- What You Should Know About Low Back Pain
- Physio Works – Physiotherapy Brisbane
- What is Back Muscle Pain?
- What Causes Back Muscle Pain?
- What are Symptoms of Back Muscle Pain?
- Warning Signs of a More Serious Back Injury?
- How is Back Muscle Pain Diagnosed?
- What is Back Muscle Pain Treatment?
- Back Pain Treatment Aims
- Back Pain Treatment Options
- What Recovery Can You Expect?
- How Can You Prevent Recurring Back Pain?
- Related Back Injuries
- Common Back Pain Treatments
- Helpful Products for Back Muscle Strains & Ligament Sprains
- FAQs about Back Muscle Strains & Ligament Sprains
- Lower Back Muscle Strain Symptoms
- Common Symptoms of a Pulled Back Muscle
- How to Treat an Aching Back
- What is causing this pain in my back?
- Risk factors
- Oh, Your Back Hurts? It’s Probably Your Posture.
What You Should Know About Low Back Pain
Self-care methods are helpful for the first 72 hours after the pain begins. If the pain doesn’t improve after 72 hours of home treatment, you should call your doctor.
Stop your normal physical activities for a couple of days and apply ice to your lower back. Doctors generally recommend using ice for the first 48 to 72 hours, then switching to heat.
Alternate ice and heat to relax muscles. The RICE protocol — rest, ice, compression, and elevation — is recommended within the first 48 hours.
Take over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB), or acetaminophen (Tylenol), to relieve pain.
Sometimes lying on your back causes more discomfort. If so, try lying on your side with your knees bent and a pillow between your legs. If you can lie comfortably on your back, place a pillow or rolled-up towel beneath your thighs to reduce the pressure on the lower back.
A warm bath or a massage can often relax stiff and knotted muscles in the back.
Low back pain can occur with a number of different conditions, including:
- muscle strain and weakness
- pinched nerves
- spinal cord misalignment
There are a number of possible medical treatments including:
- medical appliances
- physical therapy
Your doctor will determine the appropriate dosage and application of drugs and medications based on your symptoms.
Some medications your doctor may prescribe include:
- muscle relaxants
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- narcotic drugs such as codeine for pain relief
- steroids to reduce inflammation
- corticosteroid injections
Your doctor may also prescribe physical therapy, including:
- strengthening exercises
- back and spinal manipulation
For severe cases, surgery may be necessary. Surgery is usually only an option when all other treatments fail. However, if there’s loss of bowel or bladder control, or a progressive neurological loss, surgery becomes an emergency option.
A discectomy relieves pressure from a nerve root pressed on by a bulging disc or bone spur. The surgeon will remove a small piece of the lamina, a bony part of the spinal canal.
A foraminotomy is a surgical procedure that opens up the foramen, the bony hole in the spinal canal where the nerve root exits.
Intradiscal electrothermal therapy (IDET) involves inserting a needle through a catheter into the disc and heating it up for 20 minutes. This makes the disc wall thicker and cuts down on the inner disc’s bulging and irritation of the nerve.
A nucleoplasty uses a wand-like device inserted through a needle into the disc. It can then remove inner disc material. The device then uses radio waves to heat and shrink the tissue.
Radiofrequency lesioning or ablation is a way to use radio waves to interrupt the way the nerves communicate with each other. A surgeon inserts a special needle into the nerves and heats it, which destroys the nerves.
Spinal fusion makes the spine stronger and cuts down on painful motion. The procedure removes discs between two or more of the vertebrae. The surgeon then fuses the vertebrae next to each other with bone grafts or special metal screws.
A spinal laminectomy, also known as spinal decompression, removes the lamina to make the size of the spinal canal bigger. This relieves pressure on the spinal cord and nerves.
Why Your Back Is Hurting
Figuring out what’s behind your back pain isn’t always easy to start, there are a lot of confusing back-ailment terms (is a ‘bulging’ disc the same as a ‘slipped’ disc?), so it helps to understand a bit more about your anatomy.
An adult’s spine consists of a stack of 24 bones called vertebrae plus the bones of the sacrum and coccyx. These bones support the body and protect the spinal cord’a major column of nerve fibres connected to the brain that runs through the vertebrae via the spinal canal. A disc, made of cartilage and filled with a gel-like material that acts like a shock absorber, is found between each vertebra. Ligaments, muscles, tendons and small joints called facets hold the vertebrae together.
