Definition

Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column has many small bones and muscles that surround and protect the spinal cord and nerves. Low back pain is very common and affects most adults at some point in their lives.

Bones of the Lower Back
lumbar disc herniation back
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Causes

There are many possible causes for low back pain, but in most cases it is unknown. Some causes of back pain may include:

  • Muscle strains or ligament sprains
  • Disc degeneration
  • Spinal deformities
  • Injury
  • Health conditions

Risk Factors

Factors that increase your chance of low back pain include:

General factors, such as:

  • Increasing age
  • Certain activities, such as lifting, bending, or twisting
  • Lack of exercise
  • Obesity
  • Pregnancy
  • Smoking
  • Prior back injury
  • Prior back surgery

Health conditions, such as:

Occupational factors, such as:

  • Bending, twisting, or reaching
  • Exposure to vibrations
  • Heavy manual labor
  • Heavy lifting

Psychosocial factors, such as:

Symptoms

Pain is usually restricted to the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on the affected side. Muscle weakness or numbness may occur.

When Should I Call My Doctor?

Often, back pain improves with self-treatment. However, some serious symptoms may occur. They may require more immediate medical attention. Call your doctor if back pain:

  • Is severe or gets significantly worse
  • Has not started to improve within about a week
  • Causes difficulty walking, standing, or moving
  • Is worse at night or worse when you lie down
  • Spreads down your legs
  • Comes with pain or throbbing in your abdomen
  • Is new and you are over age 50 years old
  • Is associated with:
    • Numbness, weakness, or tingling in your buttocks, genitals, or legs
    • Loss of bowel or bladder control
    • Difficulty with urination
    • Fever, unexplained weight loss, or other signs of illness

You should call your doctor if you have back pain and a history of cancer or osteoporosis. You should also call if you have a history of recent infection, steroid use or IV drug use.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will focus on your back, hips, and legs. The doctor may test for strength, flexibility, sensation, and reflexes.

Imaging tests take pictures of internal structures. These include:

It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.

Your doctor may recommend other tests to help diagnose or eliminate any causes of your back pain.

Treatment

Treatment options include:

Activity

Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising.

Medication

Your doctor may recommend:

  • Over-the-counter or prescription pain relievers
  • Topical pain relievers that are applied to the skin
  • Muscle relaxants for muscle spasms
  • Antidepressants for chronic back pain

Physical Therapy

Physical therapy may include:

  • Applying hot or cold packs
  • Stretching, strengthening, and balance exercises for back and stomach muscles
  • Aerobic exercise
  • Instruction in appropriate posture and lifting
  • Massage

Alternative Medicine

Some people find pain relief from:

Surgery

Only a small number of people need surgery. It may be needed if nerve problems develop or other treatments do not provide relief. Common procedures are discectomy, laminectomy, and spinal fusion.

Prevention

To help reduce your chance of low back pain:

  • Begin a safe exercise program with the advice of your doctor.
  • Practice good posture to reduce pressure on your spine.
  • Avoid sitting or standing in one position for long periods of time.
  • Use proper body movment when playing sports, exercising, or lifting heavy objects.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.

Revision Information

  • North American Spine Society

    http://www.spine.org

  • Ortho Info—American Academy of Orthopaedic Surgeons

    http://www.orthoinfo.org

  • Canadian Orthopaedic Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

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