Back Pain

Definition
Back pain is a common complaint. Four out of five people in the United States will
experience low back pain at least once during their lives. It's one of the most common
reasons people go to the doctor or miss work.

On the bright side, you can prevent most back pain. If prevention fails, simple home
treatment and proper body mechanics will often heal your back within a few weeks
and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Causes
Your back is an intricate structure composed of bones, muscles, ligaments, tendons
and disks — the cartilage-like pads that act as cushions between the segments of your
spine. Back pain can arise from problems with any of these component parts. In some
people, no specific cause for their back pain can be found.

Strains
Back pain most often occurs from strained muscles and ligaments, from improper or
heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can
cause back pain.

Structural problems
In some cases, back pain may be caused by structural problems, such as:

 Bulging or ruptured disks. Disks act as cushions between the vertebrae in

your spine. Sometimes, the soft material inside a disk may bulge out of place
or rupture and press on a nerve. But many people who have bulging or
herniated disks experience no pain from the condition.
 Sciatica. If a bulging or herniated disk presses on the main nerve that travels
down your leg, it can cause sciatica — sharp, shooting pain through the
buttock and back of the leg.
 Arthritis. The joints most commonly affected by osteoarthritis are the hips,
hands, knees and 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.
 Skeletal irregularities. Back pain can occur if your spine curves in an
abnormal way. If the natural curves in your spine become exaggerated, your
upper back may look abnormally rounded or your lower back may arch
excessively. Scoliosis, a condition in which your spine curves to the side, also
may lead to back pain.
 Osteoporosis. Compression fractures of your spine's vertebrae can occur if
your bones become porous and brittle.
Rare but serious conditions
In rare cases, back pain may be related to:

 Cauda equina syndrome. This is a serious neurological problem affecting a

bundle of nerve roots that serve your lower back and legs. It can cause
weakness in the legs, numbness in the "saddle" or groin area, and loss of
bowel or bladder control.
 Cancer in the spine. A tumor on the spine can press on a nerve, causing back
pain.
 Infection of the spine. If a fever and a tender, warm area accompany back
pain, the cause could be an infection.

Risk factors
Factors that increase your risk of developing low back pain include:

 Smoking
 Obesity
 Older age
 Female gender
 Physically strenuous work
 Sedentary work
 Stressful job
 Anxiety
 Depression

When to seek medical advice

Most back pain gradually improves with home treatment and self-care. Although the
pain may take several weeks to disappear completely, you should notice some
improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. See a doctor
immediately if your back pain:

 Is constant or intense, especially at night or when you lie down

 Spreads down one or both legs, especially if the pain extends below the knee
 Causes weakness, numbness or tingling in one or both legs
 Causes new bowel or bladder problems
 Is associated with pain or pulsation (throbbing) in the abdomen, or fever
 Follows a fall, blow to your back or other injury
 Is accompanied by unexplained weight loss

Also, see your doctor if you start having back pain for the first time after age 50, or if
you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

Tests and diagnosis

Diagnostic tests aren't usually necessary to confirm the cause of your back pain.
However, if you do see your doctor for back pain, he or she will examine your back
and assess your ability to sit, stand, walk and lift your legs. He or she may also test
your reflexes with a rubber reflex hammer. These assessments help determine where
the pain comes from, how much you can move before pain forces you to stop and
whether you have muscle spasms. They will also help rule out more serious causes of
back pain.

If there is reason to suspect that you have a tumor, fracture, infection or other specific
condition that may be causing your back pain, your doctor may order one or more
tests:

 X-ray. These images show the alignment of your bones and whether you have
arthritis or broken bones. X-ray images won't directly show problems with
your spinal cord, muscles, nerves or disks.
 Magnetic resonance imaging (MRI) or computerized tomography (CT)
scans. These scans can generate images that may reveal herniated disks or
problems with bones, muscles, tissue, tendons, nerves, ligaments and blood
vessels.
 Bone scan. In rare cases, your doctor may use a bone scan to look for bone
tumors or compression fractures caused by osteoporosis. In this procedure,
you'll receive an injection of a small amount of a radioactive substance (tracer)
into one of your veins. The substance collects in your bones and allows your
doctor to detect bone problems using a special camera.
 Nerve studies (electromyography, or EMG). This test measures the
electrical impulses produced by the nerves and the responses of your muscles.
Studies of your nerve-conduction pathways can confirm nerve compression
caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatments and drugs

Most back pain gets better with a few weeks of home treatment and careful attention.
A regular schedule of over-the-counter pain relievers may be all that you need to
improve your pain. A short period of bed rest is okay, but more than a couple of days
actually does more harm than good. If home treatments aren't working, your doctor
may suggest stronger medications or other therapy.

