports
Injuries from contact sports or falls can result in back pain.
Cigarette Smoking
Smoking may contribute to degeneration of the discs in the spine.
Obesity
Maintenance of good weight is important for your overall health. While scientific evidence is inconclusive as to how much obesity contributes to back pain in general, extra pounds can increase pressure on the spinal muscles and disks.
Improper Lifting Techniques
Lifting objects using your back muscles instead of the stronger muscles in your legs increases your risk of back injury.
Age
As you grow older, the discs in your back begin to lose water content and degenerate, increasing the risk of disc problems and back pain, especially after age 40. However, even with some disc degeneration seen on MRI or x-rays , most people do not have back pain.
References:
Conn's Current Therapy 2001. 53rd edition. W.B. Saunders Company; 2001.
Konstantinou K. Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 33(22):2464-72, 2008 Oct 15.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd edition. Mosby, Inc.; 2001.
Winters ME, Kluetz P, Zilberstein J. Back Pain Emergencies. Medical Clinics of North America.Volume 90, Issue 3 (May 2006)
Most back pain is usually localized in the low back. Stress on the muscles and ligaments that support the spine produces strain in these tissues, and this is the usual cause of lower back pain, although there can be other, more serious causes. There exist many treatments for low back pain.
If a nerve is irritated, the pain may extend into the buttock or leg on the affected side, and weakness or numbness may be present. Other symptoms include burning, tingling or a shooting pain down the back of one leg. This is often called “sciatica.” However, the nerve involved is usually a spinal nerve, and not the sciatic nerve. Sciatica is known by many other medical terms, such as lumbosacral radicular pain or radiculopathy.
Sciatic Nerve Pain |
More serious symptoms associated with low back pain that may require immediate medical attention include:
- Pain that doesn't subside or worsens with rest
- Pain that is worse when you are reclined
- Pain that is sudden, severe, or that has gotten dramatically worse
- Progressive weakness or numbness in a leg or foot
- Difficulty walking, standing, or moving
- Numbness in the genital or rectal area
- Loss of bowel or bladder control
- Burning or difficulty with urination
- Fever, unexplained weight loss, or other signs of illness
- If there has been any trauma, fall or impact
- If you have a history of cancer, back pain should be evaluated
References:
Boden SD, Davis DO, Dina TS, Patronas NJ, and Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J. Bone and Joint Surg. 72-A:403-408, March 1990.
Boden SD. The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. Journal of Bone & Joint Surgery—American Volume. 78(1):114-24, 1996 Jan.
Conn's Current Therapy 2001. 53rd edition. W.B. Saunders Company; 2001.
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69-73.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Russo RB. Diagnosis of low back pain: role of imaging studies. Clinics in Occupational & Environmental Medicine.5(3):571-89, vi, 2006.
Textbook of Primary Care Medicine. 3rd edition. Mosby, Inc.; 2001.
Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature. Clinical Journal of Pain. 22(5):468-81, 2006 Jun.
References:
Conn's Current Therapy 2001. 53rd edition. W.B. Saunders Company; 2001.
Freedman MK. Saulino MF. Overton EA. Holding MY. Kornbluth ID. Interventions in chronic pain management. 5. Approaches to medication and lifestyle in chronic pain syndromes. Archives of Physical Medicine & Rehabilitation.89(3 Suppl 1):S56-60, 2008 Mar.
Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine.25(2):226-37, 2000 Jan 15.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd edition. Mosby, Inc.; 2001.
2008 Physical Activity Guidelines Advisory Committee Report. USDA website. Available at: http://www.health.gov/paguidelines. Accessed October 26, 2008.
Your healthcare provider will ask about your symptoms and medical history. A physical exam will be done. In particular, your back, hips, and legs and will be tested for strength, flexibility, sensation, and reflexes.
Often, patients with pain may feel an urgent need to have a medical test. It is important to understand that medical tests are not routinely required for back pain and sciatica. Most episodes of acute back pain resolve on their own over several weeks, especially with some natural treatments. In these cases, the information from an x-ray or MRI may not change the medical plan, and so these tests may be unnecessary. An MRI or x-ray is usually ordered if there is a plan to do a procedure or surgery, based on the result of the images. Studies of medical imaging have demonstrated that MRI and x-ray may be too sensitive. They can often show abnormalities that are not truly significant, such as degenerated discs in individuals who do not even have symptoms. An improper medical test can lead to improper treatment and can greatly increase medical costs. It is important for such tests to be ordered appropriately.
Tests may include:
- X-ray—This test uses radiation to take a picture of structures inside the body, especially bones. Back x-rays may show signs of arthritis , degenerative disk disease , osteoporosis , or a tumor.
