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Back Pain Causes & Treatments

Back pain is one of the most common medical complaints in the U.S. Black Tie Health, serving the greater Atlanta area, offers treatments that may prevent you from having surgery, depending on your specific situation.  We offer non-traditional treatments for back pain that may eliminate the need for addicting pain medications. The decision to undergo back surgery should not be done without considering all available options. 

Relaxing Massage can Improve Back Pain
Causes of Back Pain

According to a paper published in Pain Physician, between 54% and 80% of Americans will be affected by back pain during their lifetime. Persistent back pain is much more common in the elderly population and is associated with difficulty in activities of daily living. 

What are some causes for back pain?

The causes for low back pain are nearly innumerable. However, some of the most common causes of low back pain include:

The most critical component of treating back pain is the identification of the underlying cause. There are many patients who are improperly diagnosed and therefore continue to have pain despite treatment. This isn't to say that doctors are usually wrong or that they don't care about patients. In reality, doctors are people and people make mistakes.

Should I have surgery for back pain? Will a lumbar fusion help my back pain?

Whether or not an individual should have back surgery should be a decision made with the patient's physician. There are many considerations to take into account when making the decision whether or not to have surgery for back pain. In most cases, it is worth considering other non-surgical options before deciding to have surgery.

A study published in Spine in 2011 looked at the long-term outcomes of lumbar fusion surgeries in Workers Compensation patients. The historical cohort study looked at the outcomes of 1450 patients -  725 who were treated with a lumbar fusion for chronic low back pain and 725 who did not have surgery. The study found that the patients who did not have a lumbar fusion were better off than those who had surgery. Those who didn't have a lumbar fusion were twice (2x) more likely to be able to return to work. Those who had surgery were 5 times more likely to be permanently disabled. Those who had surgery needed more time off from work. Lastly, the patients who had a lumbar fusion were more likely to die than those who did not.


What are some treatment alternatives instead of surgery for back pain?

"It is estimated that 15 to 30 percent of all low back pain can be attributed to the sacroiliac joint."

Sacroiliac (SI) Joint Pain

What is the SI joint?

The sacroiliac joint, or SI joint, is the joint at the base of the spine where the sacrum is connected to the pelvis. This joint can become irritated for a variety of reasons, including arthritis, obesity, and acute injury. Typically, pain in the SI joint can present as pain in the lower back, and is difficult to differentiate from many other sources of back pain. This pain may radiate to the hip, buttocks, or lower back. 

For a significant period of time, many physicians were skeptical of the notion that the SI joint could be responsible for back pain. According to a review published in the Expert Review of Neurotherapeutics, an estimated 15-30% of all back pain may be attributed to the SI joint. As a result, acute or chronic injury to the sacroiliac joint should be considered as a possible cause of low back pain in most patients.

The image below is an x-ray with arrows pointing to the SI joint on either side of the spine. 

SI jont pain
X-ray with arrows pointing to the SI joint, a common source of back pain

SI Joint Pain Treatment

How is SI joint pain treated?

Sacroiliac joint pain can be treated in a number of ways. Treatment for SI joint pain is typically done first with conservative treatments and tend to be really effective. Conservative treatment for SI joint pain may include:

It is important to note that it is estimated that 80% of patients with back pain caused by SI joint dysfunction may get adequate relief with physical therapy alone. If conservative treatments fail to provide relief, other treatment options can be added to or used in place of conservative treatments. These treatments include:

Currently, surgical intervention for SI joint pain is rare. Therefore, if your back pain is caused by SI joint pain, it is unlikely that surgery will relieve the pain. In fact, a review published in Journal of Neurosurgery: Spine concluded that "evidence for the efficacy of SIJ fusion itself lacking, serious consideration of the cause of pain and alternative treatments should be given before performing the operation". 


So instead of surgery for your SI joint pain, get a second opinion from a licensed physician.

PRP for SI Joint Pain

Platelet rich plasma, or PRP, is a regenerative medicine treatment method that uses the patients own blood as the source. It involves the removal and concentration of platelets which are then injected into the area of injury. PRP has been studied as a potential treatment for back pain that is caused by pain in the sacroiliac.

A prospective randomized open blinded end point (PROBE) study published in Pain Practice in 2016 compared treating chronic back pain using corticosteroid injections with platelet rich plasma. The study evaluated 40 patients that were randomized to being treated with either methylprednisolone (the steroid) or platelet rich plasma. The patients' pain was then tracked for 3 months.


The corticosteroid injections were only 25% effective 3 months after treatment. On the other hand, PRP was found to be 90% effective in those who received PRP for SI joint pain. The study tracked 3 different standardized pain scores over the 3 months, the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Short Form (SF-12) Health Survey. All 3 scores appeared to favor PRP over the use of corticosteroids for sacroiliac joint pain. The MODQ and SF-12 scores were lower in the patients treated with steroids than the patients treated with PRP. Essentially, 3 months after treatment, patients treated with PRP for SI joint pain had significantly less pain. The authors concluded that the use of PRP in treating low back pain due to the SI joint was effective.

