Low Back Pain

Overview

Definition

Low back pain is an ache or discomfort in the lower part of the spine. This area has many small bones and muscles that surround and protect the spinal cord and nerves.

Bones of the Lower Back
lumbar disc herniation back
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Causes

Many things can cause low back pain. Some causes are:

  • Muscle strains or ligament sprains
  • Degenerative disc disease—wear and tear on discs in the spine
  • Structural problems in the spine
  • Injury
  • Other health problems, such as osteoporosis

Risk Factors

This problem is more common in older adults.

General risk factors are:

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

Health problems, such as:

  • Herniated disc —the cushions between the bones of the spine develop a bulge
  • Degenerative diseases, such as arthritis
  • Fractures due to trauma and osteoporosis
  • Spinal stenosis —narrowing of the spinal canal
  • Spondylolisthesis —slippage of a bone in the lower back
  • Ankylosing spondylitis —an autoimmune disease involving the spine
  • Cauda equina syndrome —compression of nerve roots at the base of the spinal cord
  • Tumors
  • Infections

Job-related factors, such as:

  • Bending, twisting, or reaching
  • Vibrations
  • Heavy manual labor

Psychosocial factors, such as:

  • Anxiety and depression
  • Stress
  • Repetitive tasks

SymptomsandDiagnosis

Symptoms

The main problem is pain in the low back. It may be worse with 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 also occur.

When Should I Call My Doctor?

Often, back pain improves with home care. Some problems may need care right away. Call the doctor if you have:

  • Severe or worsening pain
  • Pain that lasts longer than one week
  • Problems walking, standing, or moving
  • Pain that is worse at night or when you lie down
  • Pain that spreads down your legs
  • Pain or throbbing in your belly
  • Bain pain with:
    • Numbness, weakness, or tingling in the buttocks, genitals, or legs
    • Loss of bowel or bladder control
    • Problems urinating
    • Fever, unexplained weight loss, or other signs of illness

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The exam will focus on the back, hips, and legs.

Imaging tests are rarely needed. They may be done for pain that is severe or does not get better with treatment. They may be taken with:

  • X-rays
  • MRI scan
  • CT scan
  • Ultrasound

Other tests may be done. It depends on what the doctor thinks may be causing the pain.

Treatments

Treatment

The goal of treatment is to ease pain. Choices are:

  • Supportive care, such as resting the area for no more than 1 to 2 days, applying cold compresses, and avoiding things that may the pain worse
  • Medicines, such as:
    • Over the counter and prescription pain relievers
    • Topical pain relievers that are applied to the skin
    • Muscle relaxants to ease spasms
  • Physical therapy to improve strength, flexibility, and range of motion
  • Cognitive behavioral therapy to learn how to manage pain

Some people may need surgery, such as discectomy , laminectomy , or spinal fusion .

Prevention

There are no known guidelines to prevent this health problem. Some things that may help are:

  • Exercising regularly
  • Practicing good posture
  • Not sitting or standing in one position for too long
  • Use proper techniques when playing sports, exercising, or lifting heavy objects

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

RESOURCES

North American Spine Society http://www.spine.org 

Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org 

Canadian Orthopaedic Foundation http://www.canorth.org 

References

Acute low back pain. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-low-back-pain. Accessed January 28, 2021.

Chronic low back pain. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/chronic-low-back-pain. Accessed January 28, 2021.

National Guideline Centre. Low back pain and sciatica in over 16s: assessment and management. London (UK): National Institute for Health and Care Excellence (NICE); 2016 Nov 30. 18 p.

12/14/2016 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/condition/chronic-low-back-pain: Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA 2016;315(12):1240-1249.