- CT scan —This type of x-ray uses a computer to generate images of structures inside the body. CT scans may show disc herniations as well as tumors and other lesions.
- MRI scan —This test uses a strong magnetic field and radio waves to take pictures of structures inside the body. An MRI can show if a disc has herniated, and if there are signs of scar tissue around a nerve root. The test can detect other abnormalities, such as bony spurs pressing on a nerve root and tumors.
- Blood tests—Blood tests may include a complete blood count and sedimentation rate. Blood tests may be ordered to check for signs of infection, metabolic disease, or inflammation.
- Urine test—These tests check for urinary infection or blood in the urine.
- Nerve conduction study—In this test, an electrical current is passed through a nerve to determine the health or disease of that nerve.
- Electromyography—This test measures the electrical activity of muscle by placing needle electrodes into the muscle. By doing this the doctor can determine if the nerve going to that muscle is functioning normally or if there may be pressure on it.
- Myelography—In this test, a special dye is injected into the spinal canal. X-rays are then taken to see how the dye lines the space in the spinal canal and see if there are disc herniations or other lesions. This test may be ordered before performing back surgery.
- Biopsy—If the cause of your back pain, based on the imaging studies, appears to be the result of a tumor, your physician my take a piece of the tumor (a biopsy) to determine what kind it is and how best to treat it.
Lastly, perhaps the best way to assess how well a treatment is affecting pain is to as the patient how much their level of pain as gone down since the beginning of a certain treatment. Self-reflection like this can be extremely useful and perhaps more empowering than any of the tests written above.
You can reduce your risk of developing low back pain and sciatica by reducing the stress on your back. Guidelines for reducing stress on your back include:
- Support your back when lifting, standing, and sitting.
- Practice good posture.
- Lose weight if you are overweight.
- Exercise regularly.
- If you smoke, quit.
- Manage stress.
Support Your Back When Lifting, Standing, and Sitting
Guidelines include:
- Do not lift heavy objects alone.
- Plan ahead and ask for assistance with lifting or moving heavy objects.
- When lifting, squat down next to the object, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.
- Do not bend or twist your back.
- Avoid sitting for long periods. When you do sit, choose seats with good lumbar support, and use a footstool to raise your knees to hip level. You may be able to use a standing desk at intervals, to help avoid prolonged sitting.
- Avoid standing for long periods. If you need to stand, place a low footstool in front of you and alternate placing each foot on it for a period of time. This will take some of the load off your back.
- Do not drive for long periods. Take a break every hour to stop, get out of the car, and stretch your back.
Practice Good Posture
Poor posture and slouching can put pressure on your lower back. Stand and sit straight, and avoid sitting up in bed. If possible, find an ergonomic specialist to help teach you good posture and body mechanics, as well as help you redesign your workplace to reduce strain on your back.
Lose Weight If You Are Overweight
Maintenance of good weight is important for your overall health. While scientific evidence is inconclusive as to how much obesity contributes to back pain in general, extra pounds can increase pressure on the spinal muscles and disks. Follow the dietary and exercise plan recommended by your doctor. To lose weight you have to consume fewer calories than you expend. To maintain a healthy weight, eat an equal number of calories to those you expend. Even more exercise than minimum recommendations may be required to lose weight (see below).
Exercise Regularly
An aerobic program will improve your physical fitness, strengthen your back muscles, and help you maintain a healthy weight. Choose exercises or activities that you enjoy and will make a regular part of your day. For most people, this could include walking or participating in another aerobic activity for 30 minutes per day. The 2008 USDA Physical Activity Guidelines Advisory Committee Report recommends at minimum two hours and 30 minutes a week of moderate aerobic activity, and strengthening exercises at least two days a week. Exercise also can help you manage stress. Check with your doctor before starting any exercise program.
If You Smoke, Quit
Smoking may contribute to degeneration of the discs in the spine. Also, smokers risk possible re-injury to the back during a coughing attack. Smoking can adversely affect healing if you are having a back surgery. To heal properly, you should quit smoking two weeks before a spine fusion and stay tobacco-free for six months afterwards.
Manage Stress
Stress can increase muscle tension. Take time out to relax, exercise, and practice relaxation techniques. If you need support or assistance in reducing stress, you may want to try some of the following techniques:
- Counseling
- Stress management classes
- Relaxation techniques
- Breathing exercises
- Meditation
- Yoga
American Academy of Orthopaedic Surgeons
Address:
6300 N River RD
Rosemont, Illinois 60018-4262
Phone:
1-847-823-7186
Internet address:
http://orthoinfo.aaos.org
Description of services provided:
This website provides information about back care, exercises to strengthen the back and abdomen, proper lifting techniques, and back surgery.
