If the back pain and the pain down the leg doesn't get better, that's called a visit to the doctor. And the reason is is that a nerve is being pinched and you need to be at the doc because now this is a situation in which you need a diagnostic study. The major diagnostic study, here's what we talk in this day and age, is an MRI of the lumbar spine, which is done without contrast. It's a big huge electromagnet that excites water molecules and then the water molecules give off the energy. And so that energy then is read by things that say, ooh, where those water molecules are. And so it gives you much the same as light gives you a photograph, it gives you a picture. And we can slice people almost any way we want. And so MRI is a huge advance over CT, which was x-rays done in a similar, although non-excitatory manner. So ruptured discs, synovial cysts, maybe stenosis and there are a whole host of other things. But if you're having pain down the leg and it's acute and it's getting worse and you're not happy and anti-inflammatories aren't making you better, it's a trip to the doc. Now, once you see the doctor and you may or may not get an imaging study, some doctors will go ahead and start you on a steroid burst and there are many different steroids and steroid burst sometimes come in packs. We take five pills the first day, three pills the second day, two pills, the third, et Cetera, and then there are other ones where you may be on a steroid burst where you're on the same dose three times a day, four times a day for a week. Generally that's a first line treatment for excruciating back and leg pain. Then if the patient isn't better than it may be time for the MRI. Then after that depends on what the pathology is. So let's finish up on the potential treatments of acute low back pain. We've talked about brace, ice, anti-inflammatory and that's really the treatment. The vast, vast majority of acute muscular tenderness, low back pain is going to get better that way. If it doesn't get better, then the next step may be physical therapy. It may be Chiropractic, or it may be even a stiffer brace, or ultimately maybe injections. Surgery for acute muscular tenis, low back pain really doesn't have any place in terms of management. There's nothing surgical to do. You're only going to make a patient worse with that, and not any better.
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