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Low Back Pain

By

Peter J. Moley

, MD, Hospital for Special Surgery

Last full review/revision Nov 2020| Content last modified Nov 2020
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Low back pain becomes more common as people age, affecting more than half of people over 60. It is very costly in terms of health care payments, disability payments, and missed work.

The spine (spinal column) consists of back bones (vertebrae). There are shock-absorbing disks between each of the vertebrae. The disks have a tough, outer layer of fibrocartilage and a soft, jelly-like interior called the nucleus. Each of the vertebrae have two joints behind the disks. The joints are called facet joints. The facets of one vertebral body rest on the facets of the one below it, forming a joint. The facet joints and thus the spine are stabilized by ligaments and muscles, which include the following:

  • Two iliopsoas muscles, which run along both sides of the spine

  • Two erector spinae muscles, which run along the length of the spine behind it

  • Many short paraspinal muscles, which run between the vertebrae

The abdominal muscles, which run from the bottom of the rib cage to the pelvis, also help stabilize the spine by supporting the abdominal contents. The muscles in the buttocks also help stabilize the spine. All together, these muscles are referred to as the core muscles.

Enclosed in the spine is the spinal cord Spinal Cord The spinal cord is a long, fragile tubelike structure that begins at the end of the brain stem and continues down almost to the bottom of the spine. The spinal cord consists of bundles of nerve... read more . Along the length of the spinal cord, the spinal nerves emerge from the sides through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is called the spinal nerve root. Because of their position, spinal nerve roots can be squeezed (compressed) when the spine is injured, resulting in pain.

The lower spine (lumbar spine) connects to the spine in the upper back (thoracic spine) above and to the pelvis through the (sacrum). The lumbar spine is flexible to allow turning, twisting and bending, and provides strength—for standing, walking, and lifting. Thus, the lower back is involved in almost all activities of daily living. Low back pain can limit many activities and reduce the quality of life.

Types of back pain

Common types of back pain include local, radiating, and referred pain.

Local pain occurs in a specific area of the lower back. It is the most common type of back pain. The cause is usually a small disk injury, joint arthritis, and rarely muscle sprains and strains. The pain may be constant and aching or, at times, intermittent and sharp. Sudden pain may be felt when an injury is the cause. Local pain can be aggravated or relieved by changes in position. The lower back may be sore when touched. Muscle spasms may occur.

Radiating pain is pain that travels from the lower back down the leg. The pain can be a dull ache or be sharp and intense. It typically involves only the side or back of the leg and may travel all the way to the foot or only to the knee. Radiating pain typically indicates compression of a nerve root caused by disorders such as a herniated disk Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more Herniated Disk , sciatica Sciatica Sciatica is pain along the sciatic nerves. These nerves run from the lower back, through the buttocks, and down the legs, ending just below the knee. A herniated disk, complications of osteoarthritis... read more Sciatica , osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) , or spinal stenosis Compression of the Spinal Cord Injuries and disorders can put pressure on the spinal cord, causing back or neck pain, tingling, muscle weakness, and other symptoms. The spinal cord may be compressed by bone, blood (hematomas)... read more . Coughing, sneezing, straining, or bending over while keeping the legs straight may trigger the pain. If there is pressure on the nerve root, the pain may be accompanied by muscle weakness in the leg, a pins-and-needles sensation, or even loss of sensation. Rarely, people lose bladder control Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting about 30% of older women... read more Urinary Incontinence in Adults (urinary incontinence) or bowel control Fecal Incontinence Fecal incontinence is the loss of control over bowel movements. Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum (fecal impaction)... read more (fecal incontinence).

Referred pain What Is Referred Pain? Pain is an unpleasant sensation signaling actual or possible injury. Pain is the most common reason people visit their doctor. Pain may be sharp or dull, intermittent or constant, or throbbing... read more is felt in a different location from the actual cause of the pain. For example, some people who have a heart attack feel pain in their left arm. Referred pain from internal organs to the lower back tends to be deep and aching, and its exact location is hard to pinpoint. Typically, movement does not worsen it, unlike pain from a musculoskeletal disorder.

