| What is back pain? |
Back pain ranks second only to headaches as the most frequent pain location. More than 65 million Americans experience low back pain every year. Four out of five adults will experience at least one bout of back pain at some time in their life.
Back pain can occur for no apparent reason and at any point on your spine. The most common site for pain is your lower back because it bears the most weight and stress.
Back injuries are a common cause of disability. And even though back pain is rarely life-threatening, the annual cost in terms of lost productivity, medical expenses and workers' compensation benefits runs into the tens of billions of dollars annually in the United States.
Although back pain is common, it's also quite possible for you to prevent most back problems with simple steps such as exercise and adopting new ways to sit and stand. Even if you've injured your back before, you can learn techniques to help avoid recurrent injuries.
| Causes |
Your back is a balanced network of bones, ligaments, muscles and nerves. All of these work together to balance and bear the weight of your body and the loads you carry.
Your spine has a series of curves — in your neck, upper back and lower back. These curves help absorb the impact of day-to-day living.
Any number of factors may contribute to lower back pain, including poor muscle tone, excess weight — especially around your middle — and improper or heavy lifting. In addition, poor posture and sitting or standing in one position for a long time puts extra stress on your back.
Among the causes of back pain:
- Muscle strains. Strained muscles, tendons or ligaments or inflamed joints may cause pain
along your spine.
- Spasms. Muscle spasm is a common response to injury. The spasm is designed to immobilize
the painful area and prevent further damage.
- Osteoarthritis. This degenerative joint condition affects nearly everyone past age 60. Overloading, injury and aging can slowly cause deterioration of cartilage, the protective tissue that covers the surface of the joints of your vertebrae.
- Sciatica. Pain may occur in your leg due to inflammation or compression of nerves in your lower back.
- Osteoporosis. This condition causes porous and brittle bones, which leads to a gradual weakening of bones. The result can be painful vertebral compression fractures. People older than 50, particularly women, are prone to osteoporosis.
- Herniated disk. This condition occurs when normal wear and tear or exceptional strain causes a disk to rupture. Bulging of disks is common and often painless. It becomes painful when excessive bulging or fragments of the disk herniate or break off and place pressure on nearby nerves.
- Fibromyalgia. This chronic syndrome produces achiness, tenderness and stiffness in the muscles and joints where tendons attach to your bones. Pain is usually worse after inactivity and improves with movement.
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| When to seek medical advice |
Most back pain disappears with home treatment and self-care. Although it may take several weeks before back pain completely disappears, if you don't feel some improvement within the first 72 hours of self-care, see your doctor.
In rare cases, back pain can signal a serious medical problem. See a doctor immediately if your back pain:
- Occurs with a fever of 100.4 F for more than 48 hours
- Feels constant or intense, especially at night
- Spreads down one or both legs
- Causes weakness, numbness or tingling in one or both legs
- Interferes with bladder and bowel control
- Is associated with abdominal pain or pulsation (throbbing)
- You feel back pain after an injury
- You feel back pain now and have a history of back pain or cancer
- Your back pain has lasted more than 6 weeks
- You have back pain and are older than age 50
- You feel back pain and have lost more than 10 pounds within 6 months
| Screening and diagnosis |
Your doctor will examine your back to determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms.
You may also undergo several procedures as your doctor diagnoses back pain:
- X-ray. These images show the alignment of your bones, whether you have degenerative joint
disease and whether you have a tumor.
- Myelography. A special dye injected into your spinal canal allows a herniated disk or other
lesions to show up on X-rays.
- Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can
generate images that may reveal herniated disks or problems with bones, muscles, cartilage, ligaments,
tendons and blood vessels.
- Bone scan. You'll receive an injection of a radioactive substance (tracer) into a vein.
Using a special camera, your doctor may be able to detect bone tumors or compression fractures caused
by osteoporosis.
- Electrodiagnostic studies. Studying your nerve conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis). Electrodiagnosis measures how long it takes for an electrical charge to move from a needle in your spine to a needle in your leg.
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| Treatment |
Because most back problems aren't life-threatening, many doctors recommend home treatment first. Regardless of the type of treatment, most people find that their back pain gets better within 6 weeks.
If you have strained ligaments or severe muscle strain, your recovery could take as long as 12 weeks. But with time and proper care, even pain from a herniated disk can often be overcome.
Treatments for back pain may include:
- Medications. Prescription drugs such as nonsteroidal anti-inflammatory drugs and muscle
relaxants may relieve mild to moderate back pain. Your doctor may advise corticosteroid injections to
ease more severe back pain.
- Heat, cold and massage. When performed by a licensed professional, applications of heat,
cold and gentle massage may relieve back pain due to muscle spasms. A word of caution — manipulation
of your spine may aggravate a disk problem or cause compression fractures if you have osteoporosis.
Ask your primary care doctor if spinal manipulation is safe and helpful for you.
- Electrical stimulation. Transcutaneous electronic nerve stimulation (TENS) may help stop
pain by blocking nerve signals from reaching your brain. A physical therapist places electrodes on
your skin near the area of your pain. TENS may relieve pain in your leg due to inflammation or
compression of nerves in your back (sciatica), but it may provide little relief for chronic back pain.
