What is low back pain?

The course of low back pain depends both on its cause and on how well you treat your back.

Most back pain gets better within 4 to 6 weeks with some basic self-care. But for some people, the pain lasts longer.

Chronic back pain is pain that has lasted longer than 3 months. This kind of back pain not only wears you down, but it also can trigger other problems. If your back pain causes you to use your body in different ways (for example, to limp or to sit differently), pain can develop in other areas of your body. Pain can also cause changes in your body that tend to keep the pain going.

Chronic back pain can be difficult to treat. But by working with a doctor and trying different treatments, most people can find relief.

Back pain can come on quickly or over time. You may feel:

• Pain in your hips or buttock.
• Leg pain, numbness, tingling, or weakness. When a nerve gets squeezed—such as from a disc problem or arthritis—you may have symptoms in your leg or foot. You can even have leg symptoms from a back problem without having any pain in your back.
• Pain that's sharp or dull, sometimes with stiffness or muscle spasms. It may be in one small area or over a broad area. But even bad pain doesn't mean that it's caused by something serious.

Most acute low back pain gets better on its own within several weeks, no matter what the cause. Time and doing usual activities are all that most people need to feel better.

Using heat or ice and taking over-the-counter pain medicine also can help while your body heals.

If you aren't getting better on your own or your pain is very bad, your doctor may recommend:

• Physical therapy.
• Spinal manipulation, such as by a chiropractor.
• Acupuncture.
• Massage.
• Injections of steroid medicine in your back (especially for pain that involves your legs).

If you have chronic low back pain, treatment will help you understand and manage your pain. Treatment may include:

• Staying active. This may include walking or doing back exercises.
• Physical therapy.
• Medicines. Some of these medicines are also used for other problems, like depression.
• Pain management. Your doctor may have you see a pain specialist.
• Counseling. Having chronic pain can be hard. It may help to talk to someone who can help you cope with your pain.

Surgery isn't needed for most people. But it may help some types of low back pain.

A physical exam is the main way to diagnose low back pain. Your doctor may examine your back, check your nerves by testing your reflexes, and make sure that your muscles are strong. Your doctor also will ask questions about your back and overall health.

Most people don't need any tests right away. Tests often don't show the reason for your pain.

If your pain lasts more than 6 weeks or you have symptoms that your doctor is more concerned about, then your doctor may order tests. These may include an X-ray, a CT scan, or an MRI. Sometimes other tests such as a bone scan or nerve conduction test may be done.

Medicine can reduce low back pain, but it should be used along with other treatments, such as heat or ice. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, seem to work best for low back pain. But if you can't take NSAIDs, you can try acetaminophen. Follow your doctor's advice for all medicines.

Many health professionals can diagnose, evaluate, and treat low back pain and back injuries. This includes your family doctor, a physician assistant, or a nurse practitioner. An osteopathic doctor or chiropractor also can check back pain. You may be asked to see a specialist, such as an orthopedic surgeon.

Ease back into daily activities

• For the first day or two of pain, take it easy. But as soon as you can, get back to your normal daily life and activities.
• Get gentle exercise, such as walking. Movement keeps your spine flexible and helps your muscles stay strong.
• If you are an athlete, return to your activity carefully. Choose a low-impact option until your pain is under control.

Avoid or change activities that cause pain

• Try to avoid too much bending, heavy lifting, or reaching. These movements put extra stress on your back.
• In bed, 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.
• When you sit, place a small pillow, a rolled-up towel, or a lumbar roll in the curve of your back for extra support.
• Try putting one foot up on a stool or changing positions every few minutes if you have to stand still for a period of time.

Pay attention to body mechanics and posture

Body mechanics are the way you use your body. Posture is the way you sit or stand.

• Take extra care when you lift. When you must lift, bend your knees and keep your back straight. Avoid twisting, and keep the load close to your body.
• Stand or sit tall, with your shoulders back and your stomach pulled in to support your back.

Get support when you need it

• Let people know when you need a helping hand. Get family members or friends to help out with tasks you can't do right now.
• Be honest with your doctor about how the pain affects you.
• If you've had to take time off work, talk to your doctor and boss about a gradual return-to-work plan. Find out if there are other ways you could do your job to avoid hurting your back again.

Reduce stress

Worrying about the pain can cause you to tense the muscles in your lower back. This in turn causes more pain. Here are a few things you can do to relax your mind and your muscles:

• Take 10 to 15 minutes to sit quietly and breathe deeply. Try to focus only on your breathing. If you can't keep thoughts away, think about things that make you feel good.
• Get involved in your favorite hobby, or try something new.
• Talk to a friend, read a book, or listen to your favorite music.
• Find a counselor you like and trust. Talk openly and honestly about your problems. Be willing to make some changes.