Causes of Low Back Pain

Most back pain is caused by disorders of the spine and the joints, muscles, ligaments, and nerve roots around it or the disks between vertebrae. Often, no single specific cause can be identified. Any painful disorder of the spine may cause reflex tightening (spasm) of muscles around the spine. This spasm may worsen the existing pain. Stress may worsen low back pain, but how it does so is unclear.

Occasionally, back pain is due to disorders outside the spine, such as cancer, gynecologic disorders (for example, premenstrual syndrome Premenstrual Syndrome (PMS) Premenstrual syndrome (PMS) is a group of physical and psychologic symptoms that start several days before and usually end a few hours after a menstrual period begins. Premenstrual dysphoric... read more ), disorders of the kidneys (for example, kidney stones Stones in the Urinary Tract read more ) and urinary (for example, infections of the kidney Kidney Infection Pyelonephritis is a bacterial infection of one or both kidneys. Infection can spread up the urinary tract to the kidneys, or uncommonly the kidneys may become infected through bacteria in the... read more , bladder Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more Bladder Infection , and prostate gland Prostatitis Prostatitis is pain and swelling, inflammation, or both of the prostate gland. The cause is sometimes a bacterial infection. Pain can occur in the area between the scrotum and anus or in the... read more ) and digestive tracts (for example, diverticulitis Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more Diverticulitis ), and disorders of major arteries near the spine.

Common causes

Common causes of low back pain include

Injuries may occur during routine activities (for example, lifting, exercising, moving in an unexpected way) or result from trauma, such as a fall or car crash. Often no specific injured structures are identified with imaging tests, but doctors presume that some muscles and/or ligaments have been affected.

Osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) (degenerative arthritis) causes the cartilage between the facet joints to wear away and bone spurs (osteophytes) to form. This disorder is due in part to the wear and tear of years of use. People who repetitively stress one joint or a group of joints are more likely to develop osteoarthritis in that area. The disks between the vertebrae deteriorate, and the spaces between the vertebrae narrow, increasing the pressure on the facet joints, which become inflamed (arthritis) and form bone spurs in the openings for the nerve roots. With severe degeneration and loss of disc height the osteophytes in the opening can compress spinal nerve roots. All of these changes can cause low back pain as well as stiffness.

Vertebral compression (crush) fractures Compression Fractures of the Spine In a compression fracture of the spine, the drum-shaped part (body) of one or more back bones (vertebrae) collapses into itself and becomes squashed (compressed) into a wedge shape. Most compression... read more Compression Fractures of the Spine (fractures of spinal vertebrae) commonly develop when bone density decreases because of osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more Osteoporosis , which typically develops as people age. Vertebrae are particularly susceptible to the effects of osteoporosis. Vertebral compression fractures (which may cause sudden, severe back pain) can be accompanied by compression of spinal nerve roots (which may cause chronic back pain). However, most fractures due to osteoporosis occur in the upper and middle back and cause upper and middle rather than low back pain.

A ruptured or herniated disk Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more Herniated Disk can cause low back pain. A disk has a tough outer layer and a soft, jelly-like interior. If a disk is repeatedly overloaded by the vertebrae above and below it (as when bending forward, particularly when lifting a heavy object), the outer layer may tear (rupture), causing pain. The interior of the disk can squeeze through the tear, so that part of the interior bulges out (herniates). This bulge can compress, irritate, and even damage the spinal nerve root next to it, causing more pain and symptoms that are felt in one or both legs. A ruptured or herniated disk in the low back that affects nerves commonly causes sciatica Sciatica Sciatica is pain along the sciatic nerves. These nerves run from the lower back, through the buttocks, and down the legs, ending just below the knee. A herniated disk, complications of osteoarthritis... read more Sciatica . However, imaging studies such as magnetic resonance imaging (MRI) often show bulging disks in people who have no symptoms or problems.

