Back pain is a common reason for absence from work and for seeking medical treatment. This can be humiliating and frustrating.
It can be due to injury, activity, and certain medical conditions. Back pain may affect individuals of any age, for different reasons. When people get older, due to factors such as prior occupation and degenerative disk disease, the risk of experiencing lower back pain increases.
Lower back pain may be associated with the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, inner abdominal and pelvic organs and skin around the lumbar area.
The human back is made up of a complex structure of muscles , ligaments , tendons, disks, and bones that work together to support the body and allow us to move about.
Spine segments are cushioned with cartilage-like pads which are called disks.
Problems with either of these components can cause back pain. In some back pain cases their origin remains unknown.
Damage can result from strain, medical conditions , and poor posture, among others.
Back pain is usually caused by pressure , stress or injury. Recurring sources of back pain are:
- strained muscles or ligaments
- a muscle spasm
- muscle tension
- damaged disks
- injuries, fractures, or falls
Activities that can lead to strains or spasms include:
- lifting something improperly
- lifting something that is too heavy
- making an abrupt and awkward movement
A number of structural problems may also result in back pain.
- Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
- Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
- Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.
- Abnormal curvature of the spine: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.
- Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
- Kidney problems: Kidney stones or kidney infection can cause back pain.
Movement and posture
Back pain can also be the result of certain everyday routines or poor posture.
- coughing or sneezing
- muscle tension
- bending awkwardly or for long periods
- pushing, pulling, lifting, or carrying something
- standing or sitting for long periods
- straining the neck forward, such as when driving or using a computer
- long driving sessions without a break, even when not hunched
- sleeping on a mattress that does not support the body and keep the spine straight
Some medical conditions can lead to back pain.
- Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.
- Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain.
- Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
- Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.
- Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.
- Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.
The following factors are linked to a higher risk of developing low back pain:
- occupational activities
- a sedentary lifestyle
- poor physical fitness
- older age
- obesity and excess weight
- strenuous physical exercise or work, especially if done incorrectly
- genetic factors
- medical conditions, such as arthritis and cancer
The key symptom of back pain is an ache or discomfort somewhere in the back, and even all the way down to the buttocks and legs.
Some back problems can cause pain in other parts of the body, depending on the nerves affected.
The pain sometimes goes away without medication but please see the doctor if it occurs with any of the following people:
- weight loss
- inflammation or swelling on the back
- persistent back pain, where lying down or resting does not help
- pain down the legs
- pain that reaches below the knees
- a recent injury, blow or trauma to the back
- urinary incontinence
- difficulty urinating
- fecal incontinence, or loss of control over bowel movements
- numbness around the genitals
- numbness around the anus
- numbness around the buttocks
When to see a doctor
If you feel some numbness or tingling, or if you have back pain, you can seek medical help:
- that does not improve with rest
- after an injury or fall
- with numbness in the legs
- with weakness
- with fever
- with unexplained weight loss
Usually, a doctor should be able to treat back pain after asking about symptoms and doing a physical exam.
An imaging scan and other tests, if:
- back pain appears to result from an injury
- there may be underlying cause that needs treatment
- the pain persists over a long period
- X-rays can show the alignment of the bones and detect signs of arthritis or broken bones, but they may not reveal damage in the muscles, spinal cord, nerves, or disks.
- MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
- Bone scans can detect bone tumors or compression fractures caused by osteoporosis. A radioactive substance or tracer is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
- Electromyography or EMG measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.
The doctor may also order a blood test if infection is suspected.
Other types of diagnosis
- A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
- An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
- A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.
Chronic or acute pain?
Back pain is categorized into two types:
- Acute pain starts suddenly and lasts for up to 6 weeks.
- Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.
When a person has both occasional bouts of more severe pain and mild back pain that is relatively constant, it can be difficult for a doctor to decide if they have acute or chronic back pain.
Back pain typically recovers with rest and home remedies but occasionally it requires medical treatment.
Over-the-counter ( OTC) medications for pain relief, usually non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may relieve discomfort. Applying a hot compress or an ice pack can also reduce pressure in the sore area.
Resting from hard work will help, but moving around can ease discomfort, relieve pain and avoid weakening of muscles.
If home therapies do not reduce back pain, a doctor may prescribe the following medications, physical therapy or both.
Medication: A prescription NSAID may be needed for back pain which does not respond well to OTC painkillers. Codeine or hydrocodone can be administered for short periods, which are narcotics. Those need close physician supervision. The muscle relaxants may be used in some cases.
Antidepressants can be prescribed, such as amitriptyline, but work is ongoing to their efficacy and the evidence is contradictory.
Physical therapy: Applying heat, ice, ultrasound, and electrical stimulation — as well as some techniques of muscle-release to the back muscles and soft tissues — can help relieve pain.
As the pain improves, the physical therapist can implement some exercises of flexibility and strength for the back and abdominal muscles. Posture enhancement techniques may also help.
The patient should be advised to consistently follow the exercises, long after the pain has gone away, to avoid recurrence of back pain.
Cortisone injections: These can be inserted into the epidural space, around the spinal cord, if other methods are not successful. Cortisone is a flame retardant drug. It helps lessen inflammation around the roots of the nerves. Also injections can be used to numb areas which are thought to cause pain.
Botox: Botox (botulism toxin) is believed to be reducing pain by paralyzing sprained muscles in the spasm, according to some early reports. These injections take around 3 to 4 months to be successful.
