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

Health problems that can also cause back pain include:

  • 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

Risk Factors

This problem is more common in older adults but can happen at any age. Things that may increase the risk of injury are:

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

Job-related strain, such as:

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

SymptomsandDiagnosis

Symptoms

The back pain may be constant or come and go. 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 one side. Muscle weakness or numbness may also occur.

When Should I Call My Doctor?

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
  • Back 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 symptoms and past health. 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.

Treatments

Treatment

Back pain often improves with home care and time. If the pain is new, steps that may help to ease pain include:

  • Staying away from movement that makes pain worse—absolute rest is rarely helpful.
  • Cold or hot compresses over the area
  • Medicines, such as:
    • Over the counter and prescription pain relievers
    • Topical pain relievers that are applied to the skin
    • Muscle relaxants to ease spasms
  • Avoid intense stretching or exercise
  • Physical therapy to improve strength, flexibility, and range of motion
  • Cognitive behavioral therapy to learn how to manage pain

Back pain can linger for longer periods of time. Steps that may help chronic back pain include:

  • Regular exercise program—avoid activities that make back worse
  • Stretching program, like yoga
  • Physical therapy—to improve strength and balance, find cause of problem
  • Heat when back is stiff

Other treatments that may be helpful include:

  • Acupuncture
  • Spinal manipulation—specialist move spinal bones with controlled thrusts

Surgery may be needed for pain that is making day to day life difficult. Other treatments will be tried first before surgery. The type of surgery will depend on what is causing pain. Choices include:

  • Discectomy—remove damaged tissue between spinal bones, can relieve pressure on nerves.
  • Laminectomy—part if spinal bone is removed to ease pressure on nerves.
  • Spinal fusion—2 or more spinal bones are fused.

Prevention

Not all back pain can be prevented. Some things that may help are:

  • Regular exercise
  • Practicing good posture
  • Not sitting or standing in one position for too long
  • 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.