Back pain

If your back aches, you're not alone. Four out of five adults experience at least one bout of back pain at some time during their lifetime. In fact, low back pain is the fifth-leading cause of trips to the doctor in the United States.

In addition, back injuries are the leading cause of work-related disability. Even though back pain is rarely life-threatening, the annual cost in terms of lost productivity, medical expenses and workers' compensation benefits runs into the tens of billions of dollars in the United States.

Although back pain is common, it's also quite possible for you to prevent most back problems with simple steps such as exercise and adopting new ways to sit and stand. Even if you've injured your back before, you can learn techniques to help avoid recurrent injuries.

 

Causes

Back pain can occur for no apparent reason and at any point on your spine. The most common site for pain is your lower back because it bears the most weight and stress. Back pain can have many causes.

 

When to seek medical advice

Most back pain disappears with home treatment and self-care. Although it may take several weeks before back pain completely disappears, you should feel some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. See a doctor immediately if your back pain:

bulletFeels constant or intense, especially at night
bulletSpreads down one or both legs
bulletCauses weakness, numbness or tingling in one or both legs
bulletCauses new bowel or bladder problems
bulletIs associated with abdominal pain or pulsation (throbbing)
bulletIs the result of a fall or blow to your back
bulletIs accompanied by unexplained weight loss

Also see your doctor if you're older than age 50 or have a history of back pain or cancer.

 

Screening and diagnosis

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber hammer. These assessments help determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms.

In most cases, diagnostic tests aren't necessary to confirm the cause of your pain. However, if your doctor suspects a tumor, fracture, infection or other disease, you may undergo one or more procedures:

bulletX-ray. These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.
bulletMagnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
bulletBone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.
bulletElectomyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

 

Treatment

Most back pain gets better with home treatment within four weeks. If home treatments aren't working, your doctor may suggest:

Medications and therapies

bulletMedications. Prescription drugs such as nonsteroidal anti-inflammatory drugs and muscle relaxants may relieve mild to moderate back pain. When pain doesn't respond to simpler measures, your doctor may advise injecting cortisone — an anti-inflammatory medication — into the epidural space in your back to decrease inflammation in the area around the nerve roots.
bulletHeat or cold. When performed by a licensed professional, applications of heat or cold may relieve back pain caused by muscle spasms.
bulletElectrical stimulation. A therapist can use a small device to deliver electrical stimulation directly to the muscles of your back. This can relieve back pain from muscle spasms and strains. You may also try transcutaneous electrical nerve stimulation (TENS), a form of electrical stimulation that can suppress pain from sciatica, or a "pinched nerve." In this treatment, you place small electrodes on your skin near the area of your pain. The current isn't painful, and it may provide pain relief.
bulletBack schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work.
bulletPhysical therapy and exercise. A physical therapist can use treatments and can manipulate and massage your back's tissues to reduce pain. As pain improves, you can help prevent back pain recurrence with an exercise program that increases your flexibility, strengthens your back and abdominal muscles, and improves your posture.

 

Surgical and other procedures

Only a few people ever need surgery for back pain. Surgery is usually reserved for certain kinds of back pain that haven't responded to more conservative measures. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Common back surgeries include:

bulletLaminectomy and laminotomy. These procedures, which involve removing part of your vertebra, may relieve leg pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine.
bulletFusion. This surgery involves joining two vertebrae to eliminate painful movement. A variety of metal implants also are available to help accomplish the fusion.

 

Prevention

With a little care and attention, you may be able to avoid an aching back in the first place. Getting in better physical condition may help prevent back pain.

To keep your back healthy and strong:

bulletExercise. Regular aerobic activities that don't strain or jolt your back can increase strength and endurance in your lower back, allowing your muscles to function better. These aerobic exercises include walking, swimming or biking. Talk with your doctor about which activity is best for you.
bulletBuild muscle strength and flexibility. Conditioned abdominal and back muscles work together like a natural corset for your back. Flexibility in your hips and upper legs allows for proper pelvic bone alignment, which improves how your back feels. Doing several simple exercises on a regular basis can help support and align your back.
bulletQuit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
bulletMaintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain.

 

In addition, use proper body mechanics in everyday activities:

bulletStand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
bulletSit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
bulletLift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
bulletSleep smart. People with back pain have commonly been told to use a firm mattress, but a recent study indicates that they may sleep even better on a medium-firm mattress. Use pillows for support, but don't use a pillow that forces your neck up at a severe angle.

 

Self-care

A sore back usually settles down or improves within four weeks, unless there's a serious medical condition causing the pain. See your doctor if you don't experience any improvement after 72 hours of home treatment.

These steps can help you treat back pain at home:

bulletKeep moving. Prolonged bed rest isn't a good idea for back pain. Light activity speeds healing and recovery. If your back hurts, stop the aggravating activities, but try to keep up activities that aren't painful.
bulletApply cold, then heat. Sources of heat and cold, such as a hot bath and hot or cold compresses, can soothe sore and inflamed muscles. Use cold treatment first. Immediately after injuring your back, apply ice several times a day, for up to 20 minutes at a time. Put the ice in a bag, then wrap the bag in a cloth or towel to keep a thin barrier between the ice and your skin. Use ice for as long as spasms persist. After spasms and acute pain subside, you can apply heat from a heating pad or heat lamp to help loosen tight muscles. Limit each heat application to 20 minutes.
bulletUse pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others) may help control pain. Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil, Motrin, others) also can reduce inflammation, swelling and stiffness.
bulletConsider limited use of a support brace or corset. Braces and corsets are available over the counter at pharmacies and medical supply stores. Your doctor also may prescribe a brace customized for your back. However, research studies are divided as to whether back braces and corsets can relieve strain. They can provide warmth, comfort and a degree of support to your back. But some devices may be uncomfortable. Another drawback is that your back muscles may weaken with prolonged use of a brace or corset. It's best to use a brace or corset only for short periods or during back-straining activities. The best brace or corset you can give yourself is your own "muscle corset." You can build up your muscle corset through back strengthening and stability exercises.

 

Complementary and alternative medicine

Besides treatment provided by a doctor and self-care steps taken at home, some people have turned to complementary and alternative therapies for relief of back pain.

bulletChiropractic care. Back pain is one of the most common reasons that people see a chiropractor. If you're considering chiropractic care, talk to your doctor about the most appropriate specialist for your type of problem. In addition to chiropractors, many osteopathic doctors and some physical therapists have training in spinal manipulation.
bulletAcupuncture. Some people with low pack pain report that acupuncture helps relieve their symptoms. It may provide some help for people with chronic low back pain.

 

 By Mayo Clinic staff