This topic provides a general overview of low back pain. If you have been diagnosed with a herniated disc or spinal stenosis, see the topic Herniated Disc or Lumbar Spinal Stenosis.
What is low back pain?
Low back pain can affect the back anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body’s weight. Because of these roles, it is easily injured when you lift, reach, or twist.
Almost everyone has low back pain at one time or another. The good news is that most low back pain will go away in a few weeks with some basic self-care. But if your pain is severe or lasts more than a couple of weeks, see your doctor.
What causes low back pain?
Low back pain is often caused by overuse, strain, or injury. For instance, people often hurt their backs playing sports or working in the yard, being jolted in a car accident, or lifting something too heavy.
Aging plays a part too. Your bones and muscles tend to lose strength as you age, which increases your risk of injury. The spongy discs between the bones of the spine (vertebrae) may suffer from wear and tear and no longer provide enough cushion between the bones. A disc that bulges or breaks open (herniated disc) can press on nerves, causing back pain.
In some people, low back pain is the result of arthritis, broken vertebrae (compression fractures) caused by bone loss (osteoporosis), illness, or a spine problem you were born with.
Often doctors don't really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.
What are the symptoms?
Depending on the cause, low back pain can cause a range of symptoms. It may:
Be dull, burning, or sharp.
Be felt at a single point or over a broad area.
Come on gradually or suddenly.
Occur with muscle spasms or stiffness.
Cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee. These symptoms can occur on their own or along with low back pain. Leg symptoms are often caused by lower spine problems that place pressure on a nerve that leads to the leg.
A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs, or loss of bladder or bowel control.
Doctors say back pain is:
Acute if a spell (or episode) of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of home treatment.
Recurrent if acute symptoms come back. Most people have one or more episodes of recurrent low back pain.
Chronic if your back bothers you most of the time for longer than 3 months.
The doctor will ask questions about your past health, symptoms, and work and physical activities. He or she will also do a physical exam. Your answers and the exam can help the doctor rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first exam.
Most people do not need further testing. Imaging tests such as X-rays, CT scans, and MRIs are not helpful for diagnosing most episodes of low back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a herniated disc, a broken bone, or cancer, or if surgery is being considered or planned. You might also have imaging tests if worker’s compensation or a lawsuit is involved.
How is it treated?
Most low back pain will improve with the following treatment:
For the first day or two, rest in a comfortable position . Try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees. Do not stay in one position for too long, though. Every 2 to 3 hours, take a short walk (about 10 to 20 minutes), then rest in a comfortable position again.
Take over-the-counter pain medicine if needed, such as acetaminophen (Tylenol, for example) or an anti-inflammatory drug such as aspirin or ibuprofen (Advil or Motrin, for example). For most people, these medicines work best if taken on a regular schedule.
Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help. But you can try them to see if they help.
As soon as possible, get back to your normal activities. Staying in bed for more than 1 or 2 days can weaken your muscles and make the problem worse.
Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong. Start with easy walks of 5 to 10 minutes a day, and gradually increase your time. Walking in water up to your waist or chest is also good exercise.
A doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and lower your chance of injury.
Some people get relief from pain by using treatments such as massage, spinal manipulation (chiropractic or osteopathic manipulation), or acupuncture. Certain treatments work for some people but not for others. You may need to try different things to see which work best for you.
If your symptoms are severe or you still have them after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from physical therapy.
Having ongoing back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both counseling and medicine. A cognitive-behavioral therapist can teach stress management and pain control skills. Antidepressant medicines may help too.
Only a few people with low back pain need surgery. Surgery may help if you have a herniated disc or back pain along with symptoms of nerve damage, such as numbness in your legs. Even in these cases, most people will improve without surgery. Having surgery does not guarantee that all your pain will go away. Before you have surgery, it is a good idea to get a second opinion.
How can you prevent low back pain from returning?
After the first time you have had low back pain, you are likely to have it again. To help keep your back healthy and avoid further pain:
Practice good posture when you sit, stand, and walk.
Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
Wear low-heeled shoes with good support.
Sleep on your side. A medium-firm mattress may put the least stress on your back.
Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
Don't try to lift things that are too heavy for you. When you must lift, bend your knees and keep your back straight, keep the object you are lifting close to your belly button, and avoid lifting and twisting at the same time. See a picture of proper lifting technique .
If you sit or stand for long periods at work:
Pay attention to your posture. Sit or stand up straight, with your shoulders back.
Make sure your chair has good back support.
Take regular breaks to walk around.
If your work involves a lot of bending, reaching, or lifting:
Talk to your human resources department to see if there are other ways you can do your work.
Don't depend on a “back belt” to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting
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