Lower Back Pain: Symptoms, Causes & Treatment
If you have lower back pain, you are not alone. About 80 percent of adults experience lower back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days. In a large survey, more than a quarter of adults reported experiencing lower back pain during the past 3 months.
Men and women are equally affected by lower back pain, which can range in intensity from a dull, constant ache to a sudden, sharp sensation that leaves the person incapacitated. Pain can begin abruptly as a result of an accident or by lifting something heavy, or it can develop over time due to age-related changes of the spine. Sedentary lifestyles also can set the stage for lower back pain, especially when a weekday routine of getting too little exercise is punctuated by strenuous weekend workout.
Most lower back pain is acute, or short term, and lasts a few days to a few weeks. The majority of acute lower back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move.
Subacute lower back pain is defined as pain that lasts between 4 and 12 weeks.
Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute lower back pain has been treated. About 20 percent of people affected by acute lower back pain develop chronic lower back pain with persistent symptoms at one year. In some cases, treatment successfully relieves chronic lower back pain, but in other cases pain persists despite medical and surgical treatment.
- Pain in the back or legs.
- Stiffness and limited motion.
The pain may be continous 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 buttlocks and into the back of the thigh.
A lower back pain 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 home treatment.
The vast majority of lower back pain is mechanical in nature. In many cases, lower back pain is associated with spondylosis, a term that refers to the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
Some examples of mechanical causes of lower back pain include:
This accounts for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
A condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
Playing sports, car accidents, or a fall can injure tendons, ligaments or muscle, resulting in lower back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord.
A complete medical history and physical exam with a healthcare provider can usually identify any serious conditions that may be causing the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.
Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumors and spinal stenosis.
Treatment for lower back pain generally depends on whether the pain is acute or chronic. In general, surgery is recommended only if there is evidence of worsening nerve damage and when diagnostic tests indicate structural changes for which corrective surgical procedures have been developed.
Conventionally used treatments and their level of supportive evidence include:
- Hot or cold packs have never been proven to quickly resolve lower back injury; however, they may help ease pain and reduce inflammation for people with acute, subacute, or chronic pain, allowing for greater mobility among some individuals.
- Activity: Bed rest should be limited. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain. Strong evidence shows that people who continue their activities without bed rest following onset of lower back pain appeared to have better back flexibility than those who rested in bed for a week.
- Strengthening exercises, beyond general daily activities, are not advised for acute lower back pain, but may be an effective way to speed recovery from chronic or subacute lower back pain. Maintaining and building muscle strength is particularly important for people with skeletal irregularities.
- Physical therapy programs to strengthen core muscle groups that support the lower back, improve mobility and flexibility, are often used in combinations with other interventions. Here are some exercises you can do at home right now.
- Medications: A wide range of medications are used to treat acute and chronic lower back pain. Some are available over the counter (OTC); others require a physician’s prescription. Certain drugs, even those available OTC, may be unsafe during pregnancy, may interact with other medications, cause side effects, or lead to serious adverse effects such as liver damage or gastrointestinal ulcers and bleeding. Consultation with a health care provider is advised before use.
Recurring back pain resulting from improper body mechanics is often preventable by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture. Using ergonomically designed furniture and equipment to protect the body from injury at home and in the workplace may reduce the risk of back injury.
The use of lumbar supports in the form of wide elastic bands that can be tightened to provide support to the lower back and abdominal muscles to prevent lower back pain remains controversial. Such supports are widely used despite a lack of evidence showing that they actually prevent pain. Although there have been anecdotal case reports of injury reduction among workers using lumbar support belts, many companies that have back belt programs also have training and ergonomic awareness programs. The reported injury reduction may be related to a combination of these or other factors. Furthermore, some caution is advised given that wearing supportive belts may actually lead to or aggravate back pain by causing back muscles to weaken from lack of use.
- Always stretch before exercise or other strenuous physical activity.
- Don’t slouch when standing or sitting. The lower back can support a person’s weight most easily when the curvature is reduced. When standing, keep your weight balanced on your feet.
- Sit in a chair with good lumbar support and proper position and height for the task. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension.
- Wear comfortable, low-heeled shoes.
- Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.
- Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.
- Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.
Time to Completion: 10 minutes. You can do these exercises right away.
Exercise 1: Cat and Camel - Repeat 10 times
Get down on your hands and knees.
Let your stomach sag, allowing your back to curve downward. Hold for 5 seconds.
Arch your back. Hold for 5 seconds.
Need some extra motivation?
Get access to professional physical therapy feedback and tracking from your very own phone!
Make Physical Therapy Fun!
MIO combines the simplicity of an iOS app with wearable sensors to make physical therapy fun and effective.
Stay motivated with custom exercise programs and games. Get REAL rewards for completing your workouts!Learn More!