Lower Back Pain

Lower back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. It can range from a dull, constant ache to a sudden, sharp sensation that leaves the person incapacitated. Lower back pain can begin quickly if you fall or lift something too heavy, or it can develop over time due to age-related changes in the spine. Most low back pain is acute, or short term, and lasts a few days to a few weeks. It tends to resolve on its own with self-care and there is no residual loss of function. Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.

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Causes

Muscle or ligament strain - Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you're in poor physical condition, constant strain on your back can cause painful muscle spasms.
Bulging or ruptured disks - Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve.
Arthritis - Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
Osteoporosis - Your spine's vertebrae can develop painful fractures if your bones become porous and brittle.
Skeletal irregularities - A condition in which your spine curves to the side (scoliosis) can lead to back pain, usually not until middle age.
Spinal stenosis - A narrowing of the spinal column that puts pressure on the spinal cord and nerves.
Sciatica - Compression of the sciatic nerve, often caused by a herniated disk or bone spur.
Poor posture - Improper alignment of your body when sitting or standing puts strain on the back.
Psychological stress - Emotional stress can cause muscle tension, which may lead to back pain or make existing pain worse.
Occupational activities - Jobs that require heavy lifting, pushing, pulling, or twisting can lead to back injury and pain.

Signs and Symptoms

Muscle ache - Dull, aching pain in the lower back.
Shooting or stabbing pain - Sharp, localized pain that may radiate down your leg.
Pain that radiates down your leg - Often described as sciatica, this is pain that extends from your buttock down the back of your leg.
Pain that worsens with bending, lifting, standing or walking - Activities that put strain on your back can increase pain.
Pain that improves with reclining - Lying down often relieves pressure on the spine and can temporarily reduce pain.
Muscle stiffness - Difficulty moving or bending due to tightness in the lower back.
Reduced range of motion - Difficulty bending, twisting, or straightening your back.
Numbness or tingling - Sensations that may indicate nerve compression or damage.
Weakness - Difficulty standing or walking, or leg weakness, which could indicate nerve damage.
Pain that persists for weeks - Chronic pain that doesn't resolve with rest or self-care measures.

Diagnosis

Physical Examination

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. Your doctor might also ask you to rate your pain on a scale of zero to 10 and talk to you about how well you're functioning with your pain.

X-rays

These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won't show problems with your spinal cord, muscles, nerves or disks.

MRI or CT scans

These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

Blood tests

These can help determine whether you have an infection or other condition that might be causing your pain.

Nerve studies

Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment Options

Medications

Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium may help relieve back pain. If those aren't effective, your doctor might prescribe muscle relaxants, topical pain relievers, narcotics, antidepressants, or cortisone injections.

Physical Therapy

A physical therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help prevent pain from returning.

Alternative Treatments

Complementary therapies that may help relieve back pain include acupuncture, massage, yoga, tai chi, and chiropractic adjustments. These approaches can be particularly helpful for chronic back pain.

Home Remedies

Rest

Bed rest isn't recommended, but resting from activities that aggravate your pain can help. Aim to return to your normal activities as soon as possible.

Heat and Cold

Applying ice packs or cold compresses for 20 minutes several times a day during the first 48 hours can help reduce inflammation. After that, using heat (heating pad, hot bath) can provide comfort and relax muscles.

Over-the-counter Pain Medications

Non-prescription pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation. Always follow the recommended dosage.

Gentle Activities

Light activity like walking can help maintain strength and flexibility. Avoid activities that strain your back, but don't remain completely inactive.

Stretching

Gentle stretches for your back and hamstrings can improve flexibility and reduce tension. Yoga or tai chi may be particularly beneficial for back pain.

Preventive Care

Exercise regularly to build strength and flexibility in your back muscles.
Maintain proper posture when sitting, standing, and lifting objects.
Lift with your legs, not your back, and avoid twisting while lifting.
Maintain a healthy weight to reduce stress on your back muscles.
Quit smoking, as it reduces blood flow to the lower spine and promotes disc degeneration.
Avoid prolonged sitting or standing in one position; take frequent breaks to move around.
Use chairs with good lower back support and armrests.
Place a pillow or rolled towel in the small of your back for lumbar support when sitting.
Sleep on a medium-firm mattress to minimize curve in your spine.
Wear comfortable, low-heeled shoes to reduce strain on your back.

Surgical Options

Discectomy or Microdiscectomy

A surgical procedure to remove a portion of a herniated disk that's pressing on a nerve root or the spinal cord. In a microdiscectomy, the surgeon uses a special microscope to view the disk and nerves, allowing the procedure to be done through a smaller incision.

Laminectomy

A surgical procedure that removes a portion of the vertebral bone called the lamina to create more space for the nerves. This procedure is typically performed when spinal stenosis causes narrowing of the spinal canal that results in pain, weakness, or numbness.

Spinal Fusion

A surgical procedure that permanently connects two or more vertebrae in your spine, eliminating motion between them. Spinal fusion is used to improve stability, correct a deformity, or reduce pain. It may be recommended for conditions such as degenerative disk disease, spondylolisthesis, or fractures.

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