Lower Back Pain

Lower back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning.

What causes lower back pain?

The exact cause of lower back pain can be difficult to determine. In most cases, back pain may be a symptom of many different causes, including any or several of the following:

• Overuse, strenuous activity, or improper use (such as  repetitive or heavy lifting, exposure to vibration for prolonged periods of time)
• Injury
• Degeneration of vertebrae (often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)
• Infection
• Abnormal growth (tumor)
• Obesity (often increases weight on the spine and pressure on the disks)
• Poor muscle tone in the back
• Muscle tension or spasm
• Sprain or strain
• Ligament or muscle tears
• Joint problems (such as spinal stenosis)
• Smoking
• Protruding or herniated (slipped) disk
• Disease (such as osteoarthritis, spondylitis, compression fractures)

What are the symptoms of lower back pain?

Lower back pain is classified as acute (or short term) and chronic. Acute low back pain lasts from a few days to a few weeks. Most acute low back pain will resolve on its own. Chronic low back pain lasts for more than 3 months and often gets worse. The cause of chronic low back pain can be difficult to determine.

The following are the most common symptoms of low back pain. However, each person may experience symptoms differently. Symptoms may include discomfort or pain in the lower back that is:

• Aching
• Burning
• Stabbing
• Sharp or dull
• Well-defined or vague

The pain may radiate into one or both buttocks or even into the thigh or hip area.

The symptoms of low back pain may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is lower back pain diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for low back pain may include the following:

• X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of bones onto film.
• CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• MRI. A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.
• Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
• Electromyogram (EMG). A test to evaluate nerve and muscle function.

How is lower back pain treated?

Specific treatment for lower back pain will be determined by your doctor based on:

• Your age, overall health, and medical history
• Diagnosis
• Extent of the condition
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include:

• Activity modification
• Medicine
• Physical rehabilitation, therapy, or both
• Occupational therapy
• Weight loss (if overweight)
• No smoking
• Following a prevention program (as directed by your doctor)
• Surgery
• Assistive devices (such as mechanical back supports)

Rehabilitation is often a part of treatment for low back pain. generally, there are 3 phases of low back pain rehabilitation.

• Acute phase. During this initial phase, the physiatrist (a doctor who specializes in rehabilitation medicine) and treatment team develop a treatment plan to reduce the initial low back pain and source of inflammation. This may include using ultrasound, electrical stimulation, or specialized injections.
• Recovery phase. Once the initial pain and inflammation are better managed, the rehabilitation team then focuses on helping you return to normal daily activities while starting a specialized exercise program to regain flexibility and strength.
• Maintenance phase. In this phase, you will learn ways to prevent further injury and strain to the back, and how to start a fitness program to help further increase strength and endurance.

Can lower back pain be prevented?

The following may help to prevent lower back pain:

• Use correct lifting techniques
• Maintain correct posture while sitting, standing, and sleeping
• Exercise regularly (with proper stretching before participation)
• Avoid smoking
• Maintain a healthy weight
• Reduce stress which may cause muscle tension

When should I call my healthcare provider?

Notify your healthcare provider if:

• Your pain becomes worse or spreads to your hips, thighs, or legs
• Your pain medicine no longer works well for you
• Your pain begins to interfere with your daily activities, or interferes with activities more than usual

Living with lower back pain

Most back pain will ease in a few days to a few weeks. If the pain lasts longer than 3 months, it is considered chronic and you should talk with your health care provider. Recovery from low back pain can take time. To prevent back pain from coming back, it’s important to follow good health practices, such as:

• Maintaining a healthy weight
• Exercise regularly
• Practice good lifting techniques
• Maintain good posture while sitting, standing, and sleeping
• Avoid smoking

Key points

• Specific treatment for lower back pain depends on the cause of the pain and the severity, but often includes pain medications and muscle relaxers, physical therapy, and lifestyle changes such as stress reduction, weight loss, increased physical activity, and assistive devices such as a back support.
• A back rehabilitation program may be used as part of the treatment for low back pain.
• Measures to prevent back pain include using safe lifting techniques, correct posture, maintaining a healthy weight, not smoking, and stress reduction.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.