With that information in mind, we’ve broken down eight possible sources of your back pain.
1) Disc pain
If one of the discs is pushed a bit out of place, usually as a normal part of aging, it’s called a ‘bulging’ disc. If this disc has some cracked cartilage due to an inherited trait, wear and tear or sudden trauma and some of the shock absorbing gel inside the cartilage protrudes out, it’s called a ‘herniated’ (or ‘ruptured’ or ‘slipped’) disc. Both bulging and herniated discs may or may not cause pain.
2) Degenerative Disc Disease
You may also have heard the term “degenerative disc disease.” In fact, it’s not a disease, but rather a kind of catch-all term that refers to the condition of the discs, which lose their water content and sponginess with age, which can lead to osteoarthritis, herniated discs or bulging discs.
3) Facet joint pain
Facet joints are supplied by two nerves, and if either becomes inflamed or pinched, it can be painful.
4) Pinched nerve
Discs pushed out of place may compress a nerve. Often it’s the sciatic nerve (which runs out of the lower spine and into the leg) that is compressed or inflamed. This causes shooting pain called sciatica in the lower back, leg and buttock.
5) Spinal stenosis
This occurs when the spinal canal becomes narrowed (most often due to arthritis) and impinges on nerves, causing pain.
6) Muscle or ligament strain
An intense workout or lifting something heavy is also a frequent source of pain, especially in the lower back. Low back pain is the most common form of back pain because those muscles, ligaments and discs are under the most pressure when you’re sitting or lifting.
This is a common form of arthritis. “As we age, our nice spongy cartilage becomes thinner and is not as compressible,” explains Dr. Mary-Ann Fitzcharles, a Montreal rheumatologist and associate professor of medicine at McGill University. “The underlying bone senses this and then it responds by generating little extra ridges of bone called osteophytes or bone spurs. These little ridges rub against each other, and this mechanical irritation can cause pain.”
Fibromylagia mostly affects women and is recognized as a disturbance of the natural way the body deals with pain. “For many patients who experience back pain, it’s not because of a structural abnormality,” says Fitzcharles. “Rather, the impairment of pain-processing mechanisms means the brain is hypersensitive to incoming sensory input, or there is a lack of natural mechanisms to inhibit pain.”
Is Back Pain Serious?
Back pain is occasionally a symptom of a serious condition. If you have a history of cancer, or if your back pain is associated with fever, unexplained weight loss, or loss of bowel or bladder control, or gets severely worse when you’re lying down or at night, see a healthcare professional immediately.
Physio Works – Physiotherapy Brisbane
Article by J. Miller, A. Wong
What is Back Muscle Pain?
Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common.
In fact, back muscle pain is the most common source of back pain. The good news is, that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?
Most causes of low back pain are muscle, ligament or joint related. Commonly, these back injuries are caused by muscular strains, ligament sprains and joint dysfunction, particularly when pain arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.
The causes of simple back pain are numerous but roughly fall into the following categories.
Back Muscle Strains
Muscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems.
Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to poor joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor posture when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch and this places spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligaments are the strong fibrous bands that limit the amount of movement at available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain.
Awkward lifting, sports injuries and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are Symptoms of Back Muscle Pain?
Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.
Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and/or spasm.
- Protective back stiffness.
- Sudden back pain onset.
You will usually feels better when resting, and may find change of position painful eg sit to stand, rolling in bed, walking or bending.
Warning Signs of a More Serious Back Injury?
In these instances, or you have constant and severe back pain, please urgently consult your nearest hospital, doctor or physiotherapist.
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
How is Back Muscle Pain Diagnosed?
Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn’t significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains is similar. Most spinal practitioners refer to both injuries as a category called a “Back Strain” or “Musculoligamentous Strain”.
X-rays do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to specifically identify muscle or ligament structures are injured and to what extent. CT scans may also assist.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!
All back pain sufferers should be thoroughly examined by a spinal health practitioner eg physiotherapist. Back pain can be caused by numerous injuries and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment for simple back pain is designed to protect your injury, while hastening your muscle and ligament healing, and then look at strategies to prevent a recurrence.
Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Pain Treatment Aims
PHASE I – Pain Relief & Protection
Managing your back pain is the main reason that you seek treatment for low back pain. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Your physiotherapist will use an array of treatment tools to protect your back and reduce your pain and inflammation. These include: ice, electrotherapy eg tens, acupuncture, taping techniques, soft tissue massage, back braces. Your doctor may also recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Restoring Normal ROM, Strength
As your back pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back motion, muscle lengths and resting muscle tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Your physiotherapist will commence you on a lower back core stability program to facilitate your important muscles that dynamically control and stabilise your low back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
PHASE III – Restoring Full Function
Depending on your chosen sport, work or activities of daily living, your physiotherapist will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their backs that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Back Pain Recurrence
Recurrence of low back pain can and does regularly occur. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor deep abdominal core muscle exercises have been shown to render your back more vulnerable to instability and therefore re-injury.
To prevent a recurrence, you should continue a regular series of these exercises a few times per week. Think of your exercises as your anti-back pain pill! Your physiotherapist will assist you in identifying the best exercises for you.
Back Pain Treatment Options
There are many treatment options that your Physiotherapist will discuss with you in the treatment of your pain. Treatment varies based on the source of your individual symptoms.
A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test eases your pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future.
Back braces are available from PhysioWorks or via the following web link: Back Brace
Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture training. More info: Acupuncture
Massage always feels wonderful, plus it has wonderful muscle relaxation benefits. Massage is particularly useful when muscle spasm or chronic muscle tension is present. Regular remedial massage is also a very handy low back pain prevention strategy. More info: Massage
TENS machines are an electronic pain relieving device that will reduce your pain and your need for pain relieving drugs. More info: Tens Machine
What Recovery Can You Expect?
Back pain has many causes and EARLY diagnosis and treatment is the best way to recover quickly.
Simple back muscle pain can usually improve within a week or two of injury if you manage your injury properly. However, muscular pain or spasm lasting more than a few days is normally protective spasm overlying a more significant back injury, which should be professionally investigated. It may not be just a simple back muscle strain!
Most sufferers of low back pain will recover within about four weeks. However, this time can vary greatly as it depends on both the nature of your injury and the treatment plan that you develop with your physiotherapist.
How Can You Prevent Recurring Back Pain?
If you have suffered back pain in the past, you are unfortunately more likely to suffer in the future and worsening bouts. The most common cause of recurrent back pain is insufficient rehabilitation.
Follow the advice of your physiotherapist, who will establish a treatment plan to help your both achieve your short-term goals and help prevent a recurrence.
While there are no guarantees, it is well known that active individuals who exercise and adopt safe lifting and postures at home and at work are at a reduced risk of developing low back pain.
Discuss with your physiotherapist the specific postures and activities that you perform on a daily basis. They will aim to help you to understand how to position yourself and move with the lowest risk of injury based on your injury type and potential weaknesses.
Related Back Injuries
- Lower Back Pain
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS – Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann’s Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
- Bulging Disc – Slipped Disc – Herniated Disc
- Degenerative Disc Disease
Back Joint Injuries
- Facet Joint Pain
- Nerve Pain
- Pinched Nerve
- Sacroiliac Joint Pain
- Piriformis Syndrome
- Pregnancy Back Pain
- Ankylosing Spondylitis
- Rheumatoid Arthritis
Back Treatment Options
- Back Exercises
- Lower Back Pain Treatment
Common Back Pain Treatments
Helpful Products for Back Muscle Strains & Ligament Sprains
FAQs about Back Muscle Strains & Ligament Sprains
Lower Back Muscle Strain Symptoms
The pain from a pulled back muscle can range from merely irritating to intense and debilitating.
Common symptoms of a pulled back muscle include localized lower back pain, stiffness, tenderness, and muscle spasms. See Lower Back Pain Symptoms
Most cases of low back muscle strain start to abate within a couple of hours or days and do not lead to long-term problems. If pain has continued for more than a week or two, or if it is severe enough to disrupt daily activities, seeking medical attention is warranted.
See When to Seek Medical Care for Low Back Pain
Common Symptoms of a Pulled Back Muscle
Symptoms to expect from a pulled lower back muscle—or any type of lower back strain—typically include:
- Dull, achy low back pain. Strained muscles usually feel sore, tight, or achy. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle.
- Intensified pain with movement. Low back strain typically worsens with specific movements that activate the affected muscles. For example, there may be a flare-up of pain when getting up from a seated position, when bending forward, or when first getting out of bed in the morning.
- Pain that is localized in the low back. Pain is usually concentrated in the lower back. It may also be felt in the buttocks and/or hips, as these muscles help support the low back. Rarely does pain travel down the legs and into the calves and feet, as in cases of sciatica.