Prolotherapy for SI Joint Pain

Prolotherapy has also been studied for the treatment of SI joint pain. Prolotherapy typically involves the injection of more natural substances into an injured area in an effort to stimulate the body's ability to heal itself. Prolotherapy has been around for decades, but for a number of reasons has not become a more common treatment.

A prospective, randomized, controlled trial published in The Journal of Alternative and Complementary Medicine in 2010 compared the efficacy of prolotherapy versus corticosteroid injections for the treatment of sacroiliac joint pain. The authors concluded that not only were the effects of prolotherapy equivalent to using steroids, but the effects of prolotherapy on SI joint pain lasted longer than corticosteroid injections. 

A retrospective cohort study published in Complementary Therapies in Medicine in 2018 evaluated the effectiveness in treating SI joint pain with prolotherapy. The 103 patients diagnosed with back pain secondary to SI joint instability were treated with a series of 3 prolotherapy injections, each injection separated a month. The researchers found that prolotherapy can have clinically meaningful effectiveness on a select group of patients with SI joint pain. They also found that relief after the first injection in the series was a good indicator of improvement later.

Prolotherapy versus PRP for SI Joint Pain

A study published in the Journal of Prolotherapy in 2018 compared the effectiveness of platelet rich plasma with prolotherapy in treating SI joint pain. The study treated 45 patients with either PRP or prolotherapy and assessed the patients at 3 months and at 12 months. The researchers reported that PRP for SI joint pain was superior overall. In summary, PRP was more effective in reducing pain as 100% of all patients treated with PRP reported better function and an improvement in pain. In addition, the patients treated with PRP required fewer injections that the patients treated with prolotherapy.

It is important to note that although PRP was found to be superior to prolotherapy, both treatments can be done together and during the same visit. Also, although PRP takes fewer treatments to get superior results, PRP typically costs more than prolotherapy.

Back Pain Treatments
Iliolumbar ligament pain

Iliolumbar Ligament Pain

What is an iliolumbar ligament? Why would it hurt?

The iliolumbar ligament is a support structure for the lowest portion of the lumbar spine. The iliolumbar ligament is a band of connective tissue that connects the pelvis to the 5th lumbar vertebrae. This ligament helps to maintain alignment of the sacroiliac joint.

Conditions such as inflammation or a sprain (tear) of the iliolumbar ligament can cause a significant amount of low back pain. These kinds of injuries can be caused by falling or actions as simple as lifting with incorrect mechanics. If the injury is not allowed to heal or re-injury occurs, the result can be increased laxity of the iliolumbar ligament. Increased laxity of the ligament could potentially cause disc herniation at that level of the spine.

How is an iliolumbar ligament injury diagnosed?

The iliolumbar ligaments cannot be seen on traditional x-ray. A tear may be visible on MRI or ultrasound. However, in most instances, the diagnosis is made using physical exam findings alone. Patients typically have a significant amount of pain just above the PSIS in the lower back.

Treatments for Iliolumbar Ligament Pain

How is iliolumbar ligament pain treated?

Iliolumbar ligament pain may be treated like an other ligament sprain. However, the key to long-term pain relief is to allow complete healing of the ligament without causing further injury. Some treatments that may help speed up the healing process include:

With proper care and healing, iliolumbar ligament pain can resolve within days or weeks, depending on the severity.

If you think you may be suffering from iliolumbar ligament pain, schedule an appointment.


Research on Alternative Treatments for Back Pain

Bagagiolo D, Rosa D, Borrelli F. Efficacy and safety of osteopathic manipulative treatment: an overview of systematic reviews. BMJ Open. 2022 Apr 12;12(4):e053468. doi: 10.1136/bmjopen-2021-053468. PMID: 35414546; PMCID: PMC9021775.

Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013 Jan;13(1):99-116. doi: 10.1586/ern.12.148. PMID: 23253394.

Desai MJ, Mansfield JT, Robinson DM, Miller BC, Borg-Stein J. Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review. Pain Pract. 2020 Apr;20(4):437-453. doi: 10.1111/papr.12868. Epub 2020 Jan 28. PMID: 31869517.

Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, Cherkin D, Gagnier J, Ammendolia C, Ansari MT, Ostermann T, Dryden T, Doucette S, Skidmore B, Daniel R, Tsouros S, Weeks L, Galipeau J. Complementary and alternative therapies for back pain II. Evid Rep Technol Assess (Full Rep). 2010 Oct;(194):1-764. PMID: 23126534; PMCID: PMC4781408.

Singla, V., Batra, Y.K., Bharti, N., Goni, V.G. and Marwaha, N. (2017), Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract, 17: 782-791.

Won SJ, Kim DY, Kim JM. Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study. Medicine (Baltimore). 2022 Feb 25;101(8):e28935. doi: 10.1097/MD.0000000000028935. PMID: 35212300; PMCID: PMC8878905.

Woong Mo Kim, Hyung Gon Lee, Cheol Won Jeong, Chang Mo Kim, and Myung Ha Yoon.A Randomized Controlled Trial of Intra-Articular Prolotherapy Versus Steroid Injection for Sacroiliac Joint Pain. The Journal of Alternative and Complementary Medicine. Dec 2010.1285-1290.

Do you enjoy living with back pain?

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