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Low Back Pain

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 that surround and protect the spinal cord and nerves. Low back pain is very common. It 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. Many times, the exact source of back pain is not known. Some causes of back pain include:

Risk Factors

These factors increase your chance of developing low back pain:
  • Older age
  • Certain activities (such as lifting, bending, or twisting)
  • Lack of exercise
  • Pregnancy
  • Obesity
  • Smoking
  • Prior back injury
  • Prior back surgery
  • Other factors which may negatively influence back pain include:
    • Psychological factors, such as low job satisfaction
    • Stress

Symptoms

Pain is usually restricted in 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
  • 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 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.
Your doctor may need pictures of your body structures. This can be done with:
It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.
Your doctor may need your bodily fluids tested. This can be done with:
  • Blood tests
  • Urine test
Your doctor may want to examine your bones using a bone scan .

Treatment

Treatment options include:

Stay Active

Bed rest is not generally recommended. It may only be advised for not more than 1–2 days in those with severe back pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. By staying active and exercising, you may be able to shorten your recovery time.

Medication

Medicines that your doctor may suggest include:
  • Over-the-counter pain relievers, such as acetaminophen (Tylenol), aspirin (Bayer), or ibuprofen (Motrin, Advil)
  • Muscle relaxants for muscle spasm—These medicines are not used in cases where you need to be alert, such as driving or operating machinery.
  • Antidepressants—These may also be prescribed for chronic low back pain.

Physical Therapy

A physical therapy program may include:
  • Applying hot or cold packs
  • Doing stretching, strengthening, and balance exercises for back and stomach muscles
  • Participating in an aerobic exercise program (eg, walking, swimming)
  • Learning how to cope with back problems
  • Getting massage therapy

Alternative Medicine

Surgery

Only a small number of patients 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 .
If you have low back pain, follow your doctor's instructions .
If you have low back pain, follow your doctor's instructions .

Prevention

The following steps may help you avoid low back pain:
  • Begin a safe exercise program with the advice of your doctor.
  • Maintain a healthy weight .
  • If you smoke, quit .
  • Practice good posture to reduce pressure on your spine.
  • Avoid sitting or standing in one position for long periods of time.
  • If you must remain standing for long periods, rest one foot at a time on a small stool to relieve pressure on your lower back.
  • When lifting, hold the object close to your body, keep your back straight, and use your leg muscles to rise slowly.
  • Avoid aggravating activities, for example bending, twisting, and sudden movements.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.
  • If you have back pain during pregnancy, try wearing a BellyBra. This is a special bra to support your back and abdomen.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/

American Academy of Family Physicians http://www.familydoctor.org/

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org/

Canadian Orthopaedic Foundation http://www.canorth.org/

References

Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated December 3, 2012. Accessed December 6, 2012.

Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299-2309.

Chronic low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated November 28, 2012. Accessed December 6, 2012.

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev . 2010 Jun 16;(6):CD007612.

Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bedrest for acute low back pain and sciatica. Cochrane Database Rev. 2000;CD001254.

Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21.

Patel AT, Ogle AA. Diagnosis and management of acute low back pain. Am Fam Physician. 2000;62:2414-2415.

9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Kalus SM, Kornman LH, Quinlivan JA. Managing back pain in pregnancy using a support garment: a randomised trial. BJOG. 2008;115:68-75. Epub 2007 Nov 12.

12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.

1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009;9:147-168.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463-472.

2/24/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Sahar T, Cohen M, Ne'eman V, et al. Insoles for prevention and treatment of back pain. Cochrane Database Syst Rev. 2009;(1):CD005275.

9/2/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Urquhart D, Hoving J, Assendelft W, Roland M, van Tulder M. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2009;(3):CD001703.

11/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebsochost.com/dynamed/ : US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm . Published November 4, 2010. Accessed November 12, 2010.

12/17/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Andersen LL, Christensen KB, Holtermann A, et al. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Man Ther. 2010;15(1):100-104.

10/21/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2011 ;92(10):1681-1685.

11/29/2011 DynaMed's Systematic Literature Surveillance http:www.ebscohost.com/dynamed/ : Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):542-552.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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