Lumbar spinal stenosis Lumbar Spinal Stenosis Lumbar spinal stenosis is narrowing of the spinal canal in the lower back. The narrowing squeezes (compresses) the nerves that travel through the lower back into the legs. Osteoarthritis, injuries... read more Lumbar Spinal Stenosis is narrowing of the spinal canal, which runs through the center of the spine and contains the spinal cord and the bundle of nerves that extends downward from the bottom of the spinal cord in the lower back. It is a common cause of low back pain in older people. Spinal stenosis also develops in middle-aged people who were born with a narrow spinal canal. Spinal stenosis is caused by such disorders as osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) , spondylolisthesis Spondylolisthesis Spondylolisthesis is partial displacement of a bone in the lower back. Injuries or a degenerative condition can cause this disorder. Pain is felt in the low back and may travel down one or both... read more Spondylolisthesis , ankylosing spondylitis Ankylosing Spondylitis Ankylosing spondylitis is a spondyloarthritis characterized by inflammation of the spine (spondylitis), large joints, and fingers and toes, resulting in stiffness and pain. Prolonged joint pain... read more Ankylosing Spondylitis , and Paget disease of bone Paget Disease of Bone Paget disease of bone is a chronic disorder of the skeleton in which areas of bone undergo abnormal turnover, resulting in areas of enlarged and softened bone. The breakdown and formation of... read more Paget Disease of Bone .

Spondylolisthesis Spondylolisthesis Spondylolisthesis is partial displacement of a bone in the lower back. Injuries or a degenerative condition can cause this disorder. Pain is felt in the low back and may travel down one or both... read more Spondylolisthesis is partial displacement of a vertebra in the lower back. One type usually occurs during adolescence or young adulthood (often in athletes) caused by an injury that fractures a part of the vertebra. If both sides of the vertebra are involved, the vertebra can then slip forward over the one below it. Spondylolisthesis can also occur in older adults but mainly as the result of a degenerative condition. People who develop spondylolisthesis as adults are at risk of developing lumbar spinal stenosis.

Fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more is a common cause of pain that affects many parts of the body, sometimes including the low back. This disorder causes chronic widespread (diffuse) pain in muscles and other soft tissues in areas outside the lower back. Fibromyalgia is also characterized by poor sleep and fatigue.

Did You Know...

  • Strengthening abdominal muscles, as well as back muscles, helps support the spine and prevent low back pain.

Less common causes

Less common causes of low back pain include

Evaluation of Low Back Pain

The doctor aims to identify any serious disorders. Because low back pain is often caused by several problems, diagnosing a single cause may not be possible. Doctors may only be able to tell that the cause is a musculoskeletal disorder and how serious it is likely to be.

Warning signs

In people with low back pain, certain symptoms and characteristics are cause for concern. They include

When to see a doctor

People should see a doctor immediately if they have fever or any of the warning signs that suggest nerve damage, an abdominal aortic aneurysm Abdominal Aortic Aneurysms Abdominal aortic aneurysms are bulges (dilations) in the wall of the aorta in the part that passes through the abdomen (abdominal aorta). Abdominal aortic aneurysms typically slowly expand and... read more Abdominal Aortic Aneurysms , a digestive disorder, or a urinary tract disorder. People with most other warning signs should see a doctor within a day. If pain is not severe and people have no warning signs other than pain for more than 6 weeks, their need to see a doctor is not as urgent.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see Table: Some Causes and Features of Low Back Pain Some Causes and Features of Low Back Pain Low back pain and neck pain are among the most common reasons for health care visits. The pain usually results from problems with the musculoskeletal system—most notably the spine, including... read more Some Causes and Features of Low Back Pain ).

Doctors ask questions about the pain:

  • What is the pain like?

  • How severe is it?

  • Where is it and where does it radiate to?

  • What relieves or worsens it (for example, changes in position or weight bearing)?

  • When and how did it start?

  • Are there other symptoms (such as numbness, weakness, retention of urine, or incontinence)?

Certain characteristics of the pain can give clues to possible causes:

  • Pain in an area that is tender to the touch and is worsened by changes in position or weight bearing is usually local pain.

  • Pain that radiates down the leg, such as sciatica, is usually caused by compression of a spinal nerve root.

  • Pain that is not affected by changes in position of the back and is not accompanied by tenderness may be referred pain.

  • Pain that is constant, severe, progressively worse, and unrelieved by rest, particularly if it keeps the person awake at night, can be a disk herniation but may indicate cancer or an infection.