Medications
Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a
muscle relaxant, to relieve mild to moderate back pain that doesn't get better with
over-the-counter pain relievers. Narcotics, such as codeine or hydrocodone, may be
used for a short period of time with close supervision by your doctor.

Low doses of certain types of antidepressants — particularly tricyclic antidepressants,

such as amitriptyline — have been shown to relieve chronic back pain, independent of
their effect on depression.

Physical therapy and exercise

A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound,
electrical stimulation and muscle-release techniques, to your back muscles and soft
tissues to reduce pain. As pain improves, the therapist can teach you specific exercises
to increase your flexibility, strengthen your back and abdominal muscles, and
improve your posture. Regular use of these techniques will help prevent pain from
coming back.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your
doctor may inject cortisone — an anti-inflammatory medication — into the space
around your spinal cord (epidural space). A cortisone injection helps decrease
inflammation around the nerve roots, but the pain relief usually lasts less than six
weeks.

In some cases, your doctor may inject numbing medication into or near the structures
believed to be causing your back pain. Early studies indicate that botulism toxin
(Botox) also may help relieve back pain, perhaps by paralyzing strained muscles in
spasm. Botox injections typically wear off within three to four months.

Surgery
Few people ever need surgery for back pain. There are no effective surgical
techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved
for pain caused by a herniated disk. If you have unrelenting pain or progressive
muscle weakness caused by nerve compression, you may benefit from surgery. Types
of back surgery include:

 Fusion. This surgery involves joining two vertebrae to eliminate painful

movement. A bone graft is inserted between the two vertebrae, which may
then be splinted together with metal plates, screws or cages. A drawback to the
procedure is that it increases the chances of arthritis developing in adjoining
vertebrae.
 Disk replacement. An alternative to fusion, this surgery inserts an artificial
disk as a replacement cushion between two vertebrae.
 Partial removal of disk. If disk material is pressing or squeezing a nerve,
your doctor may be able to remove just the portion of the disk that's causing
the problem.
 Partial removal of a vertebra. If your spine has developed bony growths that
are pinching your spinal cord or nerves, surgeons can remove a small section
of the offending vertebra, to open up the passage.

Prevention
You may be able to avoid back pain by improving your physical condition and
learning and practicing proper body mechanics.

To keep your back healthy and strong:

 Exercise. Regular low-impact aerobic activities — those that don't strain or

jolt your back — can increase strength and endurance in your back and allow
 your muscles to function better. Walking and swimming are good choices.
Talk with your doctor about which activities are best for you.
 Build muscle strength and flexibility. Abdominal and back muscle exercises
(core-strengthening exercises) help condition these muscles so that they work
together like a natural corset for your back. Flexibility in your hips and upper
legs aligns your pelvic bones to improve how your back feels.
 Quit smoking. Smokers have diminished oxygen levels in their spinal tissues,
which can hinder the healing process.
 Maintain a healthy weight. Being overweight puts strain on your back
muscles. If you're overweight, trimming down can prevent back pain.

Use proper body mechanics:

 Stand smart. Maintain a neutral pelvic position. If you must stand for long
periods of time, alternate placing your feet on a low footstool to take some of
the load off your lower back.
 Sit smart. Choose a seat with good lower back support, arm rests and a swivel
base. Consider placing a pillow or rolled towel in the small of your back to
maintain its normal curve. Keep your knees and hips level.
 Lift smart. Let your legs do the work. Move straight up and down. Keep your
back straight and bend only at the knees. Hold the load close to your body.
Avoid lifting and twisting simultaneously. Find a lifting partner if the object is
heavy or awkward.

Alternative medicine
Many people choose hands-on therapies to ease their back pain:

 Chiropractic care. Back pain is one of the most common reasons that people
see a chiropractor. If you're considering chiropractic care, talk to your doctor
about the most appropriate specialist for your type of problem. In addition to
chiropractors, many osteopathic doctors and some physical therapists have
training in spinal manipulation.
 Acupuncture. Some people with low back pain report that acupuncture helps
relieve their symptoms. The National Institutes of Health has found that
acupuncture can be an effective treatment for some types of chronic pain. In
acupuncture, the practitioner inserts sterilized stainless steel needles into the
skin at specific points on the body.
 Massage. If your back pain is caused by tense or overworked muscles,
massage therapy may help loosen knotted muscles and promote relaxation.