When Should I See My Doctor
If you have back pain and have lost feeling or movement in your limbs or are having problems controlling your bowels or bladder, call triple 000 immediately and ask for an ambulance.
You should see your doctor or other health care professional for further advice if:
- your pain bothers you
- your back pain doesnt improve after a few weeks or worsens
- you have symptoms such as weight loss, tingling or numbness in the legs, or problems with bladder and/or bowel control
- you have osteoporosis
You should see your doctor as soon as possible, if you have a history of cancer, are prone to infection, or use intravenous drugs.
For most people, back pain will resolve in a few weeks with appropriate self-care. After 2 months, 9 out of 10 people will recover from back pain.
How To Sit On A Chair
To sit on a chair safely:
To help your back and make sitting more comfortable:
- Try to get up and change position regularly
- Try to sit right back in the chair
- Put a rolled up towel in the small curve at the bottom of your spine
What Are The Risk Factors For Developing Low Back Pain
Anyone can have back pain. Factors that can increase the risk for low back pain include:
Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. Weekend warriorspeople who go out and exercise a lot after being inactive all weekare more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.
Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.
Genetics: Some causes of back pain, such as ankylosing spondylitis , have a genetic component.
Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.
Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.
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About Lower Back Pain
Lower back pain is pain in the area of your back from the bottom of your ribs to the top of your legs. It can come from any of the many structures that make up your back. These include bones, joints, muscles, ligaments, nerves and tendons.
Your spine supports your back. Its made up of 24 separate bones called vertebrae stacked on top of one another. The lower section of your spine is called the lumbar spine. Below the vertebrae, at the bottom of your spine, are bones called your sacrum and coccyx. You may hear lower back pain referred to as lumbosacral pain.
Discs of cartilage sit between each vertebra, acting as shock absorbers and allowing your spine to bend. Some lower back pain originates from these discs. Your spinal cord threads through the vertebrae, carrying nerve signals between your brain and the rest of your body. If nerves at the base of your spine become compressed or inflamed, it can cause sciatica. Sciatica is a type of pain that starts in your back or buttocks and spreads down your leg.
Its usually difficult for doctors to say exactly whats causing back pain. This is because there are so many different parts to your back and tissues that surround it. Even tests such as X-rays and magnetic resonance imaging scans arent helpful for most people.
Lower Back Pain Caused By Infection
Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.
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Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
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Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- , such as a or removal of a portion of a
- a bone graft that promotes the vertebrae to fuse together
- removal of the lamina to create more space and reduce irritation and inflammation
Back Pain Culprit: Chronic Conditions
Several chronic conditions can lead to low back pain.
- Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.
- Ankylosing spondylitis inflames the joints of the spine, and sometimes the shoulders, hips, ribs, and other areas too. It causes chronic back pain and stiffness. In serious cases, spinal vertebrae start to fuse .
- Fibromyalgia causes widespread muscle aches, including back pain.
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Symptoms Of Back Pain
Back pain can range from local pain in a specific spot to generalized pain spreading all over the back. Sometimes the pain radiates away from the back to other areas of your body, such as the buttocks, legs, or abdomen. The intensity of back pain varies for each person. Depending on the type, cause, and location of your back pain, you may experience:
- Increasing pain with lifting and bending.
- Worsening pain when resting, sitting, or standing.
- Back pain that comes and goes.
- Stiffness in the morning when awakening and lessened back pain with activity.
- Pain that radiates away from the back into the buttocks, leg, or hip.
You should see a doctor if your pain does not improve after a few weeks or if any of the following symptoms happen with your back pain:
- Numbness and tingling.
- Severe back pain that does not improve with medication .
- Back pain after a fall or injury.
- Back pain along with:
- Weakness, pain, or numbness in your legs.
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.
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How Is Lower Back Pain Diagnosed
Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.
Your provider may order:
- Spine X-ray, which uses radiation to produce images of bones.
- MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
- CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
-
Electromyography to test nerves and muscles and check for neuropathy , which can cause tingling or numbness in your legs.
Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain . Urine tests check for kidney stones, which cause pain in the flank .
Back Pain And Pregnancy
Back pain during each trimester of your pregnancy can be common, and several causes are to blame. However, you should be sure to talk with your doctor about what youre experiencing, in case the pain may be part of a bigger problem.
Here are a few reasons why you may be experiencing back pain during pregnancy:
Shifting center of gravity
As your baby grows, the center of your bodys gravity moves outward. Your spine and back arch to make up for the change in balance. This put extra stress on the lower lumbar spine.