American Association of Neurological Surgeons
Address:
5550 Meadowbrook DR
Rolling Meadows, IL 60008
Internet address:
http://www.neurosurgerytoday.org/
Description of services provided:
This website provides information about back care and back surgery.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Address:
Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone:
1-301-495-4484
1-877-226-4267 (toll-free)
Email address:
niamsinfo@mail.nih.gov
Internet address:
www.niams.nih.gov
Description of services provided:
This NIH government site provides access to clinical trials, online information on a variety of medical conditions, paper publications that can be ordered, and scientific developments.
American Chronic Pain Association (ACPA)
Address:
PO Box 850
Rocklin, CA 95677
Phone:
800-533-5231
Email form:
http://www.theacpa.org/contact.asp
Internet address:
http://www.theacpa.org
Description of services provided:
With a mission to educate and increase awareness about chronic pain, this organization provides top new stories and feature articles. Major topics include strategies to manage chronic pain, a support group called "growing pains," resources, video clips from the ACPA's series "Pathways Through Pain," and frequently asked questions. Professionals and caretakers will also find helpful information on this website.
American Pain Foundation
Address:
210 N Charles ST
Suite 710
Baltimore MD 21201
Phone:
888-615–PAIN
Internet address:
http://www.painfoundation.org
Description of services provided:
The American Pain Association provides assistance for patients living with chronic pain, including networking, resources, and online information.
References:
Boden, S. D.; Davis, D. O.; Dina, T. S.; Patronas, N. J.; and Wiesel, S. W.: Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J. Bone and Joint Surg. 72-A:403-408, March 1990.
Boden SD. The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. Journal of Bone & Joint Surgery- American Volume. 78(1):114-24, 1996 Jan.
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet.2009;373:463-472.
Conn's Current Therapy 2001. 53rd ed. W.B. Saunders Company; 2001.
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med.1994;331:69-73.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Russo RB. Diagnosis of low back pain: role of imaging studies. Clinics in Occupational & Environmental Medicine. 5(3):571-89, vi, 2006.
Textbook of Primary Care Medicine. 3rd ed. Mosby, Inc.; 2001.
Zhou Y. Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature. Clinical Journal of Pain. 22(5):468-81, 2006 Jun.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Tests and Guidelines
There are no screening tests or screening guidelines for low back pain and sciatica.
Often, patients with pain may feel an urgent need to have a medical test. It is important to understand that medical tests are not routinely required for back pain and sciatica.
Most episodes of acute back pain resolve on their own over several weeks. In these cases, the information from an x-ray or MRI scan may not change the medical plan, and so these tests may be unnecessary. An MRI or x-ray is usually ordered if there is a plan to do a procedure or surgery, based on the result of the images.
Studies of medical imaging have demonstrated that MRI and x-ray may be too sensitive. They can often show abnormalities that are not truly significant, such as degenerated discs in individuals who do not even have symptoms. An improper medical test can lead to improper treatment and can greatly increase medical costs. It is important for such tests to be ordered appropriately.
References:
Conn's Current Therapy 2001. 53rd ed. W.B. Saunders Company; 2001.
Freedman MK. Saulino MF. Overton EA. Holding MY. Kornbluth ID. Interventions in chronic pain management. 5. Approaches to medication and lifestyle in chronic pain syndromes. Archives of Physical Medicine & Rehabilitation.89(3 Suppl 1):S56-60, 2008 Mar.
Konstantinou K. Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 33(22):2464-72, 2008 Oct 15.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronicpain/detailchronic_pain.htm#Spine . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd ed. Mosby, Inc.; 2001.
2008 Physical Activity Guidelines Advisory Committee Report. USDA website. Available at: http://www.health.gov/paguidelines . Accessed October 26, 2008.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with low back pain and sciatica. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them. Remember that every question you have may not be able to be answered with the first visit.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your Doctor
About Low Back Pain and Sciatica
- What is causing my back pain?
- Exactly what is sciatica? Could my pain be from sciatica?
About Your Risk of Developing Low Back Pain and Sciatica
- Based on my medical history, lifestyle, and family background, am I at further risk for low back pain and sciatica?
- How can I prevent low back pain and sciatica?
About Treatment Options
- How do I best treat low back pain and sciatica?
- Will I need to have surgery?
- What medications are available to help me?
- What are the benefits/side effects of these medications?
- Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?
- Are there any alternative or complementary therapies that will help me?
About Lifestyle Changes
- Should I engage in exercise?
- What kind of exercise is best?
- How often should I exercise?
- How do I get started with an exercise program?
- How can I find help to quit smoking?
- Do I need to lose weight? If so, how much?
About Your Outlook
- How do I know that my prevention or treatment program is effective?
- Will I always be plagued by low back pain and sciatica?
- Will the back pain worsen as I grow older?
- Will I need to find a different job?