Doctors may ask the person to move in certain ways to determine the type of pain. Doctors typically ask the person to bend forward and backward. They may have the person lie flat and then lift their leg without bending the knee to see if it brings on pain, which would suggest a herniated disc. Doctors may also check a person's abdomen for tenderness or a mass and the pulses, particularly in people over 55, who may have an aortic aneurysm Abdominal Aortic Aneurysms Abdominal aortic aneurysms are bulges (dilations) in the wall of the aorta in the part that passes through the abdomen (abdominal aorta). Abdominal aortic aneurysms typically slowly expand and... read more Abdominal Aortic Aneurysms . They may examine the prostate in men by doing a digital rectal examination and the internal reproductive organs in women by doing a pelvic examination.

With information about the pain, the person’s medical history, and results of a physical examination, doctors may be able to determine the possible cause.

Table
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Testing

Usually, no tests are needed because most back pain results from osteoarthritis, strains and sprains, or other minor musculoskeletal disorders and resolves within 6 weeks. Imaging tests are often needed if

People who did not respond to initial treatment or those whose symptoms have worsened or changed may also undergo testing.

X-rays of the lower back show only the bones. They can help detect degenerative changes due to osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) , vertebral compression fractures Compression Fractures of the Spine In a compression fracture of the spine, the drum-shaped part (body) of one or more back bones (vertebrae) collapses into itself and becomes squashed (compressed) into a wedge shape. Most compression... read more Compression Fractures of the Spine , spondylolisthesis Spondylolisthesis Spondylolisthesis is partial displacement of a bone in the lower back. Injuries or a degenerative condition can cause this disorder. Pain is felt in the low back and may travel down one or both... read more Spondylolisthesis , and ankylosing spondylitis Ankylosing Spondylitis Ankylosing spondylitis is a spondyloarthritis characterized by inflammation of the spine (spondylitis), large joints, and fingers and toes, resulting in stiffness and pain. Prolonged joint pain... read more Ankylosing Spondylitis . However, magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more Magnetic Resonance Imaging (MRI) (MRI) or computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more Computed Tomography (CT) (CT) provides clearer images of bones and, particularly MRI, can show soft tissues (including disks and some nerves). MRI or CT is usually necessary when doctors are checking for disorders that cause subtle changes in bone and disorders of soft tissue. For example, MRI or CT can confirm or exclude the diagnosis of a herniated disk Diagnosis A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more Diagnosis , spinal stenosis, cancer, and usually infection. These tests can also indicate whether nerves are being compressed.

Prevention of Low Back Pain

People can reduce their risk of developing low back pain by doing the following:

  • Exercising

  • Strengthening and stretching muscles

  • Maintaining a healthy weight

  • Maintaining good posture

  • Using proper lifting techniques

The most effective way to prevent low back pain is to exercise regularly. Aerobic exercise and specific muscle-strengthening and stretching exercises can help.

Aerobic exercise, such as swimming and walking, improves general fitness and generally strengthens muscles.

Specific exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) can help stabilize the spine and decrease strain on the disks that cushion the spine and the ligaments that hold it in place.

Muscle-strengthening exercises include pelvic tilts and abdominal curls. Stretching exercises include the knee-to-chest stretch. Stretching exercises can increase back pain in some people and therefore should be done carefully. As a general rule, any exercise that causes or increases back pain should be stopped. Exercises should be repeated until the muscles feel mildly but not completely fatigued. Breathing during each exercise is important. People who have back pain should consult a doctor before beginning to exercise.

Exercises to Prevent Low Back Pain

Pelvic Tilts

Lie on the back with the knees bent, the heels on the floor, and the weight on the heels. Press the small of the back against the floor, contract the buttocks (raising them about half an inch [1 cm] from the floor), and contract the abdominal muscles. Hold this position for a count of 10. Repeat 20 times.

Exercises to Prevent Low Back Pain

Abdominal Curls

Lie on the back with the knees bent and feet on the floor. Place the hands across the chest. Contract the abdominal muscles, slowly raising the shoulders about 10 inches (25 cm) from the floor while keeping the head back (the chin should not touch the chest). Then release the abdominal muscles, slowly lowering the shoulders. Do 3 sets of 10.

Exercises to Prevent Low Back Pain

Knee-to-Chest Stretch

Lie flat on the back. Place both hands behind one knee and bring it to the chest. Hold for a count of 10. Slowly lower that leg and repeat with the other leg. Do this exercise 10 times.