Weight gain
Weight gain can be a healthy part of pregnancy, but even the little bit youre likely to gain during those 9 months can put more stress on your back and core muscles.
Hormones
As your body prepares to deliver the baby, it releases hormones that loosen the ligaments that stabilize your pelvis and lumbar spine. These same hormones can cause the bones in your spine to shift, which may lead to discomfort and pain.
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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.
Why Is Lower Back Pain Such A Common Problem
The bottom part of your back typically has just five vertebrae fewer than your neck and mid-back. And these vertebrae do a lot of heavy lifting! Your lower back is where your spine connects to your pelvis, bearing the weight of your upper body. This area experiences a lot of movement and stress, which may lead to wear, tear and injuries.
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Injections And Other Procedures
If you have severe sciatica, your doctor may suggest an epidural injection. Epidural injections contain a local anaesthetic and steroid to relieve pain and reduce inflammation. Theyre only recommended for sciatica and not non-specific lower back pain.
If your back pain is chronic and other treatments havent helped, your doctor may suggest a procedure called radiofrequency denervation. Its only suitable for certain types of back pain. Your doctor will refer you to a specialist to assess whether it would help you.
You’ve Been In Pain For Over A Week
Most back pain will subside after a few days, but if you’ve been experiencing pain for over a week, then it’s time to call a doctor. Your doctor will perform any examinations or tests required to help get to the bottom of your pain before it could become a bigger problem. As is the case with many health conditions, prevention and addressing problems early is key.
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Diagnosis Of Lower Back Pain
A doctor will likely begin by requesting a complete medical history and conducting a thorough physical exam to determine where youre feeling the pain. The physical exam can also reveal whether the pain affects your range of motion.
In addition, a doctor may check your reflexes and responses to certain sensations. This helps them determine if your lower back pain is affecting your nerves.
Unless your symptoms are concerning or you have neurologic loss, a doctor will probably monitor your condition for a few weeks before sending you for more testing. This is because most lower back pain resolves with simple self-care treatments.
Symptoms that require more testing include:
- lack of bowel control
Seek medical attention immediately if you experience any of these symptoms in addition to lower back pain.
Referred Pain To And From The Lumbar Spine
Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back. Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve.. Sources of referred pain to the low back may include abdominal aneurysm , tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine. On the other hand, pain can be referred from the low back and be felt in another location, as is often the case with . For example, it is not rare for a patient with a slipped disc in the lower back to have pain in the back of the thigh, or in the calf or even the foot, and not have any low back pain. This situation requires a doctor to sort out the type of pain and to do the examination required to show that the pain is actually coming from the spine .
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Treatment Options For Acute Lower Back Pain
Most low back pain is due to muscle strain and spasm and does not require surgery. To treat the pain, medications such as acetaminophen , nonsteroidal anti-inflammatory agents , gabapentin or pregabalin can be used. NSAIDs suppress inflammation, pain and fever by inhibiting certain inflammation-causing chemicals in the body. Acetaminophen reduces pain and fever, but does not inhibit inflammation. Gabapentin and pregabalin, medications that have been used for antiseizure activity, also have the ability to block pain. Opioids provide pain relief and may at times be prescribed to manage severe back pain. However, opioids have many problems, such as habituation, constipation and lightheadedness, and are avoided when possible and used for the shortest possible duration. Epidural injection is an option if the back pain does not respond to these treatments. Each person is different in terms of response to medication.
Other nonsurgical treatments for lower back pain include Intradiscal electrothermal therapy , nucleoplasty, and radiofrequency lesioning.
What Are The Treatments For Lower Back Pain
Lower back pain usually gets better with rest, ice and over-the-counter pain relievers. After a few days of rest, you can start to get back to your normal activities. Staying active increases blood flow to the area and helps you heal.
Other treatments for lower back pain depend on the cause. They include:
- Medications: Your provider may recommend nonsteroidal anti-inflammatory drugs or prescription drugs to relieve pain. Other medications relax muscles and prevent back spasms.
- Physical therapy : PT can strengthen muscles so they can support your spine. PT also improves flexibility and helps you avoid another injury.
- Hands-on manipulation: Several hands-on treatments can relax tight muscles, reduce pain and improve posture and alignment. Depending on the cause of pain, you may need osteopathic manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief and restore function.
- Injections: Your provider uses a needle to inject medication into the area thats causing pain. Steroid injections relieve pain and reduce inflammation.
- Surgery: Some injuries and conditions need surgical repair. There are several types of surgery for low back pain, including many minimally invasive techniques.
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