Often doctors don’t know what causes low back
What are the symptoms?
Depending on the cause, low back pain can cause a range of symptoms. The
pain may be dull or sharp. It may be in one small area or over a broad area.
You may have muscle spasms.
Low back pain can also cause leg symptoms,
such as pain, numbness, or tingling, often extending below the knee.
rare but serious problem called cauda
equina syndrome can occur if the nerves at the end of the spinal
cord are squeezed. Seek emergency treatment if you have weakness or numbness in
both legs or you lose bladder or bowel control.
Most low back pain is
short-term (acute) and will go away in a few weeks. It is more likely to become
long-lasting (chronic) if you are depressed or under
How is low back pain
Your doctor will ask questions about your past health,
symptoms, and activities. He or she will also do a physical exam. Your answers
and the exam can help rule out a serious cause for the pain. In most cases,
doctors are able to recommend treatment after the first exam.
But if you have a back pain problem that has lasted longer than 6 weeks,
or if your doctor thinks you may have more than muscle pain, it might be time
for one of these tests.
How is it
Most low back pain will improve with basic first aid, which
includes continuing to do light activity such as walking, and taking
over-the-counter pain medicine as needed.
Walking is the simplest and
maybe the best exercise for the lower back. It gets your blood moving and helps
your muscles stay strong.
Your doctor or physical therapist can
recommend more specific exercises to help your back muscles get stronger. These
may include a series of simple exercises called core stabilization.
Strengthening the muscles in your trunk can improve your posture, keep your
body in better balance, and lower your chance of injury.
symptoms are severe or you still have symptoms after 2 weeks of self-care, see
your doctor. You may need stronger pain medicines, or you might benefit from manual therapy.
of the various treatments for back pain work for some people but not for
others. You may need to try different things to see which work best for you,
Having ongoing (chronic) back pain can make you
depressed. In turn, depression can have an effect on your level of pain and
whether your back gets better. People with depression and chronic pain often
benefit from both antidepressant medicines and counseling. Counseling can help
you learn stress management and pain control skills.
How can you prevent low back pain from returning?
After you’ve had low back pain, you’re likely to have it again. But there
are some things you can do to help prevent it. And they can help you get better
faster if you do have low back pain again.
To help keep your back
healthy and avoid further pain:
Practice good posture when you sit,
stand, and walk. “Good posture” generally means your ears, shoulders, and hips
are in a straight line.
Get regular, low-impact exercise. Walk, swim,
or ride a stationary bike. Stretch before you exercise.
tumors, which are growths on the bones and ligaments of the
spine, on the spinal cord, or on nerve roots.
Symptoms of low back pain depend on the
Back sprain or strain
Muscle spasms, cramping, and stiffness.
the back and sometimes in the buttock. It may come on quickly or gradually. It
most often occurs in episodes. Certain movements make it worse, and doing light
activities such as walking makes it feel better. The worst pain usually lasts
48 to 72 hours and may be followed by days or weeks of less severe
Symptoms typically include:
Leg pain. If pain extends
below the knee, it is more likely to be due to pressure on a nerve than to a
muscle problem. Most commonly, it’s a pain that starts in the buttock and
travels down the back of the leg as far as the ankle or foot. This pain pattern
is known as sciatica (say “sy-AT-ih-kuh”). For more information, see the topic Sciatica.
Nerve-related problems, such as tingling, numbness, or weakness in
one leg or in the foot, lower leg, or both legs. Tingling may begin in the
buttock and extend to the ankle or foot. Weakness or numbness in both legs, or
loss of bladder and/or bowel control, are symptoms of cauda equina syndrome,
which requires immediate medical attention.
Starts gradually, gets worse over time, and lasts longer than 3 to 6 months.
Is generally worse in the morning or after prolonged periods of
inactivity. Arthritis pain gets better when you move
Symptoms of diseases that affect the spine depend on the disease. They may
Pain that is worse in the affected part of the spine (for
instance, if there is a compression fracture, tumor, or infection).
Pain that starts gradually, is constant, and may be sharp or a dull ache.
Bed rest doesn’t help and may make it worse (for example, tumors on the spine
often cause night pain). The pain lasts longer than 2 to 3 weeks.
Sensitivity of the spine to touch and pressure.
Pain that wakes you up from sleep.
The course of low back pain depends both on its cause
and on how well you treat your back.
