Patient education: Low back pain in adults (The Basics)

How worried should I be about low back pain? — Do not assume the worst. Almost everyone gets back pain at some point. Low back pain can be scary. But even when the pain is severe, it usually goes away on its own within a few weeks. The cases that require urgent care or surgery are rare.

See your doctor or nurse if you have back pain and you:

●Recently had a fall or an injury to your back

●Have numbness or weakness in your legs

●Have problems with bladder or bowel control

●Have unexplained weight loss

●Have a fever or feel sick in other ways

●Take steroid medicine, such as prednisone, on a regular basis

●Have diabetes or a medical problem that weakens your immune system

●Have a history of cancer or osteoporosis

You should also see a doctor if:

●Your back pain is so severe that you cannot perform simple tasks

●Your back pain does not start to improve within 4 weeks

What are the parts of the back? — The back is made up of (figure 1):

●Vertebrae – A stack of bones that sit on top of one another like a stack of coins. Each of these bones has a hole in the center. When stacked, the holes in the bones form a hollow tube that protects the spinal cord.

●Discs – Rubbery discs sit in between each of the vertebrae to add cushion and allow movement.

●Spinal cord and nerves – The spinal cord is the highway of nerves that connects the brain to the rest of the body. It runs through the vertebrae within the spinal canal. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, the legs, and the rest of the body. This is why problems in the back can cause leg pain or bladder or bowel problems.

●Muscles, tendons, and ligaments – Together, the muscles, tendons, and ligaments are called the "soft tissues" of the back. These soft tissues support the back and help hold it together.

What causes low back pain? — Many different things can cause low back pain. Most of the time, doctors do not know the exact cause.

Back pain can happen if you strain a muscle. This is often what has happened when a person "throws out" their back. This refers to pain that starts suddenly after physical activity, like lifting something heavy or bending over.

Back pain can also happen if you have:

●Damaged, bulging, or torn discs

●Arthritis affecting the joints of the spine

●Bony growths on the vertebrae that crowd nearby nerves

●A vertebra out of place

●Narrowing in the spinal canal

●A tumor or infection (but this is very rare)

Should I get an imaging test? — Most people do not need an imaging test such an X-ray, CT scan, or MRI. Most cases of back pain go away a few weeks. Doctors usually do not order imaging tests unless there are signs of something unusual.

If your doctor does not order an imaging test, do not worry. They can still learn a lot about your pain just from looking you over and talking with you.

How can the doctor or nurse tell what is wrong just by talking to me? — Your symptoms tell your doctor or nurse a lot about the cause of your pain. For example:

●If your pain started after you did something specific, like lifting a heavy object or twisting your back, you might have strained a muscle

●If your pain spreads down the back of 1 thigh, it could be a sign that 1 of the nerves that go to your leg is being pinched by a bulging or torn disc

●If your pain goes all the way down both legs, it could be a sign that you have a narrowed spinal canal. This is most often due to bony growths on your spine.

How is back pain treated? — Most people with an episode of low back pain do not have a serious medical problem, and can try simple treatments such as:

●Staying active – The best thing you can do is to stay as active as possible. People with low back pain recover faster if they stay active. If your pain is severe, you might need to rest for a day or 2. But it's important to get back to walking and moving as soon as possible. While you should avoid heavy lifting and sports while your back hurts, try to keep doing your normal daily activities.

●Heat – Some people find that it helps to use a heating pad or heated wrap. Be careful to avoid high heat settings to prevent skin burns.

●Medicines – First, you can try pain medicines that you can get without a prescription. In many cases, doctors suggest first trying a nonsteroidal antiinflammatory drug, or "NSAID." NSAIDs include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). These might work better than acetaminophen (sample brand name: Tylenol) for back pain.

If non-prescription medicines do not help, let your doctor or nurse know. In some cases, doctors prescribe a medicine to relax the muscles (called a "muscle relaxant"). But keep in mind that muscle relaxants are not generally used in people older than 65. In older people, these medicines can cause side effects such as trouble urinating or confusion.

●Treatments to help with symptoms – Some treatments might help you feel better for a little while. They include:

•Spinal manipulation – This is when a chiropractor, physical therapist, or other professional moves or "adjusts" the joints of your back. If you want to try this, talk to your doctor or nurse first.

•Acupuncture – This is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals.

•Massage – A massage therapist massages the muscles and other soft tissues in your back.

While back pain usually goes away within a few weeks, some people do continue to have pain for longer. In this case, additional treatments might include:

●Self-care – This involves being aware of your pain. While you should rest when you need to, it's important to stay active as much as you can. Things like applying heat and doing gentle stretches can help you feel better, too.

●Physical therapy – A physical therapist is an exercise expert who can teach you stretches and movements to help strengthen your muscles. The goal is to relieve pain but also help you get back to your normal activities.

Exercises you can try include walking, swimming, or using an exercise bike. Some people also find that tai chi or yoga can help with their back pain. Finding activities you enjoy can help you stay active.

●Reducing stress – Some people find that it helps to try something called "mindfulness-based stress reduction." This involves going to a group program to practice relaxation and meditation. If your back pain is making you feel anxious or depressed, talk to your doctor or nurse. There are other treatments that can help with these problems.

Some people wonder if injections (shots) can help to relieve back pain. In some cases, doctors might recommend a shot of medicine to numb the area or reduce swelling. But this has only been proven to work in specific situations.

Only a small number of people will need surgery to treat back pain.

What can I do to keep from getting back pain again? — The best thing you can do is to stay active. Doing exercises to strengthen and stretch your back can help. You can also:

●Learn to lift using your legs instead of your back

●Avoid sitting or standing in the same position for too long

Having back pain can be frustrating and scary. But it can help to know that doing these things can lower your risk of having another episode.

More on this topic

Patient education: Herniated disc (The Basics)
Patient education: Spinal stenosis (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)
Patient education: Coccyx injury (The Basics)
Patient education: Laminectomy (The Basics)
Patient education: Degenerative disc disease (The Basics)
Patient education: Back exercises (The Basics)
Patient education: Exercises for sciatic pain (The Basics)

Patient education: Back pain in children and adolescents (Beyond the Basics)
Patient education: Low back pain in adults (Beyond the Basics)