See Anatomy Of Nerve Pain
In This Article:
- Pulled Back Muscle and Lower Back Strain
- Lower Back Muscle Strain Symptoms
- Causes and Diagnosis of Lower Back Strain
- Pulled Back Muscle Treatment
- Exercises for Lower Back Muscle Strain
- Lower Back Strain Video
- Stiffness, difficulty walking or standing. Typical movements may be limited when a low back muscle is strained, making it difficult to bend, shift positions, or walk or stand for extended periods.
- Local tenderness and inflammation. A muscle strain may become inflamed and feel tender to the touch. Muscle spasms and cramps can cause intense pain and temporarily limit mobility, as the affected area in the lower back may be swollen for a few days.
- Pain relief when resting. Briefly resting the low back muscles allows them to relax, alleviating tension and spasms. Reclining in a supported position, such as sitting in a recliner with legs elevated or lying in bed or on the floor with the knees slightly elevated, may temporarily reduce pain. Pain will likely intensify when getting up to move again.
Watch: Causes of Back Muscle Spasms Video
See Lower Back Pain Symptoms, Diagnosis, and Treatment
A common underlying component of the intense pain associated with a lower back muscle strain is from muscle spasms. The acute contraction of muscle fibers in the lower back, which are intertwined within and around an extensive network of nerves, can cause intense pain. This pain is often described as surprisingly severe.
Watch: Video: What Is Your Back Muscle Spasm Telling You?
Pain from a muscle strain or pulled muscle usually comes on suddenly and can be linked to a specific event or activity. The severe pain tends to resolve within one to two weeks.
It is not uncommon to feel a lower level of pain with intermittent pain flare-ups for up to 4 to 6 weeks after the initial injury.
How to Treat an Aching Back
Whether it’s from lifting too many heavy boxes or twisting your spine the wrong way, a stabbing pain in the back can happen to anyone.
When it comes to easing an aching back, some people swear by ice packs, while others find relief in heating pads. Some hit the gym to stretch, and others stay in bed. But the best remedy for back pain may be a little bit of all of the above.
What Causes Back Pain
People may say they’ve “thrown out” their backs, but the reality is that doctors often don’t know what’s happening when a case of acute, or short-term, back pain strikes.
“For most people, it means their back hurts,” says Richard A. Deyo, MD, MPH,the Kaiser-Permanente Endowed Professor of Evidence-Based Medicine in the department of family medicine at Oregon Health & Science University in Portland. “But it’s often impossible to know the precise anatomical cause of back pain because the back has so many sources of pain.”
The idea of throwing your back out may itself be misleading, according to physical therapist Kathleen Shillue, DPT, OCS, a clinical services manager at Beth Israel Deaconess Medical Center in Boston.
“People will say, ‘Oh, I threw my back out picking up a box,’ but it was probably the hundreds or thousands of episodes of bending before that that led to it,” Shillue says. “It’s repetitive use that puts us at risk for back injury.”
The good news, though, is that back pain is rarely serious, and the vast majority of people will get better with time.
“People are often fearful that they will be disabled by an episode of acute back pain, but probably 90 percent or more will get better,” Dr. Deyo says. “It will take time, but they will get better.”
What to Do When Back Pain Strikes
Deyo and Shillue agree that when back pain strikes, the best advice you can follow is to resume normal activity as soon as possible. “The biggest myth is people should just lie down and not do anything,” Shillue says. “That can lead to more problems because the lack of activity causes joints to get stiffer and weaker.”
In fact, though it sounds counterintuitive, there is growing evidence that maintaining normal activity is better than bed rest for treating back pain. “I was trained as a physician to recommend bed rest for a week or two weeks,” Deyo says, “but now there is plenty of research that suggests that it is not only not helpful — it is probably harmful.”
Greg Shure, DC, a chiropractor and founder of Madison Square Wellness in New York City, agrees. “Movement should always be encouraged over rest to prevent the muscles from seizing up,” he says.
To treat back pain, one of the first steps is to consider an over-the-counter non-steroidal anti-inflammatory drug such as ibuprofen, according to guidelines issued by the Agency for Healthcare Research and Quality in November 2016.
If you get frequent bouts of back pain, carrying these medications with you can be helpful. Be sure to follow package instructions for these medications, and talk with your healthcare provider before taking them if you have certain medical conditions (such as kidney disease, liver disease, heart disease, or a history of bleeding problems).
