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What is Lower Back Pain?

Low back pain is very common. Depending on how severe it is, lower back pain can feel like a dull ache or a sharp pain. Sometimes, the pain radiates (spreads) to the buttocks and the top of the legs. In most cases, lower back pain is a muscle problem and is not a sign of nerve or spine damage.

Acute low back pain (pain that lasts 8 weeks or less) is the second most-common reason that people visit their doctor. More than 80% of people will have an episode of acute low back pain sometime in their lives. In most cases, it gets better with simple treatments at home. Surgery typically does not help lower back pain and is not recommended.

Chronic low back pain lasts more than 8 weeks or keeps coming back. Surgery does not usually help chronic low back pain. Usually, the doctor will work with a team of people to help someone who has chronic low back pain learn to use movement and exercise to lessen pain. If needed, the doctor will recommend or prescribe medicine to help manage the pain. They will also try to understand what conditions might be making the pain worse. For example, they may recommend a program to help with weight loss or quitting tobacco. Or, they may suggest treatment for anxiety, depression, or other mental health problems that can make lower back pain worse.

Symptoms

Symptoms of lower back pain include:

  • A dull ache, burning, or sharp pain in the low part of the back
  • Pain that radiates (spreads) to the buttocks and the top of the legs
  • Trouble moving, especially bending, twisting, or getting up from lying down or sitting

When to See a Doctor

See a doctor immediately or go to the nearest emergency room if you have any of these symptoms:

  • Trouble going to the bathroom
  • Trouble controlling your urine or bowels
  • Blood in your urine

Make an appointment to see your doctor if you develop any of these symptoms:

  • Sudden, severe pain
  • Severe back pain that gets worse over several weeks instead of getting better
  • Numbness or weakness in your legs
  • Fever

You may also decide to see the doctor if your back pain lasts longer than 8 weeks or keeps coming back. In most cases, there’s no magic cure for back pain. Your doctor may not even be able to tell you the exact cause of your pain. However, your doctor can make sure your back pain is not because of a serious condition and recommend treatments for controlling pain and continuing daily activities.

Causes

The exact cause of lower back pain is often hard to pinpoint. Most acute lower back pain is probably caused by muscle strain. It’s usually from doing an activity you’re not used to, like yard work, moving furniture, or heavy lifting. Or, you may have sprained the ligaments between the bones in your back the vertebrae) or in the joint in the lower back.

Less often, one of the discs that normally cushions your vertebrae can push out and press on a nerve. The good news is that acute lower back pain is rarely caused by damage to your spine or by any other serious medical condition. In most cases, you can recover and get back to normal daily activities on your own.

Diagnosis and Tests

In most cases, a doctor can rule out serious conditions from a medical history and physical exam alone. Typically, there is no need special lab tests, x-rays, or MRIs. These tests don’t usually help. If the doctor suspects a serious condition, the doctor will refer the patient to an appropriate medical specialist.

Treatments

Not all lower back pain episodes require a doctor’s visit. Most people can manage their pain on their own and return to normal activities as soon as ready. Try these suggestions:

  • Keep moving. It’s natural to want to avoid using your back when it hurts. However, for most types of back pain, inactivity — especially bed rest — can slow the healing process and make your muscles weaker, tighter, and more painful. Avoid activities that make your pain worse, but stay as active as possible.
  • Find a comfortable position. When you do rest, you may have to experiment with positions to relieve your lower back pain. Try lying on your back with a pillow under your thighs or on your side with your knees bent and a pillow between your legs.
  • Apply heat or cold. Cold (an ice pack or bag of frozen peas) can lessen your lower back pain, while heat (a hot water bottle, heating pad, or warm bath) can loosen tight muscles. Apply ice or heat for 15 minutes at a time each hour. Switch between the 2 for best results. Use ice for 15 minutes during the first hour. Then, use heat for 15 minutes during the next hour.
  • Try simple pain medicine. Control lower back pain with non-steroidal anti-inflammatory medicines like ibuprofen. You can also try acetaminophen (Tylenol). Pain medicine should control the pain enough that you can be active. If you take any other medicines, check with your doctor before taking any of these pain relievers. Also, be sure to follow the directions on the packaging.

If you go to the doctor, the doctor will talk with you about staying active, avoiding bed rest, and moving your body in ways that won’t hurt your back. The doctor may also recommend:

  • Medicines for pain relief. Your doctor may recommend over-the-counter or prescription anti-inflammatories (like ibuprofen or naproxen). For more severe cases, you might need to take a short course of muscle relaxers to reduce muscle tension and increase ability to move. Acute back pain rarely requires treatment with steroids or narcotics.
  • Physical therapy. A physical therapist can give you an individual exercise program to make you stronger and more flexible. It’s best to get this treatment as early as possible for relieving lower back pain. If your insurance doesn’t cover physical therapy, ask your doctor for exercises you can do on your own at home.

Prevention

Doctors and researchers have discovered factors that can reduce your chances of having lower back pain. Here are some suggestions:

  • Practice good body mechanics. The term “body mechanics” refers to how you move and hold your body. It’s one of the most important things you can do to protect your back. For example:
    • Bend your knees as you lift to make your legs do the hard work, not your back.
    • Lift only as much as you can handle comfortably.
    • Switch positions when you are standing for a long time.
    • Use good posture when sitting — keep your legs level with your hips, and put a rolled up towel or small pillow behind your low back.
    • Sleep on a mattress with firm support.
  • Get regular exercise. Regular activity keeps your body strong and flexible to support your back. Get regular exercise that includes aerobic training (such as walking, swimming, or cycling) as well as exercises to make your stomach and lower back stronger.
  • Manage your weight. Extra pounds put extra stress on your back. To lose weight, eat more fruits and vegetables, keep portions small, avoid junk food, and exercise regularly.
  • Avoid back stress and strain. Activities that require heavy lifting or twisting or that cause your body to vibrate, can place lots of stress and strain on your back.
  • Find ways to reduce or manage life stress. Unmanaged stress has also been shown to affect lower back pain. It can cause muscle tension and sometimes a back spasm.
  • Don’t smoke or use tobacco. Studies show that smokers have twice as much lower back pain as non- smokers. Ask your doctor about these and other resources to help you quit: