Back Pain

Back pain can range from a dull, constant ache to a sudden, sharp pain.

Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take a while. Taking over-the-counter pain relievers and resting can help. However, staying in bed for more than 1 or 2 days can make it worse.

If your back pain is severe or doesn't improve after three days, you should call your health care provider. You should also get medical attention if you have back pain following an injury.

Treatment for back pain depends on what kind of pain you have, and what is causing it. It may include hot or cold packs, exercise, medicines, injections, complementary treatments, and sometimes surgery.

 

One of the best ways to prevent back pain is to keep your back muscles strong. Follow these steps to help protect your back and prevent back pain:
  • Do back-strengthening and stretching exercises at least 2 or 3 times a week.
  • Stand and sit up straight.
  • Avoid heavy lifting. If you do lift something heavy, bend your knees and keep your back straight. This way, your leg muscles will do most of the work.
  • Stay active and eat a balanced diet.
  •  If you are overweight, lose weight to help lower the strain on your back.

 

Although anyone can have back pain, a number of factors increase your risk. They include:

Age

The first attack of low back pain typically occurs between the ages of 30 and 40. Back pain becomes more common 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.

Diet

A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity, which can put stress on the back.

Heredity 

Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, have a genetic component.

Race

Race can be a factor in back problems. African American women, for example, are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine—also called the lumbar spine—slips out of place.

The presence of other diseases

Many diseases can cause or contribute to back pain. These include various forms of arthritis, such as osteoarthritis and rheumatoid arthritis, and cancers elsewhere in the body that may spread to the spine.

Occupational risk factors

Having a job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.

Cigarette smoking

Although smoking may not directly cause back pain, it increases your risk of developing low back pain and low back pain with sciatica. (Sciatica is back pain that radiates to the hip and/or leg due to pressure on a nerve.) Furthermore, smoking can slow healing, prolonging pain for people who have had back injuries, back surgery, or broken bones.

 

It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Medical problems that can cause back pain include the following:

Mechanical problems

A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disk degeneration, which simply means that the disks located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms, muscle tension, and ruptured disks, which are also called herniated disks.

Injuries 

Spine injuries such as sprains and fractures can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis. Less commonly, back pain may be caused by more severe injuries that result from accidents or falls.

Acquired conditions and diseases

Many medical problems can cause or contribute to back pain. They include scoliosis, a curvature of the spine that does not usually cause pain until middle age; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. Although osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, a condition of widespread muscle pain and fatigue.

Infections and tumors

Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the disks that cushion the vertebrae, which is called diskitis. Tumors also are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.

Although the causes of back pain are usually physical, emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.

 

Aching back.

Diagnosing the cause of back pain requires a medical history and a physical exam. If necessary, your doctor may also order medical tests, which may include x rays.

Questions your doctor may ask might include the following

  • Have you fallen or injured your back recently?
  • Does your back feel better—or hurt worse—when you lie down?
  • Are there any activities or positions that ease or aggravate pain?
  • Is your pain worse or better at a certain time of day?
  • Do you or any family members have arthritis or other diseases that might affect the spine?
  • Have you had back surgery or back pain before?
  • Do you have pain, numbness, or tingling down one or both legs?

During a physical exam, your doctor may

  • watch you stand and walk
  • check your reflexes to look for slowed or heightened reflexes, either of which might suggest nerve problems
  • check for fibromyalgia by examining your back for tender points, which are points on the body that are painful when pressure is applied to them
  • check for muscle strength and sensation
  • check for signs of nerve root irritation.

Often a doctor can find the cause of your pain with a physical and medical history alone. However, depending on what the history and exam show, your doctor may order medical tests to help find the cause.

Following are some tests your doctor may order:

X rays

Traditional x rays use low levels of radiation to project a picture onto a piece of film (some newer x rays use electronic imaging techniques). They are often used to view the bones and bony structures in the body. Your doctor may order an x ray if he or she suspects that you have a fracture or osteoarthritis or that your spine is not aligned properly.

Magnetic resonance imaging (MRI)

MRI uses a strong magnetic force instead of radiation to create an image. Unlike an x ray, which shows only bony structures, an MRI scan produces clear pictures of soft tissues, too, such as ligaments, tendons, and blood vessels. Your doctor may order an MRI scan if he or she suspects a problem such as an infection, tumor, inflammation, or pressure on a nerve. An MRI scan, in most instances, is not necessary during the early phases of low back pain unless your doctor identifies certain “red flags” in your history and physical exam. An MRI scan is needed if the pain persists for longer than 3 to 6 weeks or if your doctor feels there may be a need for surgical consultation. Because most low back pain goes away on its own, getting an MRI scan too early may sometimes create confusion for the patient and the doctor.

Computed tomography (CT) scan

A CT scan allows your doctor to see spinal structures that cannot be seen on traditional x rays. A computer creates a three-dimensional image from a series of two-dimensional pictures that it takes of your back. Your doctor may order a CT scan to look for problems including herniated disks, tumors, or spinal stenosis.

Blood tests

Although blood tests are not used generally in diagnosing the cause of back pain, your doctor may order them in some cases.

 

Treatment for back pain generally depends on what kind of pain you experience: acute or chronic.

Acute Back Pain

Acute back pain usually gets better on its own and without treatment, although you may want to try acetaminophen, aspirin, or ibuprofen to help ease the pain. Perhaps the best advice is to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness, relieve pain, and have you back doing your regular activities sooner. Exercises or surgery are not usually advisable for acute back pain.

Chronic Back Pain

Treatment for chronic back pain falls into two basic categories: the kind that requires an operation and the kind that does not. In the vast majority of cases, back pain does not require surgery. Doctors will nearly always try nonsurgical treatments before recommending surgery.

Nonsurgical Treatments

Hot or cold

Hot or cold packs—or sometimes a combination of the two—can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, both improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.

Exercise

Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce the risk of it returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:

Flexion

The purposes of flexion exercises, which are exercises in which you bend forward, are to (1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; (2) stretch muscles of the back and hips; and (3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disk, check with your doctor before performing flexion exercises because they may increase pressure within the disk, making the problem worse.

Extension

With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting and raising the trunk, each exercise performed while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.

Stretching

The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.

Aerobic

Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the disks and actually do more harm than good. In addition, avoid high-impact activities if you have disk disease. If back pain or your fitness level makes it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.