To Stretch or Not to Stretch
While being active is recommended during an episode of back pain, doing back exercises or stretches to ease acute back pain is not. “For acute pain, it is not wise to be doing specific back exercises so much as trying to maintain your normal exercise routine,” Deyo says.
Shillue also recommends avoiding positions or exercises that cause pain.
After the back pain has subsided, though, doing exercises that strengthen the muscles in the back can help reduce the risk of a repeat injury.
Deyo says it’s not clear yet whether one type of exercise is best at preventing and treating chronic back pain. So far, it seems that a combination of strength training, stretching exercises, and aerobic activity is most effective.
If back pain episodes become frequent, you may need more exercise. “It may be a warning sign that you need to strengthen the muscles that you need to support your back,” Shillue says.
Treat Back Pain With Ice or Heat?
The use of cold or hot compresses has not been scientifically proven to resolve short-term back pain, but it might help you feel better.
“There is not a lot of evidence that one is better than the other,” Shillue says. She usually recommends icing the affected area first to ease any immediate inflammation associated with back pain. Apply ice for about 15 to 20 minutes at a time, as often as needed, for the first 48 to 72 hours after an injury.
If your back pain is caused by muscle tightness, applying heat may help relax the muscles. But Shillue cautions not to leave the heat on for longer than 20 minutes at a time and never to sleep with a heating pad.
Both icing and applying heat are harmless ways to treat back pain, Deyo says, “but the reality is that neither produces a change in temperature in the tissues deep in the back so much as at the surface.”
“One rule of thumb is ice during the first 24 hours to help reduce the inflammation, usually 10 to 20 minutes every hour,” Dr. Shure adds.
When to Get Medical Help
Most cases of back pain resolve by themselves within a few weeks without medical attention.
“Many people feel they have to go to the doctor and get an X-ray or MRI scan, but the truth is those things are really not helpful for acute onset of back pain,” Deyo says. “There are a lot of opportunities to be misled by things that have been there for a long time and may not represent the cause of back pain at all.”
However, there are warning signs and symptoms that your back pain may need medical attention, such as:
- Weakness or numbness in one or both legs
- Loss of bowel or bladder control
- Back pain that doesn’t start to get better within a few days
Also, if you have a history of cancer or any ongoing medical issues, check with your healthcare provider if you experience back pain.
What is causing this pain in my back?
If you buy something through a link on this page, we may earn a small commission. How this works.
Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and debilitating.
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.
Share on PinterestProblems with the spine such as osteoporosis can lead to back pain.
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:
- strained muscles or ligaments
- a muscle spasm
- muscle tension
- damaged disks
- injuries, fractures, or falls
Activities that can lead to strains or spasms include:
- lifting something improperly
- lifting something that is too heavy
- making an abrupt and awkward movement
A number of structural problems may also result in back pain.
- Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
- Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
- Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.
- Abnormal curvature of the spine: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.
- Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
- Kidney problems: Kidney stones or kidney infection can cause back pain.
Movement and posture
Back pain can also result from some everyday activities or poor posture.
- coughing or sneezing
- muscle tension
- bending awkwardly or for long periods
- pushing, pulling, lifting, or carrying something
- standing or sitting for long periods
- straining the neck forward, such as when driving or using a computer
- long driving sessions without a break, even when not hunched
- sleeping on a mattress that does not support the body and keep the spine straight
Some medical conditions can lead to back pain.
- Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.
- Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain.
- Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
- Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.
- Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.
- Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.
The following factors are linked to a higher risk of developing low back pain:
- occupational activities
- a sedentary lifestyle
- poor physical fitness
- older age
- obesity and excess weight
- strenuous physical exercise or work, especially if done incorrectly
- genetic factors
- medical conditions, such as arthritis and cancer
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:
- weight loss
- inflammation or swelling on the back
- persistent back pain, where lying down or resting does not help
- pain down the legs
- pain that reaches below the knees
- a recent injury, blow or trauma to the back
- urinary incontinence
- difficulty urinating
- fecal incontinence, or loss of control over bowel movements
- numbness around the genitals
- numbness around the anus
- numbness around the buttocks
When to see a doctor
You should seek medical help if you experience any numbness or tingling, or if you have back pain:
- that does not improve with rest
- after an injury or fall
- with numbness in the legs
- with weakness
- with fever
- with unexplained weight loss
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:
- back pain appears to result from an injury
- there may be underlying cause that needs treatment
- the pain persists over a long period
An X-ray, MRI, or CT scan can give information about the state of the soft tissues in the back.