Exercises to Prevent Low Back Pain

Maintaining good posture when standing and sitting reduces stress on the back. Slouching should be avoided. Chair seats can be adjusted to a height that allows the feet to be flat on the floor, with the knees bent up slightly and the lower back flat against the back of the chair. If a chair does not support the lower back, a pillow can be used behind the lower back. Sitting with the feet on the floor rather than with the legs crossed is advised. People should avoid standing or sitting for long periods. If prolonged standing or sitting is unavoidable, changing positions frequently may reduce stress on the back.

Learning to lift correctly helps prevent back injury. The hips should be aligned with the shoulders (that is, not rotated to one side or the other). People should not bend over with their legs nearly straight and reach out with their arms to pick up an object. Instead, they should bend at the hips and knees. Bending this way keeps the back straighter and brings the arms down to the object with the elbows at the side. Then, keeping the object close to the body, they lift the object by straightening their legs. This way, the legs, not the back, lift the object. Lifting an object over the head or twisting while lifting increases the risk of back injury.

Treatment of Low Back Pain

If a specific cause can be diagnosed, that disorder is treated. For example, antibiotics are used to treat a prostate infection Prostatitis Prostatitis is pain and swelling, inflammation, or both of the prostate gland. The cause is sometimes a bacterial infection. Pain can occur in the area between the scrotum and anus or in the... read more . However, there is no specific treatment for musculoskeletal pain due to sprains or strains nor for many other musculoskeletal causes. But many general measures can help. Usually, these general measures are also used when a spinal nerve root is compressed.

General measures for back pain

Measures include

  • Modifying activities

  • Taking drugs that relieve pain

  • Applying heat or cold to the painful area

  • Light exercise as tolerated

For low back pain that has recently developed, treatment begins with avoiding activities that stress the spine and cause pain—such as lifting heavy objects and bending. Bed rest does not hasten the resolution of the pain, and most experts recommend continued light activity. Bed rest, if required to relieve severe pain, should last no more than 1 or 2 days. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Spinal corsets and traction Traction Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more are not helpful. Traction may delay recovery.

Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes given to relieve muscle spasms, but their usefulness is controversial. These drugs are not recommended for older people, who are more likely to have side effects such as drowsiness and confusion. Doctors try not to prescribe muscle relaxants unless people have visible and palpable muscle spasms. If prescribed, muscle relaxants should be used for no more than 72 hours. Doctors sometimes tell people to take them only at bedtime.

Application of heat Heat therapy Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more or cold Cold therapy (cryotherapy) Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more may help (see Treatment of Pain and Inflammation Treatment of Pain and Inflammation Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more ). Cold is usually preferred to heat during the first 2 days after an injury. Ice and cold packs should not be applied directly to the skin. An ice pack should be enclosed (for example, in plastic) and placed over a towel or cloth. The ice is removed after 20 minutes, then reapplied for 20 minutes over a period of 60 to 90 minutes. This process can be repeated several times during the first 24 hours. Heat, using a heating pad, can be applied for the same periods of time. Because the skin on the back may be insensitive to heat, heating pads must be used cautiously to prevent burns. People should not use a heating pad at bedtime to avoid the risk of falling asleep with the pad still on their back.

Massage Massage Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more may provide some temporary relief of low back pain. Some studies suggest that acupuncture may have similar benefits, but others suggest little or no benefit. Spinal manipulation, done by chiropractors or some other doctors (such as osteopathic doctors), may also provide relief when combined with an exercise program. However, spinal manipulation may increase the risk of further injury and should be avoided in people who have inflammatory arthritis, neck problems that cause instability of neck vertebrae, or a herniated disk Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more Herniated Disk .

After the pain has subsided, light activity, as recommended by a doctor or physical therapist Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more , can speed healing and recovery. In some cases, a course of treatment with a physical therapist can help. Specific exercises to strengthen and stretch the back and to strengthen core muscles are usually recommended to help prevent low back pain from becoming chronic or recurring.

Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so.

Other preventive measures Prevention Low back pain and neck pain are among the most common reasons for health care visits. The pain usually results from problems with the musculoskeletal system—most notably the spine, including... read more Prevention (maintaining good posture, lifting correctly) should be continued or started. In response to these measures, most episodes of back pain resolve in several days to 2 weeks. Regardless of treatment, 80 to 90% of such episodes resolve within 6 weeks.