Most low back pain goes away within
several weeks. But after you have had back pain once, you’re more likely to
have it again. Many people who recover have back pain again within a year, and
most people will have it again sometime during their lives.
(chronic) pain not only makes you tired, irritable, and less productive and
less active but also can trigger other problems. If your back pain causes you
to use your body in different ways (for example, to limp or to sit
differently), pain can develop in other areas of the body. Pain can also cause
biochemical changes in your body that tend to keep the pain going.
What Increases Your Risk
A risk factor is something that increases
your chances of having back pain. Having more risk factors means you have a
higher chance of having back pain.
Physical and family
Being middle-aged or older
Having a family history of back pain
Having had a back injury
Being pregnant. A woman’s back is significantly stressed by
carrying a baby.
Risk factors you can
change with lifestyle changes
Not getting regular exercise
Doing a job or other activity that requires long periods of sitting, heavy
lifting, bending or twisting, repetitive motions, or constant vibration, such
as using a jackhammer or driving certain types of heavy equipment
Smoking. People who smoke are more likely than people who don’t smoke to
have low back pain.
Being overweight. Excess body weight, especially
around the waist, may put strain on your back, although this has not been
proved. But being overweight often also means being in poor physical condition,
with weaker muscles and less flexibility. These can lead to low back pain.
Having poor posture.
Slumping or slouching on its own may not cause low back pain. But after the
back has been strained or injured, bad posture can make pain worse. “Good
posture” generally means your ears, shoulders, and hips are in a straight line.
If this posture causes pain, you may have another condition such as a problem
with a disc or bones in your back.
Being under stress. Stress and other
emotional factors are believed to play a major role in low back pain,
particularly chronic low back pain. Many people unconsciously tighten their
back muscles when they are under stress.
Risk factors you might change with medical treatment
Having long periods of depression
Using medicines long-term
that weaken bones, such as corticosteroids
Having an illness or disease
that causes chronic
When to Call a Doctor
Call 911 or
other emergency services immediately if:
Back pain occurs with
chest pain or other symptoms of a heart attack.
A person has signs of
damage to the spine after an injury (such as a car accident, fall, or direct
blow to the spine). Signs may include:
Being unable to move part of the
Severe back or neck pain.
Weakness, tingling, or numbness
in the arms or legs.
Call your doctor now if:
You have new numbness in your
legs or numbness in your legs that is getting worse.
You have new
weakness in your legs or weakness in your legs that is getting worse. (This
could make it hard to stand up.)
You have a new loss of
bowel or bladder control.
You have new or increased back pain with fever, painful urination, or other
signs of a urinary tract infection.
You have long-term back pain that
suddenly gets much worse, and you did not cause it by being more active.
You have a history of cancer or HIV infection, and you have new or
increased back pain.
Your doctor will begin by asking
questions about your medical
history, your symptoms, and your work and physical activities.
He or she will also do a physical
exam. The questions and exam can help rule out a serious cause
for your pain. Your doctor may also ask questions about stress at home and at
work that may make you more susceptible to chronic pain.
If your back
pain has lasted for less than 6 weeks, it may be best to wait to do any
testing. This is because most back pain goes away on its own in a month or
But if you have a back pain problem that has lasted longer than 6
weeks, or if your doctor thinks you may have more than muscle pain, it might be
time for a test.
“I thought, ‘Okay, it will hurt for a day or two, and
that’s it.’ But it lasted a lot longer. It took about 3 weeks. I guess we’re
used to fast cures. We take an aspirin, and the headache goes away. We take the
antibiotic, and the infection disappears.” –Lorna
Almost everyone has low back pain at some
time. The good news is that most low back pain will go away in a few days or
weeks with some basic self-care. This includes first aid, self-massage and
using heat or ice.
Some people are afraid that
doing too much may make their pain worse. In the past, people stayed in bed,
thinking this would help their backs. Now experts think that, in most cases,
getting back to your normal activities is good for your back, as long as you
avoid things that make your pain worse.
For the first day or two
of pain, take it easy. But
as soon as possible, get back to your normal daily life and activities.
Movement helps your muscles stay strong. Lying down for too long can make
your problem worse.
If you are an athlete, return to your activity
carefully. Choose a low-impact option until your pain is under control.
Think about your posture, whether you are sitting or standing.
