Low Back Pain
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More InDepth Information on This Condition

Definition
Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column has many small bones and muscles that surround and protect the spinal cord and nerves. Low back pain is very common and affects most adults at some point in their lives.

Bones of the Lower Back

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Causes
There are many possible causes for low back pain, but in most cases it is unknown. Some causes of back pain may include:

  • Muscle strains or ligament sprains
  • Disc degeneration
  • Spinal deformities
  • Injury
  • Health conditions
Risk Factors
Factors that increase your chance of developing low back pain include:

General factors, such as:

  • Increasing age
  • Certain activities, such as lifting, bending, or twisting
  • Lack of exercise
  • Obesity
  • Pregnancy
  • Smoking
  • Prior back injury
  • Prior back surgery
Health conditions, such as:

Occupational factors, such as:

  • Bending, twisting, or reaching
  • Exposure to vibrations
  • Heavy manual labor
  • Heavy lifting
Psychosocial factors, such as:

Symptoms
Pain is usually restricted to the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on the affected side. Muscle weakness or numbness may occur.

When Should I Call My Doctor?
Often, back pain improves with self-treatment. However, some serious symptoms may occur. They may require more immediate medical attention. Call your doctor if back pain:

  • Is severe or gets significantly worse
  • Has not started to improve within about a week
  • Causes difficulty walking, standing, or moving
  • Is worse at night or worse when you lie down
  • Spreads down your legs
  • Comes with pain or throbbing in your abdomen
  • Is new and you are over age 50 years old
  • Is associated with:
    • Numbness, weakness, or tingling in your buttocks, genitals, or legs
    • Loss of bowel or bladder control
    • Difficulty with urination
    • Fever, unexplained weight loss, or other signs of illness
You should call your doctor if you have back pain and a history of cancer or osteoporosis. You should also call if you have a history of recent infection, steroid use or IV drug use.

Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. The exam will focus on your back, hips, and legs. The doctor may test for strength, flexibility, sensation, and reflexes.

Imaging tests take pictures of internal structures. These include:

It is important to keep in mind that imaging tests, may not be helpful or appropriate right after a back injury.

Your doctor may recommend other tests to help diagnose or eliminate any causes of your back pain.

Treatment
Treatment options include:

Activity
Bed rest is not generally recommended. It may be suggested for no more than 1-2 days in those with severe pain. Your doctor may recommend that you restrict certain activities for a period of time and then resume them as soon as possible. You may be able to shorten your recovery time by staying active and exercising.

Medication
Your doctor may recommend:

  • Over-the-counter or prescription pain relievers
  • Topical pain relievers that are applied to the skin
  • Muscle relaxants for muscle spasms
  • Antidepressants for chronic back pain
Physical Therapy
Physical therapy may include:

  • Applying hot or cold packs
  • Stretching, strengthening, and balance exercises for back and stomach muscles
  • Aerobic exercise
  • Instruction in appropriate posture and lifting
  • Massage
Alternative Medicine
Some people find pain relief from:

Surgery
Only a small number of people need surgery. It may be needed if nerve problems develop or other treatments do not provide relief. Common procedures are diskectomy, laminectomy, and spinal fusion.

Prevention
To reduce your chance of developing low back pain, take these steps:

  • Begin a safe exercise program with the advice of your doctor.
  • Practice good posture to reduce pressure on your spine.
  • Avoid sitting or standing in one position for long periods of time.
  • Use proper body movment when playing sports, exercising, or lifting heavy objects.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.



RESOURCES:
American Academy of Orthopaedic Surgeons

American Academy of Family Physicians

CANADIAN RESOURCES
Canadian Orthopaedic Association

Canadian Orthopaedic Foundation

References:
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Chronic low back pain. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated November 22, 2013. Accessed November 26, 2013.

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612.

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Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21.

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1/30/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.

2/17/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009;9:147-168.

2/17/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463-472.

2/24/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Sahar T, Cohen M, Ne'eman V, et al. Insoles for prevention and treatment of back pain. Cochrane Database Syst Rev. 2009;(1):CD005275.

9/2/2009 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Urquhart D, Hoving J, Assendelft W, Roland M, van Tulder M. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2009;(3):CD001703.

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12/17/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Andersen LL, Christensen KB, Holtermann A, et al. Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: a one-year randomized controlled trial. Man Ther. 2010;15(1):100-104.

10/21/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2011 ;92(10):1681-1685.

11/29/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):542-552.

11/25/2013 DynaMed's Systematic Literature Surveillance.https://dynamed.ebscohost.com/about/about-us: Wegner I, Widyahening IS, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013 Aug 19;8.

Last Reviewed November 2013



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