Traction: It uses pulleys and weights to stretch the leg. This could cause a herniated disk to move back into position. It can also relieve pain, but it is only during traction.
Cognitive behavioral therapy ( CBT): CBT will help by encouraging new ways of thinking to treat chronic back pain. These can include methods of relaxation, and ways to sustain a positive attitude. Studies also shown that CBT patients appear to become more involved and perform exercise, contributing to a reduced risk of recurrence of back pain.
Complementary therapies can be used either individually or in combination with traditional therapies.
Chiropractic, osteopathy, shiatsu, and acupuncture may help alleviate back pain, and may also encourage relaxation.
- An osteopath specializes in treating the skeleton and muscles.
- A chiropractor treats joint, muscle and bone problems. The main focus is the spine.
- Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with the fingers, thumbs and elbows.
- Acupuncture originates from China. It consists of inserting fine needles and specific points in the body. Acupuncture can help the body release its natural painkillers — endorphins — as well as stimulating nerve and muscle tissue.
- Yoga involves specific poses, movements, and breathing exercises. Some may help strengthen the back muscles and improve posture. Care must be taken that exercises do not make back pain worse.
Complementary therapy trials have delivered mixed results. Some people experienced substantial benefit while others did not. It is necessary to employ a well-qualified and licensed therapist when considering alternative therapies.
Transcutaneous electrical nerve stimulation (TENS): is a common treatment for chronic back pain patients. The TENS system provides minute, electrical pulses by electrodes mounted on the skin throughout the body.
Experts believe that TENS encourages the body to produce endorphins, and can block signals of pain that return to the brain. TENS trials produced mixed results. Others reported no advantages, while others suggested others people could find it helpful.
Under the direction of a doctor or health care professional a TENS machine should be used.
It should not be used by someone who is:
TENS is considered “safe, non-invasive, inexpensive, and patient-friendly,” and appears to minimize discomfort, although more research is required to support its efficacy in enhancing rates of operation.
Back pain surgery is very rare. If a patient has a herniated disk surgery, this may be an option , particularly if there is persistent pain and compression of the nerves that can lead to muscle weakness.
Examples of surgical procedures include:
- Fusion: Two vertebrae are joined together, with a bone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.
- Artificial disk: An artificial disk is inserted; it replaces the cushion between two vertebrae.
- Diskectomy: A portion of a disk may be removed if it is irritating or pressing against a nerve.
- Partially removing a vertebra: A small section of a vertebra may be removed if it is pinching the spinal cord or nerves.
Injecting cells to regenerate spine discs: Scientists at Duke University, North Carolina, have developed new biomaterials that can provide the nucleus pulposus with a booster shot of reparative cells, effectively eliminating pain caused by degenerative disorder.
Steps to reduce the risk of developing back pain primarily include addressing some of the risk factors.
Exercise: Daily exercise helps develop body strength and weight control. Guided aerobic activities with low impacts can boost heart health without straining or jerking the back. Speak to a health care provider before you undertake any fitness programme.
There are two key forms of exercise that humans can do to minimize back pain risk:
- Core-strengthening exercises work the abdominal and back muscles, helping to strengthen muscles that protect the back.
- Flexibility training aims at improving core flexibility, including the spine, hips, and upper legs.
Smoking: A substantially higher percentage of smokers have incidences of back pain relative to non-smokers of the same age , height, and weight.
Body weight: People carry weight, and where they carry it affects the risk of back pain. The disparity between obese and normal-weight individuals in risk of back pain is significant. There is also a greater risk for people who carry their weight in the abdominal area versus the buttocks and the hip.
Posture when standing: Make sure you have a neutral pelvic position. Stand upright, head forward, back straight, and put the weight on both feet equally. Keep your legs straight and head up to your spine.
Posture when sitting: A good work seat will have strong back support, arm rests and a base swivel. Try keeping your knees and hips straight when sitting, and putting your feet flat on the floor, or using a footstool. Ideally you should be able to sit upright in the small of your back with the help. Make sure your elbows are at right angles and your forearms are horizontal while using a keyboard.
Lifting: Use your legs to lift things, instead of your back.
Keep your back as straight as you can, with one leg slightly forward keeping your feet apart so you can maintain your balance. Just bend at the knees, hold the weight close to your body and straighten the legs as little as possible when adjusting your back position.
Initially, bending your back is unavoidable, but when you bend your back try not to hesitate and make sure that your abdominal muscles are relaxed to bring your pelvis in. Most importantly, before lifting, don’t straighten your legs or you can use your back for most of the work.
At the same time, do not lift and twist: If anything is particularly heavy, see if you can lift it with someone else. While lifting, keep looking straight forward, not up or down, so your neck’s back is like a continuous straight line from your spine.
Moving things: Moving stuff around the floor, using your leg strength, is better for your back than dragging them out.
Shoes: Flat shoes, on the back, put less pressure.
Driving: Proper support for your back is critical. Be sure the wing mirrors are aligned correctly so you don’t need to twist. Pedals should be placed squarely before your feet. Have plenty of breaks, if you’re on a long journey. Get out of your car and hike around.
Bed: You should have a mattress that holds your spine straight, while protecting your shoulders and buttocks at the same time. Using a pillow but not one that causes a steep angle in your back.