Low Back Pain

What is low back pain?

Low back pain is pain and stiffness in the lower back. It is one of the most common reasons people miss work.

How does it occur?

Low back pain is usually caused when a ligament or muscle holding a vertebra in its proper position is strained. Vertebrae are bones that make up the spinal column through which the spinal cord passes. When these muscles or ligaments become weak or strained, the spine loses its stability, resulting in pain.

Low back pain can occur if your job involves lifting and carrying heavy objects, or if you spend a lot of time sitting or standing in one position or bending over. It can be caused by a fall or by unusually strenuous exercise. It can be brought on by the tension and stress that cause headaches in some people. It can even be brought on by violent sneezing or coughing.

People who are overweight may have low back pain because of the added stress on their back.

Back pain may occur when the muscles, joints, bones, and connective tissues of the back become inflamed as a result of an infection or an immune system problem. Arthritic disorders as well as some congenital and degenerative conditions may cause back pain.

Back pain accompanied by loss of bladder or bowel control, difficulty in moving your legs, or numbness or tingling in your arms or legs may indicate an injury to your spine and nerves, which requires immediate medical treatment.

What are the symptoms?

Symptoms include:

• pain in the back or legs
• stiffness, spasm, or limited motion

The pain may be continuous or may occur only in certain positions. It may be aggravated by coughing, sneezing, bending, twisting, or straining during a bowel movement. The pain may occur in only one spot or may spread to other areas, most commonly down the buttocks and into the back of the thigh.

A low back strain typically does not produce pain past the knee into the calf or foot. Tingling or numbness in the calf or foot may indicate a herniated disk or pinched nerve.

Be sure to see your healthcare provider if:

• You have weakness in your leg, especially if you cannot lift your foot, because this may be a sign of nerve damage.
• You have new bowel or bladder problems as well as back pain, which may be a sign of severe injury to your spinal cord.
• You have pain that gets worse despite treatment.

How is it diagnosed?

Your healthcare provider will review your medical history and examine you. He or she may order X-rays. In certain situations an MRI, CT scan, or bone scan may be ordered.

How is it treated?

The following are ways to treat low back pain:

• Using a heating pad or hot water bottle.
• Resting in bed on a firm mattress. Often it helps to lie on your back with your knees raised. However, some people prefer to lie on their side with their knees bent.
• Taking aspirin, ibuprofen, or other anti-inflammatory medications; muscle relaxants; or other pain medications if recommended by your healthcare provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
• Having your back massaged by a trained person.
• Having traction, if recommended by your provider.
• Wearing a belt or corset to support your back.
• Do the exercises recommended by your provider. Your provider may also have you go to a physical therapist for rehabilitation and other treatments.
• Talking with a counselor, if your back pain is related to tension caused by emotional problems.

When the pain subsides, ask your healthcare provider about starting an exercise program such as the following:

• Exercise moderately every day, using stretching and warm-up exercises suggested by your provider or physical therapist.
• Exercise vigorously for about 30 minutes two or three times a week by walking, swimming, using a stationary bicycle, or doing low-impact aerobics.

Participating regularly in an exercise program will not only help your back, it will also help keep you healthier overall.

How long will the effects last?

The effects of back pain last as long as the cause exists or until your body recovers from the strain, usually a day or two but sometimes weeks.

How can I take care of myself?

In addition to the treatment described above, keep in mind these suggestions:

• Practice good posture. Stand with your head up, shoulders straight, chest forward, weight balanced evenly on both feet, and pelvis tucked in.
• Lose weight if you are overweight
• Try putting an ice pack wrapped in a towel on your back for 20 minutes, 1 to 4 times per day. Set an alarm to avoid frostbite from using the ice pack too long.
• If your back muscles are stiff, try an electric heating pad on a low setting (or a hot water bottle wrapped in a towel to avoid burning yourself) for 20 to 30 minutes. Don't let the heating pad get too hot, and don't fall asleep with it. You could get a burn.
• Put a pillow under your knees when you are lying down.
• Sleep without a pillow under your head.

Pain is the best way to judge the pace you should set in increasing your activity and exercise. Minor discomfort, stiffness, soreness, and mild aches need not interfere with activity. However, limit your activities temporarily if:

• Your symptoms return.
• The pain increases when you are more active.
• The pain increases within 24 hours after a new or higher level of activity.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your back recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

It is important that you have fully recovered from your low back pain before you return to any strenuous activity. You must be able to have the same range of motion that you had before your injury. You must be able to walk and twist without pain.

What can I do to help prevent low back pain?

You can reduce the strain on your back by doing the following:

• Don't push with your arms when you move a heavy object. Turn around and push backwards so the strain is taken by your legs.
• Whenever you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
• Bend your knees and hips and keep your back straight when you lift a heavy object.
• Avoid lifting heavy objects higher than your waist.
• Hold packages you carry close to your body, with your arms bent.
• Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Bend your knees when you bend over.
• Sit close to the pedals when you drive and use your seat belt and a hard backrest or pillow.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your knees.
• Put a pillow under your knees when you sleep on your back.
• Raise the foot of the bed 8 inches to discourage sleeping on your stomach unless you have other problems that require that you keep your head elevated.

To rest your back, hold each of these positions for 5 minutes or longer:

• Lie on your back, bend your knees, and put pillows under your knees.
• Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower legs and feet on a chair.
• Lie on your back, bend your knees, and bring one knee up to your chest and hold it there. Repeat with the other knee, then bring both knees to your chest. When holding your knee to your chest, grab your thigh rather than your lower leg to avoid over flexing your knee.