Low Back Pain
Definition
Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column has many small bones that surround and protect the spinal cord and nerves. Low back pain is very common. It affects most adults at some point in their lives.
Bones of the Lower Back
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Causes
There are many possible causes for low back pain. Many times, the exact source of back pain is not known. Some causes of back pain include:
-
Muscle strains or ligament sprains in the area (most common cause of back pain), such as from:
- Heavy lifting or lifting incorrectly
- Sudden unusual movement
- Herniated (ruptured) disc —the cushions between the bones of the spine bulge out of place
- Disc degeneration —caused by aging or arthritis
- Spinal stenosis —narrowing of the spinal canal
- Spondylolisthesis —slippage of a bone in the lower back
- Fractures due to trauma and/or osteoporosis
- Fibromyalgia —a condition that causes muscle aches and fatigue
-
In rare cases:
- Ankylosing spondylitis —a autoimmune disease involving the spine
- Tumors
- Infections
- Arterial problems such as an aortic aneurysm
- Cauda equina syndrome —nerve roots at the base of the spinal cord are compressed
Symptoms
Pain is usually restricted in the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on the affected side. Muscle weakness or numbness may occur.
When Should I Call My Doctor?
Often, back pain improves with self-treatment. However, some serious symptoms may occur. They may require more immediate medical attention. Call your doctor if back pain:
- Is severe or gets significantly worse
- Has not started to improve within about a week
- Causes difficulty walking, standing, or moving
- Is worse at night or worse when you lie down
- Spreads down your legs
- Comes with pain or throbbing in your abdomen
- Is new and you are over age 50
-
Is associated with:
- Numbness, weakness, or tingling in your buttocks, genitals, or legs
- Loss of bowel or bladder control
- Difficulty with urination
- Fever, unexplained weight loss, or other signs of illness
You should call your doctor if you have back pain and a history of cancer or osteoporosis. You should also call if you have a history of steroid use or IV drug use.
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will focus on your back, hips, and legs. The doctor may test for strength, flexibility, sensation, and reflexes.
Your doctor may need pictures of your body structures. This can be done with:
It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.
Your doctor may need your bodily fluids tested. This can be done with:
- Blood tests
- Urine test
Your doctor may want to examine your bones using a bone scan.
Treatment
Treatment options include:
Stay Active
Bed rest is not generally recommended. It may only be advised for not more than 1–2 days in those with severe back pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. By staying active and exercising, you may be able to shorten your recovery time.
Medication
Medicines that your doctor may suggest include:
- Over-the-counter pain relievers, such as acetaminophen (Tylenol), aspirin (Bayer), or ibuprofen (Motrin, Advil)
- Muscle relaxants for muscle spasm—These medicines are not used in cases where you need to be alert, such as driving or operating machinery.
- Antidepressants—These may also be prescribed for chronic low back pain.
Physical Therapy
A physical therapy program may include:
- Applying hot or cold packs
- Doing stretching, strengthening, and balance exercises for back and stomach muscles
- Participating in an aerobic exercise program (eg, walking, swimming)
- Learning how to cope with back problems
- Getting massage therapy
Alternative Medicine
- Relaxation training
- Biofeedback
- Acupuncture
- Chiropractic or osteopathic manipulation
- Massage
- Yoga
Surgery
Only a small number of patients need surgery. It may be needed if nerve problems develop or other treatments do not provide relief. Common procedures are diskectomy, laminectomy, and spinal fusion.
If you have low back pain, follow your doctor's instructions.
Prevention
The following steps may help you avoid low back pain:
- Begin a safe exercise program with the advice of your doctor.
- Maintain a healthy weight.
- If you smoke, quit.
- Practice good posture to reduce pressure on your spine.
- Avoid sitting or standing in one position for long periods of time.
- If you must remain standing for long periods, rest one foot at a time on a small stool to relieve pressure on your lower back.
- When lifting, hold the object close to your body, keep your back straight, and use your leg muscles to rise slowly.
- Avoid aggravating activities, for example bending, twisting, and sudden movements.
- Consider job retraining if your work requires a lot of heavy lifting or sitting.
- If you have back pain during pregnancy, try wearing a BellyBra. This is a special bra to support your back and abdomen.
RESOURCES:
American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org/
American Academy of Family Physicians
http://www.familydoctor.org/
CANADIAN RESOURCES
Canadian Orthopaedic Association
http://www.coa-aco.org/
Canadian Orthopaedic Foundation
http://www.canorth.org/
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Last reviewed November 2012 by Brian Randall, MD
Last Updated: 11/26/2012
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