Low Back Pain

Causes

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

• Muscle strains or ligament sprains
• Degenerative disc disease—wear and tear on discs in the spine
• Structural problems in the spine
• Injury
• Osteoporosis—weakened bones

Health problems that can also cause back pain are:

• 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 raise 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

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.

Diagnosis

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

Pictures rarely need to be taken. They may be done for pain that is severe or does not get better with treatment.

Treatment

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

• Staying away from movement that makes pain worse—complete 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

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

• A regular exercise program that avoids things that make the back worse
• Physical therapy to improve strength, flexibility, and range of motion
• Cognitive behavioral therapy to learn how to manage pain

People who are not helped by these methods may need surgery. The type of surgery will depend on what is causing pain. Choices are:

• Discectomy—removes damaged tissue between spinal bones to ease pressure on nerves
• Laminectomy—part of a spinal bone is removed to ease pressure on nerves
• Spinal fusion—two or more spinal bones are fused to prevent them from moving

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
• Using proper technique when playing sports, exercising, or lifting heavy objects