When Should I See A Doctor If I Have Lower Back Pain
In many cases lower back pain stops on its own. But if it doesnt, here are some guidelines on when you may want to start seeking professional help:
- If the pain lasts four weeks or longer
- If the pain keeps getting worse as time goes by
- If you are experiencing other symptoms, such as fever, major weight loss or weight gain, loss of function or weakness in extremities, bladder problems, etc.
Diagnosing Lower Back Pain
To diagnose lower back pain, a doctor will first do a physical exam. Theyll look at how well you move and if your back has any visible issues.
Then theyll take a medical history. This will cover your symptoms, any recent injuries, previous back issues, and the severity of your pain.
A physical exam and medical history are often enough for a doctor to determine the cause of your pain. However, they may also need to do an imaging test. Potential tests include:
- X-ray, which can find broken or misaligned bones.
- CT scan, which shows soft tissues such as the discs between vertebrae and potential tumors
- myelogram, which uses dye to enhance the contrast in a CT scan or X-ray to help a doctor identify nerve or spinal cord compression
What Is The Outlook For People With Lower Back Pain
The outlook depends on the cause of pain. Most people with back strains and sprains recover and do not have long-term health issues. But many people will have another episode within a year.
Some people have chronic back pain that doesnt get better after several weeks. Older people with degenerative conditions such as arthritis and osteoporosis may have symptoms that get worse over time. Surgery and other treatments are effective at helping people with a range of injuries and conditions live pain-free.
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Persistent Low Back Pain
Nonspecific low back pain is classed as chronic if it lasts for longer than six weeks. In some people it lasts for months, or even years. Symptoms may be constant. However, the more usual pattern is one in which symptoms follow an irregular course. That is, reasonably long periods of mild or moderate pain may be interrupted by bouts of more severe pain.
Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
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Find Relief Through Ice And Heat
Break out that bag of frozen peas for the first 48 hours after the pain sets in, and put it to use for 20 minutes a session, several sessions per day. After those two days are behind you, switch to 20-minute intervals with a heating pad.
Localized cooling shuts down capillaries and reduces blood flow to the area, which helps ease the swelling, says Lisa DeStefano, DO, an associate professor at Michigan State Universitys College of Osteopathic Medicine in East Lansing. Cold also thwarts your nerves ability to conduct pain signals. Heat, on the other hand, loosens tight muscles and increases circulation, bringing extra oxygen to the rescue.
Don’t Rest An Achy Back
Doctors used to prescribe bed rest for back pain. But now we know that lying still is one of the worst things you can do. It can make back pain worse and lead to other complications. Don’t rest for more than a day or two. It’s important to get up and slowly start moving again. Exercise has been found to be one of the most effective ways to relieve back pain quickly. Try swimming, walking, or yoga.
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What Are Some Other Causes Of Lower Back Pain
The shape of your spine, and well as spinal diseases, are other culprits in lower back pain. Depending on a range of factors, your doctor may look for:
Abnormal spinal curvature. A normal spine resembles a gently curved letter S when seen from the side. Abnormal curves include:
Lordosis, in which the spine curves too far inward at the lower back
Kyphosis, in which the spine is abnormally rounded in the upper back
, in which the spine curves from side to side, often in a C shape
Normal and abnormal curves of the spine
Arthritis. There are more than 100 types of arthritis, many of which can cause lower back pain. The most common types include osteoarthritis , , and .
. Compression of the bundle of nerves that forms below the spinal cord in the lumbar spine. It is a rare but serious disorder that requires immediate medical attention and possibly emergency surgery. CES got its name from the fact that the fanned-out bundle of nerves resembles the base of a horses tail.
. Both infections of discs and bone can cause severe pain and require prompt medical attention.
. Your bones lose mass faster than it can be replaced, making them brittle. They can even fracture with little or no warning. These fractures are especially common in the spine, where they’re called vertebral compression fractures. Both men and women lose bone mass as they age, but postmenopausal women lose it much faster and so are more at risk for osteoporosis.
Other Conditions Causing Lower Back Pain
There are many causes of back pain. Overuse injuries are a very common source of lower back pain and stiffness. However this usually goes away after a few days. Others causes of chronic pain include:
- Disc tear
- Spondylolisthesis. Normal wear and tear makes it hard for your joints and ligaments to keep your spine in the proper position, especially as we age. When a vertebrae moves more than it should, it can slide forward and on top of another. When this happens, bones can press on the spinal nerves and cause lower back pain.
- Vertebral fractures caused by osteoporosis
- Spinal stenosis. A narrowing of the spine space around the spinal cord can put pressure on nerves. The narrowing is typically caused by bone spurs that have developed as a result of osteoarthritis.
- Scoliosis. An abnormal curvature of the spine can cause back pain.
Less commonly, low back pain can be a sign of a serious medical condition, such as diabetes or a pinched nerve. In the case of a pinched nerve, the pain may be accompanied by symptoms like fever, chills, night sweats, or loss of bladder control.
