Low Back Pain
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 common and affects most adults at some point in their lives.
|Bones of the Lower Back|
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Low back pain in more common in older adults.
Factors that increase your chance of low back pain include:
General factors, such as:
- Certain activities, such as lifting, bending, or twisting
- Prior back injury
- Prior back surgery
Health conditions, 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/or 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 —nerve roots at the base of the spinal cord are compressed
Occupational factors, such as:
- Bending, twisting, or reaching
- Exposure to vibrations
- Heavy manual labor
- Heavy lifting
Psychosocial factors, such as:
- Anxiety and depression
- Low job satisfaction
- Repetitive, monotonous tasks
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 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.
You will be asked 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 are rarely needed. They may be done for pain that is severe or does not respond to treatment. If needed, imaging tests options include:
- MRI scan
- CT scan
Your doctor may recommend other tests to help diagnose or eliminate any causes of your back pain.
Treatment options include:
Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Certain activities may be restricted for a period of time and then resumed as soon as possible. Recovery time may be shortened by staying active and exercising.
Your doctor may advise:
- Over-the-counter or prescription pain relievers
- Topical pain relievers that are applied to the skin
- Muscle relaxants for muscle spasms
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
Cognitive behavioral therapy is often used to help manage chronic pain and stress. It is a form of talk therapy that may be done individually or in a group. A therapist will help you identify negative thoughts and teach you to unlearn these thought patterns. You will also learn new, helpful habits to manage your pain with minimal disruption to your life.
Some people find pain relief from:
- Relaxation training
- Chiropractic or osteopathic manipulation
- Stress reduction techniques
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 .
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 movement when playing sports, exercising, or lifting heavy objects.
- Consider job retraining if your work requires a lot of heavy lifting or sitting.
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.
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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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