<human>: I have pain in the lower portion of my right back extending to my right side a little bit. I did a urine test and there are no infections. I also do not recall doing any activity that could have caused a strained muscle. The pain is really bad when I lay down in bed and try to turn over.
<bot>: Hi, Thanks for your query and Welcome to Chat Doctor. I am Chat Doctor. You have mentioned pain in your lower back region with radiation of pain to the Right side, I guess your lower limb. Anyways since you are certain that there was no injury which could have actually caused a muscle strain etc., then we will have to work up in your case to actually rule out a fiscal prolapse or a degeneration etc. Before I can give you some advice I would like you to send me the following details:- What was the cause of onset of this pain if you can recall it?- Duration of the back pain and if present, your leg pain?- Apart from your back pain do you also have any associated numbness, weakness in limbs, paresthesia etc. as well?- Any aggravating or relieving factors of your symptoms?- How much distance can you walk, and what are your analgesic requirements on a daily basis?- What investigations and management has been done till now for your existing problems? I can tell you that lower back pain could be due to many reasons but at your age it is mainly postural and sometimes Fiscal in nature in which the Inter vertebral disc has lost height as a result of which there can be a mechanical back pain which is very discomforting for the patient. Rarely there can be a bony instability like pars defect or something which can lead to pain while doing work or activity involving movements at spine region. But the majority of these conditions actually can be managed conservatively with Posture maintenance, physical therapy and medications. Although I am sure you have tried a lot of medications and alternate form of treatments, but till the time I can see your details, If you have localized back pain with no other neurological symptoms like numbness, weakness, paresthesia etc., then you can start with following recommendations for initial period of 2-3 weeks:- To maintain proper posture of your back while working and sleeping, try maintaining an erect posture as much as possible- If pain is more than you can take a short course of an anti-inflammatory medications which suits you-Physical therapy initially under supervision of a trained physiotherapist, initially concentrating on SWD/IT or LASER therapy for back pain and TENS for your radiating leg pain-Adequate calcium & vitamin D intake if levels are low in body-Hot fomentation can be done at home 3-4 times in a day, if possible-Analgesic spray or ointment for local application can be used after fomentation- Avoid lifting heavyweight/ acute forward bending in mornings and take adequate precautions till pain completely subsides.etc will observe you for next 2-3 weeks how you respond to this conservative management protocol. If there is no clinical improvement, then we will plan for your investigations including blood tests, X-Rays and if your back pain is a long-standing one, then MRI of lower back region. Do not hesitate to contact me if you need any further assistance/SOS with more clinical details and test reportsThanks & Regards