When you're in a lot of pain, you might wonder if you need surgery to fix what's wrong so that you can feel better.

Every case is different. But most people don't need surgery for low back pain.

When surgery may help

Reasons for having surgery for low back pain include:

• You have nerve pain from herniated discs. This is why most back surgeries are done. The disc problem causes pain in your leg that prevents you from doing everyday tasks. You may have pain, numbness, or tingling through your buttock and down the back of your leg (sciatica) or in the front of your thigh.
• A spinal fracture caused by an injury.
• An infection in your spine.
• A problem that causes your spine to be unstable.
• A tumor in your spine.
• Spinal stenosis. This is the narrowing of the spinal canal.
• Loss of feeling or weakness in your back or legs that gets worse over time.
• Loss of control of your bowel or bladder.

Back surgery doesn't always work. Depending on the condition, you may still have back pain after surgery.

A rehabilitation program is very important after most back surgery. If you can't or won't commit to physical therapy after surgery, you may not be a good candidate for surgery.

Surgery choices

There are several types of back surgery. Some, like a discectomy, can help people who have severe symptoms. Others have not been proved to work.

If you do need surgery, you and your doctor will decide which type is best for you. Having surgery for a herniated disc or another back problem is a big decision.

Types of surgeries include:

• Discectomy for a herniated disc. This removes the herniated disc material that is causing the problem.
• Laminectomy for spinal stenosis. This surgery relieves pressure on the spinal cord nerve roots.
• Kyphoplasty and vertebroplasty. These surgeries are done to try to relieve pain from compression fractures of the spine.
• Surgeries for tumors and infection.
• Spinal fusion. This is surgery to join, or fuse, two or more vertebrae in the low back.

Almost everyone has low back pain at some time. The good news is that most low back pain will go away in a few days or weeks with some basic self-care.

Some people are afraid that doing too much may make their pain worse. In the past, people stayed in bed, thinking this would help their backs. Now doctors think that, in most cases, getting back to your normal activities is good for your back, as long as you avoid doing things that make your pain worse.

Back pain is very common in adults. Some people are more at risk than others. For example, if you're overweight, you're pregnant, or you have had a previous back injury, fracture, or surgery, you may be more likely to have low back pain.

You can choose from a number of alternative treatments for your low back pain. Because some of these treatments are new or aren't yet well researched, they may not be covered by health insurance.

• Massage may reduce low back pain for a short time. It is likely to work best if you also learn to do exercises for your back and learn the best ways to lift and move to protect your back.
• Biofeedback may provide short-term pain relief, but there isn't enough evidence to show it will help.
• Acupuncture may help reduce pain and allow you to be active for a short time after treatment, but not any more than other treatments.
• Acupressure uses pressure on certain points in the body to decrease symptoms. Small studies suggest that it reduces pain and allows a person to be more active.
• Relaxation techniques can help reduce muscle tension, stress, and depression.
• Yoga is another way to stay active and get help with relaxation and managing stress. There is some evidence that yoga may help people with chronic low back pain to control their symptoms and stay more active. But it's not clear if yoga is more helpful than any other activity or treatment for chronic low back pain. There are different types of yoga. Talk to your doctor before you start a yoga program.
• Capsaicin cream may help relieve pain. It's a substance contained in cayenne peppers. Capsaicin cream is put on the skin over the painful area.
• Transcutaneous electrical nerve stimulation (TENS) gives brief pulses of electricity to nerve endings in the skin to relieve pain.

In most cases, there isn't a clear cause. This can be frustrating, because your back hurts and there's no obvious reason. Your back pain can be caused by:

Overuse or muscle strain.

This can happen from playing sports, lifting heavy things, or not being physically fit.

A herniated disc.

This is a problem with the cushion between the bones in your back.

Arthritis.

With age, you may have changes in your bones that can narrow the space around your nerves.

Other causes.

In rare cases, the cause is a serious illness like an infection or cancer. But there are usually other symptoms too.

Low back pain is pain in your back that can happen anywhere below the ribs and above the legs. It can be dull or sharp, in only one spot, or over a broad area.

Many people with low back pain feel as if their legs are weak. They will still have normal strength in their leg muscles. But moving their legs usually causes discomfort and gives them a sense of weakness.

True leg weakness leaves you unable to use some of your leg muscles normally. This can happen when a herniated disc presses on the nerve roots that make up the sciatic nerve. Pressure on the nerve interferes with its ability to control the leg muscles.