Slumping or slouching alone may not cause low back pain. But after the back has
been strained or injured, bad posture can make pain worse. “Good posture”
generally means your ears, shoulders, and hips are in a straight line. If this
posture causes pain, you may have another condition such as a problem with a
disc or bones in your back.
Stretch and strengthen your back
When you no longer have acute pain,
you may be ready for gentle strengthening exercises for your stomach, back, and
legs, and perhaps for some stretching exercises. Exercise may not only help
decrease low back pain but also may help you recover faster, prevent reinjury
to your back, and reduce the risk of disability from back pain.
is the simplest and perhaps the best exercise for the low back. Your doctor or
a physical therapist can recommend more specific exercises to help your back
muscles get stronger. These may include a series of simple exercises called
core stabilization. The muscles of your trunk, or core, support your spine.
Strengthening these muscles can improve your posture, keep your body in better
balance, and decrease your chance of injury.
low back pain can create a vicious circle. You have back pain,
and you begin to worry about it. This causes stress, and your back muscles
begin to tense. Tense muscles make your back pain worse, and you worry more …
which makes your back worse … and so on.
There are lots of ways to
teach yourself to relax.
You may be tempted to do a diet overhaul and change everything about the
way you eat. But you will be more successful at staying with the changes you
make if you pick just one eating habit at a time to work on.
moving. Try to make physical activity a regular part of your day, just like
brushing your teeth. Start small, and build up over time. Moderate activity is
safe for most people, but it’s always a good idea to talk to your doctor before
you start an exercise program.
Change your thinking. Our
thoughts have a lot to do with how we feel and what we do. If you can stop your
brain from telling you discouraging things and have it start encouraging you
instead, you may be surprised at how much healthier you’ll be-in mind and body.
People who smoke take longer to heal-from any injury,
not just back pain. If you stop smoking, you may feel better sooner.
People who smoke are also much more likely to have back pain than people who
don’t smoke. This is because the nicotine and other toxins from smoking can
keep spinal discs from getting all the nutrients they need from the blood,
making disc injury more likely. These discs cushion the bones in your spine. An
injured disc can cause low back pain.
Smoking also increases your
risk of bone loss (osteoporosis).
Medicine can decrease low back pain and
reduce muscle spasms in some people. But medicine alone isn’t an effective
treatment for low back pain. It should be used along with other treatments,
such as walking and using heat or ice.
There are several medicines your doctor may
recommend, depending on how long you have had pain, what other symptoms you
have, and your medical history. Be safe with medicines. Read and follow
all instructions on the label.
The medicines recommended most often
Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory
drugs like ibuprofen and naproxen. You can buy these
medicines without a prescription. Some of them also come in stronger doses. For
those, you’ll need a prescription.
Muscle relaxants. These medicines
can help with severe muscle spasms that happen when the back pain starts (acute phase). Side effects,
such as drowsiness, are common.
Opioid pain relievers. These are
very strong medicines that are sometimes tried to ease severe back pain
that has not been controlled by other medicines. They are usually taken for
only 1 to 2 weeks.
Antidepressants. Some of these medicines,
such as amitriptyline and
duloxetine, not only treat
depression but also may help with chronic pain.
sometimes used for low back pain are:
Anesthetic or steroid injections.
These have been prescribed for chronic low back pain, but they have not been
researched enough to know if they work well for back pain. They may give
short-term relief from leg pain related to a back problem.
These are sometimes used to treat low back pain, even though there isn’t strong
evidence that they help.
injection. This is a shot into the back muscles. It has not
been well tested for chronic low back pain.
Medicines that work for
some people don’t work for others. Let your doctor know if the medicine you are
taking doesn’t work for you. You may be able to take another medicine for your
When you’re in a lot of pain, you might
wonder if you need surgery to fix what’s wrong so that you can feel better.
Every case is different. But most people don’t need surgery for low back
When surgery may help
Most back surgeries are done to treat nerve pain from herniated discs. Surgery might be an option when a disc
problem causes pain in your leg that prevents you from doing everyday tasks.
You may have pain, numbness, or tingling through your buttock and down the back
of your leg (sciatica) or
in the front of your thigh.
A comprehensive rehabilitation program
is very important after most back surgery. As you regain flexibility,
recondition your back and stomach muscles, and increase your endurance for
activity, you increase your chances of treatment success.