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What Are Some Less Invasive Or Noninvasive Back Pain Treatments
Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.
Medications. When over-the-counter pills and topicals dont do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:
Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
Muscle relaxants, such as baclofen or carisoprodol
Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
, such as oxycodone or hydrocodone, on a short-term basis.
Physical therapy . PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:
Injections. An or a may provide short-term pain relief when lower back pain causes sciatica symptoms, such as leg pain.
How Is Low Back Pain Diagnosed
Along with a complete medical history and physical exam, tests for low back pain may include:
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For Fast Relief: Advil Liqui
Dosage: 200 mg ibuprofen
Why experts recommend it:
The solubilized ibuprofen in the capsules is more easily absorbed into the bloodstream. This leads to faster relief. The capsule form also makes it easier to swallow.
How it works: Advil Liqui-Gels contain ibuprofen, another nonsteroidal anti-inflammatory drug. Ibuprofens effects do not last as long as naproxen sodium . However, it may be less harsh on the gastrointestinal system. Evidence from a 2016 study showed that liquid gels may provide faster pain relief than tablets.
How to use Advil Liqui-Gels:
Use as directed on the label or as instructed by your doctor
Do not exceed 6 capsules in 24 hours unless instructed by a doctor
If NSAIDs cause you to have gastrointestinal problems, try taking them with food
Precautions when taking NSAIDs :
Nonsteroidal anti-inflammatory drugs can increase the chance of serious gastrointestinal problems such as ulcers, bleeding, inflammation, and perforations.
People who take NSAIDs such as naproxen and ibuprofen, may have a higher heart attack or stroke risks than people who do not take these medications. People with kidney problems, or those who have had coronary artery bypass graft surgery, should not take NSAIDs.
Nonsteroidal anti-inflammatory drug side effects:
Ask a medical professional if you have any questions about taking NSAIDs.
Common, mild side effects of NSAIDs:
Severe side effects of nonsteroidal anti-inflammatory drugs:
Inflammatory Lower Back Pain
Although comparatively few patients have low back pain due to a systemic inflammatory condition, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.
Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications
People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. Its important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.
syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:
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When Are Diagnostic Tests For Lower Back Pain Necessary
Many patients do not need X-rays in the first few weeks of pain because their pain will end up resolving. Many more do not need CT scans or MRI imaging, which are overly sensitive and often reveal abnormalities not related to the patients pain. These forms of imaging can be extremely useful, however, if a person has chronic or severe pain, and/or neurological symptoms. Blood tests may be ordered if an infection or tumor is suspected.
How Is Low Back Pain Treated
Treatment may include:
- A prevention program
- Assistive devices
Rehabilitation is often a part of treatment for low back pain. Generally, there are 3 phases of low back pain rehab.
- Acute phase. During this initial phase, the physiatrist and treatment team develop a plan to reduce the initial low back pain and source of inflammation. This may include using ultrasound, electrical stimulation, or specialized injections.
- Recovery phase. Once the initial pain and inflammation are better managed, the rehab team focuses on helping you return to normal daily activities while starting a specialized exercise program to regain flexibility and strength.
- Maintenance phase. In this phase, you will learn ways to prevent further injury and strain to the back. You will also learn how to start a fitness program to help further increase strength and endurance.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
What Are The Most Common Lower Back Surgery Procedures
Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:
. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.
. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.
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What Are The Symptoms Of Lower Back Pain
Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.
Pain may be sharp or dull and achy, and it may radiate to your bottom or down the back of your legs . If you strain your back during an activity, you may hear a pop when it happened. Pain is often worse in certain positions and gets better when you lie down.
Other symptoms of lower back pain include:
- Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
- Posture problems: Many people with back pain find it hard to stand up straight. You may stand crooked or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
- Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.
The Journey To Relief Begins With Better Back Beliefs
These are the most important back pain belief upgrades:
- Treatments such as strong medications, injections, and surgery are not effective or necessary in the overwhelming majority of cases.
- Low back pain is rarely a serious medical condition, rarely persists, and rarely deteriorates later in life. Even when it does persist, it usually isnt related to tissue damage, and scans are almost never helpful in diagnosing the cause of back pain.
- Pain with exercise and movement is mostly not a useful warning that harm is being done to the spine. Even intense exercise doesnt cause wear and tear damage, and flare-ups dont mean youve damaged something and have to rest.
- Low back pain is not caused by weak core muscles or prevented by strong ones.
Each of these contradicts a major myth or two about back pain, and is strongly supported by the science. By the end of this tutorial, I hope youre convinced of each one. But initially? Most people will have trouble swallowing them. Even professionals will especially the ones whose income depends on denying these.
Embracing them, instead of the myth of fragility and all its implications, is half the battle. But its really tough when youre facing intense, chronic back pain. Sure, most acute low back pain fades steadily up to 90% of it, for uncomplicated cases. And so does a lot of so-called chronic low back pain!
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