Definition

Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column has many small bones and muscles that surround and protect the spinal cord and nerves. Low back pain is very common and affects most adults at some point in their lives.

Bones of the Lower Back

lumbar disc herniation back

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Causes

There are many possible causes for low back pain, but in most cases it is unknown. Some causes of back pain may include:

    
  • Muscle strains or ligament sprains
  • Disc degeneration
  • Spinal deformities
  • Injury
  • Health conditions
  • Risk Factors

    Factors that increase your chance of developing low back pain include:

    General factors, such as:

        
  • Increasing age
  • Certain activities, such as lifting, bending, or twisting
  • Lack of exercise
  • Obesity
  • Pregnancy
  • Smoking
  • Prior back injury
  • Prior back surgery
  • Health conditions, such as:

        
  • Herniated disc—the cushions between the bones of the spine develop a bulge
  • Degenerative diseases, such as arthritis
  • Fractures due to trauma and/or osteoporosis
  • Spinal stenosis—narrowing of the spinal canal
  • Spondylolisthesis—slippage of a bone in the lower back
  • Ankylosing spondylitis—a autoimmune disease involving the spine
  • Cauda equina syndrome—nerve roots at the base of the spinal cord are compressed
  • Tumors
  • Infections
  • Occupational factors, such as:

        
  • Bending, twisting, or reaching
  • Exposure to vibrations
  • Heavy manual labor
  • Heavy lifting
  • Psychosocial factors, such as:

        
  • Anxiety and depression
  • Stress
  • Low job satisfaction
  • Repetitive, monotonous tasks
  • Symptoms

    Pain is usually restricted to the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on the affected side. Muscle weakness or numbness may occur.

    When Should I Call My Doctor?

    Often, back pain improves with self-treatment. However, some serious symptoms may occur. They may require more immediate medical attention. Call your doctor if back pain:

        
  • Is severe or gets significantly worse
  • Has not started to improve within about a week
  • Causes difficulty walking, standing, or moving
  • Is worse at night or worse when you lie down
  • Spreads down your legs
  • Comes with pain or throbbing in your abdomen
  • Is new and you are over age 50 years old
  • Is associated with:     
  • Numbness, weakness, or tingling in your buttocks, genitals, or legs
  • Loss of bowel or bladder control
  • Difficulty with urination
  • Fever, unexplained weight loss, or other signs of illness
  • You should call your doctor if you have back pain and a history of cancer or osteoporosis. You should also call if you have a history of recent infection, steroid use or IV drug use.

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will focus on your back, hips, and legs. The doctor may test for strength, flexibility, sensation, and reflexes.

    Imaging tests take pictures of internal structures. These include:

        
  • X-rays
  • CT scan
  • MRI
  • It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.

    Your doctor may recommend other tests to help diagnose or eliminate any causes of your back pain.

    Treatment

    Treatment options include:

    Activity

    Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising.

    Medication

    Your doctor may recommend:

        
  • Over-the-counter or prescription pain relievers
  • Topical pain relievers that are applied to the skin
  • Muscle relaxants for muscle spasms
  • Antidepressants for chronic back pain
  • Physical Therapy

    Physical therapy may include:

        
  • Applying hot or cold packs
  • Stretching, strengthening, and balance exercises for back and stomach muscles
  • Aerobic exercise
  • Instruction in appropriate posture and lifting
  • Massage
  • Alternative Medicine

    Some people find pain relief from:

        
  • Relaxation training
  • Biofeedback
  • Acupuncture
  • Chiropractic or osteopathic manipulation
  • Yoga
  • Traction methods to relieve pressure on the spine
  • Surgery

    Only a small number of people need surgery. It may be needed if nerve problems develop or other treatments do not provide relief. Common procedures are diskectomy, laminectomy, and spinal fusion.

    Prevention

    To reduce your chance of developing low back pain, take these steps:

        
  • Begin a safe exercise program with the advice of your doctor.
  • Practice good posture to reduce pressure on your spine.
  • Avoid sitting or standing in one position for long periods of time.
  • Use proper body movment when playing sports, exercising, or lifting heavy objects.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.