[44M] Experiencing lower back pain triggered by standing

Patient Description

A 44-year-old male reports chronic lower back pain, localized to the left side where the pelvic bone meets the vertebrae, for about a year. The pain is described as dull, escalating to sharp and stabbing when triggered by certain movements after prolonged standing. The intensity of the pain can reach an 8 out of 10. The patient finds relief when the back 'pops' upon straightening out, which is believed to be a muscle spasm. The patient has a history of being rear-ended in a car accident, after which soft tissue damage in the neck and arthritis in the back were diagnosed. The patient's mother has scoliosis, indicating a family history of musculoskeletal disorders. Current medications include Gabapentin (300mg, taken weekly) and Ibuprofen (600mg, taken a few times a week), along with a regular multivitamin. The patient does not experience pain while sitting, walking, or running, even capable of running half-marathons without discomfort. No numbness, tingling, weakness in the legs, or changes in bladder or bowel control are reported. There is no unexplained weight loss, fever, or known allergies to medications.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible causes for your symptoms include:

  • Mechanical Lower Back Pain: This is a common condition that is often caused by strain from lifting heavy objects or making sudden movements. The pain is typically located in the lower back, and can range from a dull ache to a sharp or stabbing sensation. It can be exacerbated by certain activities or positions, such as standing for extended periods of time.

    • Treatment often involves physical therapy, pain management with over-the-counter or prescription medications, and lifestyle modifications such as regular exercise and maintaining a healthy weight.
  • Lumbar Facet Joint Syndrome: This condition occurs when the small joints located along the spine become painful due to arthritis or injury. The pain is often worse after periods of inactivity or when standing or bending backwards.

    • Treatment usually involves physical therapy, pain management with medications, and sometimes injections or surgery.
  • Sacroiliac Joint Dysfunction: This condition occurs when the sacroiliac joint, which connects the lower spine and pelvis, becomes inflamed or injured. The pain is often located in the lower back and buttock area, and can be exacerbated by standing or walking for extended periods of time.

    • Treatment usually involves physical therapy, pain management with medications, and sometimes injections or surgery.

Please note that these are potential causes based on the information you've provided, and it's important to consult a healthcare provider for a formal diagnosis.

What you can do

  1. Continue taking your prescribed medications as directed by your healthcare provider.
  2. Try to avoid activities that exacerbate your pain, such as standing for extended periods of time.
  3. Regular exercise can help strengthen your back and improve flexibility. Consider activities that are low-impact and easy on the back, such as swimming or walking.
  4. Applying heat or cold to your back may help alleviate pain. Use a heating pad or ice pack for 15-20 minutes at a time.
  5. Over-the-counter pain relievers, such as ibuprofen, can help manage pain. However, these should be used sparingly and under the guidance of a healthcare provider.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe back pain that doesn't improve with rest
  • Pain that radiates down one or both legs, especially if the pain extends below the knee
  • Weakness, numbness, or tingling in one or both legs
  • Unexplained weight loss
  • Back pain accompanied by fever
  • Difficulty controlling your bladder or bowels

Remember, I'm an AI and this advice is based on the information you've provided. It's always important to consult with a healthcare provider for an accurate diagnosis and treatment.

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9 mo ago


People Also Ask


What are common causes of chronic lower back pain?

Common causes of chronic lower back pain include mechanical issues such as muscle strain, lumbar facet joint syndrome, sacroiliac joint dysfunction, arthritis, and previous injuries. It's important to consult a healthcare provider for an accurate diagnosis.


How can mechanical lower back pain be managed effectively?

Mechanical lower back pain can be managed with physical therapy, pain management using over-the-counter or prescription medications, lifestyle modifications like regular exercise, maintaining a healthy weight, and avoiding activities that exacerbate the pain.


What is lumbar facet joint syndrome and how is it treated?

Lumbar facet joint syndrome is a condition where the small joints along the spine become painful due to arthritis or injury. Treatment typically involves physical therapy, pain management with medications, and sometimes injections or surgery.


When should I seek immediate medical attention for back pain?

You should seek immediate medical attention if you experience severe back pain that doesn't improve with rest, pain radiating down the legs, weakness, numbness, or tingling in the legs, unexplained weight loss, back pain with fever, or difficulty controlling bladder or bowels.

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