Low Back Pain

The back is a well-designed structure made up of bone, muscles, nerves and other soft tissues. You rely on your back to be the workhorse of the body — its function is essential for nearly every move you make. Because of this, the back can be particularly vulnerable to injury and back pain can be disabling.

Four out of five adults have at least one bout of back pain sometime during life. In fact, back pain is one of the most common reasons for health care visits and missed work. However, you can prevent most back pain. Simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul.

Your lower back bears most of the weight and stress of your body. Back pain most often occurs from strained back muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Often, there's an accumulation of stress with one particular event unleashing the pain. In many cases, there may not be an obvious cause.

The following specific conditions can also cause back pain. Because there's a definable cause, the conditions often also have a defined treatment.

  • Herniated disk. This occurs when disk material presses on a nerve.
  • Sciatica. This condition often occurs when a herniated disk impinges on the sciatic nerve
  • causing sharp, shooting pain through the buttocks and back of the leg.
  • Spinal stenosis. This condition occurs when the space around the spinal cord and nerve rootsnarrows due to arthritis and bone overgrowth. This can press or pinch a nerve.
  • Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerativ changes in the spine that often come with aging.
  • Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward over another.

These rare but far more serious causes of back pain also have specific treatment related to the underlying cause.

  • Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.
  • Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.
  • Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.
  • Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.

Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be difficult to treat.

Most back pain gradually improves with home treatment and self-care. Although it may take several weeks before it completely disappears, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. See a doctor immediately if your back pain:

  • Is constant or intense, especially when lying down or at night
  • Spreads down one or both legs
  • Causes weakness, numbness or tingling in one or both legs
  • Causes new bowel or bladder problems
  • Is associated with abdominal pain or pulsation (throbbing), or fever
  • Follows a fall, blow to your back or other injury
  • Is accompanied by unexplained weight loss
  • Also, see your doctor if this is new pain and you're older than age 50 or have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, iyour doctor may order one or more tests:

  • X-ray. These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.

  • Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

  • Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.

  • Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. However, it is important to realize that although the symptoms may disappear, you may have an underlying problem that caused the pain. Locating and correcting the cause of the problem is the best approach for you.

  • Physiotherapy and rehabilitation. A therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurring. nerve roots.

  • Electrical stimulation. A procedure uses a unit that sends a weak electrical current through specific points on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments.

To keep your back healthy and strong:

  • Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.

  • Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.

  • Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.

  • Maintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain.

  • Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.

  • Sit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.

  • Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

  • Sleep smart. People with back pain have commonly been told to use a firm mattress, but recent studies indicate that a medium-firm mattress might be better. Use pillows for support, but don't use a pillow that forces your neck up at a severe angle.

These tips can help you treat back pain at home:

  • Keep moving. Prolonged bed rest isn't a good idea for back pain. Light activity speeds healing and recovery. If your back hurts, stop the aggravating activities, but try to keep up activities that aren't painful.

  • Apply cold, then heat. Sources of heat and cold, such as a hot bath and hot or cold compresses, can soothe sore and inflamed muscles. Use cold treatment first. Immediately after injuring your back, apply ice several times a day, for up to 20 minutes at a time. Put the ice in a bag, then wrap the bag in a cloth or towel to keep a thin barrier between the ice and your skin. Use ice for as long as spasms persist. After spasms and acute pain subside, you can apply heat from a heating pad or heat lamp to help loosen tight muscles. Limit each heat application to 20 minutes.