- X-rays can show the alignment of the bones and detect signs of arthritis or broken bones, but they may not reveal damage in the muscles, spinal cord, nerves, or disks.
- MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
- Bone scans can detect bone tumors or compression fractures caused by osteoporosis. A radioactive substance or tracer is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
- Electromyography or EMG measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.
The doctor may also order a blood test if infection is suspected.
Other types of diagnosis
- A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
- An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
- A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.
Chronic or acute pain?
Back pain is categorized into two types:
- Acute pain starts suddenly and lasts for up to 6 weeks.
- Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.
If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.
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.
- An osteopath specializes in treating the skeleton and muscles.
- A chiropractor treats joint, muscle and bone problems. The main focus is the spine.
- Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with the fingers, thumbs and elbows.
- Acupuncture originates from China. It consists of inserting fine needles and specific points in the body. Acupuncture can help the body release its natural painkillers — endorphins — as well as stimulating nerve and muscle tissue.
- Yoga involves specific poses, movements, and breathing exercises. Some may help strengthen the back muscles and improve posture. Care must be taken that exercises do not make back pain worse.
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:
- is pregnant
- has a history of epilepsy
- has a pacemaker
- has a history of heart disease
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:
- Fusion: Two vertebrae are joined together, with a bone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.
- Artificial disk: An artificial disk is inserted; it replaces the cushion between two vertebrae.
- Diskectomy: A portion of a disk may be removed if it is irritating or pressing against a nerve.
- Partially removing a vertebra: A small section of a vertebra may be removed if it is pinching the spinal cord or nerves.
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:
- Core-strengthening exercises work the abdominal and back muscles, helping to strengthen muscles that protect the back.
- Flexibility training aims at improving core flexibility, including the spine, hips, and upper legs.
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.
Oh, Your Back Hurts? It’s Probably Your Posture.
There are many “posture police” out there, and you may be one of them. Physical Therapists talk to patients about it all the time, urging them to “sit up straight,” “tighten your tummy muscles,” “keep your shoulders back and your head up.” It is intuitive to think that if someone has a large thoracic kyphosis (a hump on their upper back) and neck pain, we should fix their posture and the pain will improve.
It makes sense that poor posture leads to back pain…or does it? Should we spend time looking for postural abnormalities and asymmetries? Should we attempt to correct deviations from what is considered ideal? Recent studies may be able to provide some insights and answers to some of our most pressing questions regarding posture and pain.
Research looking for correlations between back pain and posture typically involves a couple of different study designs – most frequently cross sectional studies and prospective studies. The results aren’t completely cut and dry, but most do not support the theory that bad posture causes back pain.
Here are some of the findings:
- No association between leg length inequality and back pain.
- No significant difference in lumbar lordosis or leg length inequality between three groups of 321 males with severe back pain, moderate pain, or no pain.
- No association between measurements of neck curvature and neck pain.
- No significant difference in lumbar lordosis, pelvic tilt, leg length discrepancy and the length of abdominal, hamstring and iliopsoas muscles in 600 people with and without back pain.
- Teenagers with postural asymmetry, excessive thoracic kyphosis and/or lumbar lordosis were no more likely to develop back pain in adulthood than peers with “better” posture.
- Pregnant women with greater increases in low back curve during pregnancy were no more likely to develop back pain.
- People who work occupations involving frequent awkward postures do not have higher levels of back pain.
A systematic review done in 2008 that analyzed more than 54 studies on the link between pain and posture has the most compelling evidence dispelling any correlation between posture and various back and neck pain. The quality of the studies was generally poor, but they were not able to exhibit any association between measurements of sagittal spinal alignment and pain.
The research indicates that, if any correlation exists between posture and pain, it is weak and circumstantial. It may even be the case that pain causes bad posture, and not the other way around, as studies show that people who are injected with a solution causing back pain will unconsciously change their postural strategies.
The general takeaway is that you shouldn’t spend too much time worrying about trying to change static posture to conform to some normative ideal, as many studies show that it is likely not a factor in back pain. Instead, encourage patients to stay comfortable, keep moving, work to improve function and make sure to use good alignment and form when engaged in strenuous exercise or end range activities. If back pain persists, it may be a good idea to make a physical therapy appointment. For more information about treatment for back and neck pain or to make an appointment .