If you are
unable or unwilling to commit to physical therapy after surgery, you may not be
a good candidate for surgery.
whether to have surgery
If you and your doctor are considering surgery,
get as much information as you can about possible results, and consider whether
you will be willing to do physical therapy after surgery. It is also a good
idea to get a second
opinion before you decide to have surgery.
surgery isn’t always successful. Depending on the condition, you may still have
back pain after surgery.
You can choose from a number of
treatments for your low back pain. Because some of these treatments are new or
not yet well researched, they may not be covered by health insurance.
The following complementary treatments are often used for low back pain.
may reduce low back pain for a short time. It is probably most effective if you also learn to do exercises for your back and
learn the best ways to lift
and move to protect your back.
hasn’t been well studied as a treatment for low back pain. Recent research
hasn’t shown that biofeedback is effective for controlling low back pain.
may help reduce pain and increase the ability to be active for a short time
after treatment but not any more than other treatments.footnote 1
Acupressure uses pressure on certain
points in the body to decrease symptoms. Small studies suggest that acupressure
reduces pain and allows a person to be more active.footnote 2
Relaxation techniques can help
reduce muscle tension, stress, and depression.
Yoga is another way to stay
active and get help with relaxation and managing stress. Small studies suggest
that yoga classes may help people with chronic low back pain control their
symptoms and stay more active.footnote 3, footnote 4 It is not
clear whether yoga is more helpful than other activity or treatment for chronic
low back pain. There are different types of yoga. Talk to your doctor before
you start a yoga program.
Capsaicin cream may help relieve pain.footnote 5 Capsaicin is a substance contained in cayenne peppers. Capsaicin cream is applied directly to the skin over the painful area.
Here are some other treatment choices to
Back school teaches you all about
back care, how to stand and sit, and how to move your body in a safer way.
Radiofrequency ablation of
nerves. This may reduce chronic low back pain in some people by
preventing pain signals from reaching the brain. It is sometimes used for pain
from problems with the small joints in the spine called facet joints.
An intrathecal pain pump. This is a small tube inserted under the skin and
deeper tissues along the midline of the back and into the spinal canal. The
tube connects to a small reservoir of medicine inserted under the skin of your
belly. The medicine is regularly delivered to the area of pain through the
Coping With Chronic Back Pain
Low back pain can take a toll on your
mental health. You may feel fear, frustration, and anger or have depression and
anxiety because of ongoing pain. Those common reactions can make your pain last
even longer. If pain is starting to get you down:
Let people know
when you need a helping hand. Ask family members or friends to help out with
physical tasks you can’t do right now.
Be honest with your doctor
about your pain. Ask for a referral to a counselor or pain management
specialist. A prescription antidepressant or antianxiety medicine may also help
with chronic pain.
Work with your health professionals and your work
supervisor to make a return-to-work plan, if needed. Ask for an ergonomic
consultation if you need to learn how to do some of your job duties differently
to avoid hurting your back again.
One Man’s Story:
“I started feeling sad and angry a lot. I didn’t want to do anything. My
back was hurting more. I was having trouble focusing on my work. My life just
started feeling smaller and smaller.”-Ravi
You may have to lean on friends and
family when facing difficult situations caused by chronic pain or other
problems. Your loved ones can play an important role in supporting your
recovery. Your doctor and community also may give you extra support.
Asking for support from others is not always easy. It can be hard to tell
someone about your problems. But don’t be afraid to ask for help.
you can get support
Family. Family members can help you cope
by giving you comfort and encouragement.
strong relationships with others is important for your emotional well-being.
Helping is a big part of friendship. At times you may be the one who encourages
Your doctor. Find someone you trust and feel comfortable with. Be
open and honest about your fears and concerns. Your doctor can help you get the
right treatments, including treatment for depression or other problems.
Religious groups. Religious or spiritual groups may help you meet
people and get involved in the community. Some religious organizations can help
you get counseling or other social support services.
groups. Social groups can help you meet new people and get involved in
activities you enjoy.
Community support groups. In a
support group, you can talk to others who have dealt with the same problems or
illness as you. You can encourage one another and learn ways of coping with
“I really work at finding the good things in my day. It helps
me get through the day, and I think it makes my pain not bother me as
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ByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP – Emergency Medicine Adam Husney, MD – Family Medicine E. Gregory Thompson, MD – Internal Medicine Kathleen Romito, MD – Family Medicine Specialist Medical ReviewerKathleen Romito, MD – Family Medicine