It can result from injury, activity and some medical conditions. Back pain can affect people of any age, for different reasons. As people get older, the chance of developing lower back pain increases, due to factors such as previous occupation and degenerative disk disease.
Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.
Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.
The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones, which work together to support the body and enable us to move around.
The segments of the spine are cushioned with cartilage-like pads called disks.
Problems with any of these components can lead to back pain. In some cases of back pain, its cause remains unclear.
Damage can result from strain, medical conditions, and poor posture, among others.
Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:
Activities that can lead to strains or spasms include:
A number of structural problems may also result in back pain.
Back pain can also result from some everyday activities or poor posture.
Examples include:
Some medical conditions can lead to back pain.
The following factors are linked to a higher risk of developing low back pain:
Lower back pain also tends to be more common in women than in men, possibly due to hormonal factors. Stress, anxiety, and mood disorders have also been linked to back pain.
The main symptom of back pain is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs.
Some back issues can cause pain in other parts of the body, depending on the nerves affected.
The pain often goes away without treatment, but if it occurs with any of the following people should see their doctor:
You should seek medical help if you experience any numbness or tingling, or if you have back pain:
A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination.
An imaging scan and other tests may be required if:
An X-ray, MRI, or CT scan can give information about the state of the soft tissues in the back.
The doctor may also order a blood test if infection is suspected.
Back pain is categorized into two types:
Back pain usually resolves with rest and home remedies, but sometimes medical treatment is necessary.
Over-the-counter (OTC) pain relief medication, usually nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen, can relieve discomfort. Applying a hot compress or an ice pack to the painful area may also reduce pain.
Resting from strenuous activity can help, but moving around will ease stiffness, reduce pain, and prevent muscles from weakening.
If home treatments do not relieve back pain, a doctor may recommend the following medication, physical therapy, or both.
Medication: Back pain that does not respond well to OTC painkillers may require a prescription NSAID. Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by the doctor. In some cases, muscle relaxants may be used.
Antidepressants, such as amitriptyline, may be prescribed, but research is ongoing at to their effectiveness, and the evidence is conflicting.
Physical therapy: Applying heat, ice, ultrasound, and electrical stimulation — as well as some muscle-release techniques to the back muscles and soft tissues — may help alleviate pain.
As the pain improves, the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help.
The patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence
Cortisone injections: If other options are not effective, these may be injected into the epidural space, around the spinal cord. Cortisone is an anti-inflammatory drug. It helps reduce inflammation around the nerve roots. Injections may also be used to numb areas thought to be causing the pain.
Botox: Botox (botulism toxin), according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm. These injections are effective for about 3 to 4 months.
Traction: Pulleys and weights are used to stretch the back. This may result in a herniated disk moving back into position. It can also relieve pain, but only while traction is applied.
Cognitive behavioral therapy (CBT): CBT can help manage chronic back pain by encouraging new ways of thinking. It may include relaxation techniques and ways of maintaining a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.
Complementary therapies may be used alongside conventional therapies or on their own.
Chiropractic, osteopathy, shiatsu, and acupuncture may help relieve back pain, as well as encouraging the patient to feel relaxed.
Studies on complementary therapies have given mixed results. Some people have experienced significant benefit, while others have not. It is important, when considering alternative therapies, to use a well qualified and registered therapist.
Transcutaneous electrical nerve stimulation (TENS) is a popular therapy for patients with chronic back pain. The TENS machine delivers small electric pulses into the body through electrodes that are placed on the skin.
Experts believe TENS encourages the body to produce endorphins and may block pain signals returning to the brain. Studies on TENS have provided mixed results. Some revealed no benefits, while others indicated that it could be helpful for some people.
A TENS machine should be used under the direction of a doctor or health professional.
It should not be used by someone who is:
TENS is considered “safe, noninvasive, inexpensive, and patient friendly,” and it appears to reduce pain, but more evidence is needed to confirm its effectiveness in improving activity levels.
TENS machines and other pain relief methods can be purchased online.
Surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness.
Examples of surgical procedures include:
Injecting cells to regenerate spine discs: Scientists from Duke University, North Carolina, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effectively eliminating pain caused by degenerative disc disease.
Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.
Exercise: Regular exercise helps build strength and control body weight. Guided, low-impact aerobic activities can boost heart health without straining or jerking the back. Before starting any exercise program, talk to a health care professional.
There are two main types of exercise that people can do to reduce the risk of back pain:
Diet: Make sure your diet includes enough calcium and vitamin D, as these are needed for bone health. A healthful diet also helps control body weight.
Smoking: A significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height, and weight.
Body weight: The weight people carry and where they carry it affects the risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable. People who carry their weight in the abdominal area versus the buttocks and hip area are also at greater risk.
Posture when standing: Make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet. Keep your legs straight and your head in line with your spine.
Posture when sitting: A good seat for working should have good back support, arm rests and a swivel base. When sitting, try to keep your knees and hips level and keep your feet flat on the floor, or use a footstool. You should ideally be able to sit upright with support in the small of your back. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.
Lifting: When lifting things, use your legs to do the lifting, rather than your back.
Keep your back as straight as you can, keeping your feet apart with one leg slightly forward so you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.
Bending your back initially is unavoidable, but when you bend your back try not to stoop, and be sure to tighten your stomach muscles so that your pelvis is pulled in. Most important, do not straighten your legs before lifting, or you will be using your back for most of the work.
Do not lift and twist at the same time: If something is particularly heavy, see if you can lift it with someone else. While you are lifting keep looking straight ahead, not up or down, so that the back of your neck is like a continuous straight line from your spine.
Moving things: It is better for your back to push things across the floor, using your leg strength, rather than pulling them.
Shoes: Flat shoes place less of a strain on the back.
Driving: It is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks. Get out of the car and walk around.
Bed: You should have a mattress that keeps your spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.