Treatment of chronic back pain

Additional measures are needed for chronic low back pain. Aerobic exercise may help, and weight reduction, if necessary, is advised. If analgesics are ineffective, other treatments can be considered.

Transcutaneous electrical nerve stimulation In some cases, treating the underlying disorder eliminates or minimizes the pain. For example, setting a broken bone in a cast or giving antibiotics for an infected joint helps reduce pain.... read more (TENS) may be used. The TENS device produces a gentle tingling sensation by generating a low oscillating current. This current can block transmission of some pain sensation from the spinal cord to the brain. The current can be applied to the painful area several times a day for 20 minutes to several hours at a time, depending on the severity of the pain.

Sometimes a corticosteroid (such as dexamethasone or methylprednisolone) plus a local anesthetic (such as lidocaine) can be periodically injected into facet joints in the spine or the epidural space—between the spine and the outer layer of tissue covering the spinal cord. The epidural injections may be more effective for sciatica caused by a herniated disk than for lumbar spinal stenosis. However, it is not clear that they produce a long-term benefit. They are usually effective only for several days to weeks. Their main use is to relieve pain enough that an exercise program, which can provide long-term pain relief, can be started.

Surgery for back pain

If a herniated disk is causing relentless or chronic sciatica, weakness, loss of sensation, or loss of bladder and bowel control, surgical removal of the bulging part of the disk (diskectomy) and sometimes part of the vertebra (laminectomy) may be necessary.

For severe spinal stenosis, a large part of the back of the vertebra (the lamina) may be surgically removed to widen the spinal canal (lumbar laminectomy). A general anesthetic is usually required. The hospital stay is usually 4 or 5 days. People may need 3 to 4 months before they can resume all of their activities. About two thirds of people have a good or full recovery. For most of the rest, such surgery may prevent pain and keep other symptoms from worsening.

When the spine is unstable (as may result from a severe herniated disk, spondylolisthesis, or after laminectomy for spinal stenosis), surgery can be done to fuse vertebrae together (called lumbar spinal fusion). However, fusion decreases mobility and may put additional stress on the rest of the spine and cause further problems.

Low Back Pain: Surgery

Vertebral compression fractures

Vertebral compression fractures Treatment In a compression fracture of the spine, the drum-shaped part (body) of one or more back bones (vertebrae) collapses into itself and becomes squashed (compressed) into a wedge shape. Most compression... read more Treatment are quite common among women over 50 years of age. They can be treated conservatively with nonsurgical options such as braces, pain relievers, and possibly calcitonin nasal spray, which does not help bone healing but may decrease pain.

If pain is not adequately controlled, two surgical options are available:

  • Vertebroplasty: A cement mixture is injected into the fractured bone.

  • Kyphoplasty: A balloon is inserted into the fractured bone to create space. The balloon is then filled with cement.

However, recent studies have shown that, in the long term, these surgical procedures are no more effective than nonsurgical options.

Key Points about Low Back Pain

  • Low back pain is very common and usually caused by a musculoskeletal disorder of the spine plus other factors, such as fatigue, obesity, and lack of exercise.

  • In young people, low back pain is rarely serious, and testing is usually unnecessary unless symptoms persist for weeks.

  • People who have warning signs or who are over age 55 should see a doctor without delay.

  • Strengthening abdominal and back muscles with specific exercises can help prevent the most common types of low back pain.

  • For most low back pain, avoiding activities that stress the back, taking pain relievers, and sometimes applying ice or heat are sufficient treatment.

  • Prolonged bed rest and traction can delay recovery.

  • In severe cases, for example, when people have abnormal sensation and weakness in the legs, surgery may be needed.

  • Vertebral compression fractures can be treated conservatively (with bracing, pain relievers, and calcitonin nasal spray) or occasionally more aggressively with surgery.

Drugs Mentioned In This Article

Generic Name Select Brand Names
MEDROL
AMRIX
TYLENOL
OZURDEX
ROBAXIN
SOMA
SKELAXIN
MIACALCIN
XYLOCAINE
VALIUM
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