- Back schools. These programs, available in many communities, focus on managing back pain
and preventing its recurrence. Classroom study generally involves back anatomy and function, followed
by practice sessions on how to protect your back at home and work.
- Exercise and physical therapy. Once your pain subsides, your doctor or a physical therapist can design an exercise program to improve your flexibility, strengthen your back and abdominal muscles and improve your posture.
- Laminectomy. This procedure may relieve leg pain by removing bone spurs or disk fragments
that protrude into your spinal canal or press on nerve roots within your spine.
- Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A variety of metal implants also are available to help accomplish the fusion.
| Prevention |
With a little care and attention, you may be able to avoid an aching back in the first place. Getting in better physical condition may help prevent back pain.
To keep your back healthy and strong:
- Exercise. Regular aerobic activities that don't strain or jolt your back can increase
strength and endurance in your lower back, allowing your muscles to function better. These aerobic
exercises may include walking, swimming or biking. Talk with your doctor about which activity is best
for you.
- Build muscle strength and flexibility. Conditioned abdominal and back muscles work together like a natural corset for your back. Flexibility in your hips and upper legs allows for proper pelvic bone alignment, which improves how your back feels. Doing several simple exercises on a regular basis can help support and align your back.
- Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of
time, alternate placing your feet on a low footstool to take some of the load off your lower back.
- Sit smart. Choose a seat with good lower back support or place a pillow or rolled towel in
the small of your back to maintain its normal curve. Keep your knees and hips level.
- Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight
and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting
simultaneously.
- Sleep smart. Lie on a firm mattress. Use pillows for support, but don’t use a pillow that forces your neck up at a severe angle.
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| Self-Care |
A sore back often settles down or improves within 6 weeks with rest. Rest for only 1 or 2 days if your back pain is severe, because prolonged bed rest can reduce your muscle strength and lead to further disability.
These steps can help you treat back pain at home:
- Apply cold, then heat. Sources of heat and cold, such as a hot bath and hot or cold
compresses, can soothe sore and inflamed muscles. Use cold treatment first. Immediately after injuring
your back, apply ice several times a day, for up to 20 minutes at a time. Put the ice in a bag, then
wrap the bag in a cloth or towel to keep a thin barrier between the ice and your skin. Use ice for as
long as spasms persist. After spasms and acute pain subside, you can apply heat from a heating pad or
heat lamp to help loosen tight muscles. Limit each heat application to 20 minutes.
- Use pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others)
may help control pain. Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil,
Motrin, others) also can reduce inflammation.
- Consider limited use of a support brace or corset. Back braces and corsets can relieve strain and support your back. However, some devices may be uncomfortable. Another drawback is that your back muscles may weaken with prolonged use of a brace or corset. It's best to use a brace or corset only for short periods or during back-straining activities. Braces and corsets are available over-the-counter at pharmacies and medical supply stores. Your doctor also may prescribe a brace customized for your back.
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| Complementary and alternative medicine |
Besides treatment provided by a doctor and self-care steps taken at home, some people have turned to chiropractic care and acupuncture for relief of back pain.
Chiropractic care
Until the mid-1970s, many people considered chiropractic care unconventional therapy. But people's perceptions and use of chiropractic treatments have evolved. A 1997 survey tallied about 190 million office visits to chiropractors annually, illustrating how much more accepted this treatment option has become.
Although chiropractors don't prescribe drugs or perform surgery, their practice does include traditional medical practices, such as physical, neurological and orthopedic examinations. And many of their services are covered by Medicare and private insurance.
Back pain is the most common reason people see a chiropractor. Chiropractic treatment is based on the philosophy that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain.
Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm.
In 1994, the Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research, rated spinal manipulation as an effective treatment for acute back pain. However, most acute forms of low back pain improve within 2 to 4 weeks. Randomized clinical trails offer little evidence that long-term chiropractic treatment is effective.
If you're considering chiropractic treatment, use these tips to get the most from your care:
- Talk to your doctor about the most appropriate specialist for your type of problem. In addition to
chiropractors, many osteopathic doctors and some physical therapists have training in spinal
manipulation. Because manipulation has risks, always use properly trained and licensed practitioners.
- If you seek chiropractic care, find someone who attended a school accredited by the Council on
Chiropractic Education.
- As with other medical specialists, see only chiropractors who are willing to work with the other
members of your health care team.
- Avoid chiropractors who view spinal manipulation as a cure-all for diseases such as diabetes and cancer. No evidence supports this idea.
An acupuncturist inserts hair-thin needles under your skin, causing little or no pain. The needles usually stay in for 15 to 30 minutes, and you may need several sessions. Research suggests that pain relief may come from the release of endorphins, your body's natural painkillers.
Although noting a lack of rigorously controlled research about the benefits of acupuncture, the National Institutes of Health concluded in 1998 that acupuncture may help conditions that involve chronic pain, including low back pain. The Mayo Pain Clinic has used acupuncture since 1974 in some cases in which people don't experience pain relief from medications or nerve blocks.
To find a qualified practitioner, ask for a referral from your physician or contact the American Academy of Medical Acupuncture (AAMA). Visit the AAMA Web site or call 323-937-5514. AAMA's members are licensed physicians with more than 200 hours of special training in acupuncture.
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— February 21, 2003 —
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