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This topic provides a general overview of low back pain. If you have been diagnosed with a herniated disc or spinal stenosis, see the topic Herniated Disc or Lumbar Spinal Stenosis.
Low back pain can happen anywhere below the ribs and above the legs. It is possible to hurt your back when you lift, reach, or twist. In fact, almost everyone has low back pain at one time or another.
Causes of low back pain include:
Often doctors don't know what causes low back pain.
Depending on the cause, low back pain can cause a range of symptoms. The pain may be dull or sharp. It may be in one small area or over a broad area. You may have muscle spasms.
Low back pain can also cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee.
A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs or you lose bladder or bowel control.
Most low back pain is short-term (acute) and will go away in a few weeks. It is more likely to become long-lasting (chronic) if you are depressed or under stress.
Your doctor will ask questions about your past health, symptoms, and activities. He or she will also do a physical exam. Your answers and the exam can help rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first exam.
Tests such as X-rays, CT scans, and MRIs usually don't help.
But if you have a back pain problem that has lasted longer than 6 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for one of these tests.
Most low back pain will improve with basic first aid, which includes continuing to do light activity such as walking, and taking over-the-counter pain medicine as needed.
Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.
Your doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. Strengthening the muscles in your trunk can improve your posture, keep your body in better balance, and lower your chance of injury.
If your symptoms are severe or you still have symptoms after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from manual therapy.
Each of the various treatments for back pain work for some people but not for others. You may need to try different things to see which work best for you, such as:
Having ongoing (chronic) back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both antidepressant medicines and counseling. Counseling can help you learn stress management and pain control skills.
After you've had low back pain, you're likely to have it again. But there are some things you can do to help prevent it. And they can help you get better faster if you do have low back pain again.
To help keep your back healthy and avoid further pain:
If you sit or stand for long periods at work:
If your work involves a lot of bending, reaching, or lifting:
Health Tools help you make wise health decisions or take action to improve your health.
Often doctors don't know what causes low back pain. The most common causes of low back pain are:
Less common spinal conditionsthat can cause low back pain include:
Symptoms of low back pain depend on the cause.
Symptoms typically include:
Osteoarthritis of the spine usually causes pain that:
Symptoms of diseases that affect the spine depend on the disease. They may include:
The course of low back pain depends both on its cause and on how well you treat your back.
Most low back pain goes away within several weeks. But after you have had back pain once, you're more likely to have it again. Many people who recover have back pain again within a year, and most people will have it again sometime during their lives.
Long-lasting (chronic) pain not only makes you tired, irritable, and less productive and less active but also can trigger other problems. If your back pain causes you to use your body in different ways (for example, to limp or to sit differently), pain can develop in other areas of the body. Pain can also cause biochemical changes in your body that tend to keep the pain going.
A risk factor is something that increases your chances of having back pain. Having more risk factors means you have a higher chance of having back pain.
Call 911 or other emergency services immediately if:
Call your doctor nowif:
For more information, see the topic Back Problems and Injuries.
Most low back pain doesn't require a visit to a doctor.
If the pain doesn't get better after 1 or 2 days and you can't do your normal daily activities, call your doctor.
If you still have mild to moderate pain after at least 2 weeks of home treatment, talk with your doctor. He or she may want to check for problems that may be causing your back pain.
The following health professionals can diagnose the cause of back pain, evaluate back injuries, and start treatment.
You may also be referred to one of the following specialists:
Your doctor will begin by asking questions about your medical history, your symptoms, and your work and physical activities. He or she will also do a physical exam. The questions and exam can help rule out a serious cause for your pain. Your doctor may also ask questions about stress at home and at work that may make you more susceptible to chronic pain.
If your back pain has lasted for less than 6 weeks, it may be best to wait to do any testing. This is because most back pain goes away on its own in a month or so.
But if you have a back pain problem that has lasted longer than 6 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for a test.
Tests for low back pain include:
Sometimes other tests can be useful, such as a bone scan or an electromyogram and nerve conduction. These are used to look for bone, nerve, and muscle/nerve problems that might be causing low back pain.
Experts divide low back pain into two categories:
Learn about the first aid steps you can take when you first get back pain, such as using heat or ice, taking medicine, and not resting too much.
Sometimes acute low back pain lasts longer than a few days, even after you try first aid steps. In such a case, you might add another treatment, such as acupuncture or manual therapy.
If your pain is very bad, your health care provider may recommend short-term use of a muscle relaxant. Some people consider epidural steroid shots.
Answers From an Expert:
"Stay as active as you can. Doctors used to say to rest, but it turns out that this is not the case. The more active you are, the better you will be, and the faster you will heal."— Dr. Robert Keller
Read more advice from this back specialist.
One Woman's Story:
"I thought, 'Okay, it will hurt for a day or two, and that's it.' But it lasted a lot longer. It took about 3 weeks. I guess we're used to fast cures. We take an aspirin, and the headache goes away. We take the antibiotic, and the infection disappears." — Lorna
Read more about how Lorna learned to be patient with her back.
If you have chronic back pain, one type of treatment by itself doesn't always stop your pain. Spinal manipulation can work to relieve low back pain. Other treatments can too.
If over-the-counter medicines combined with these treatments have not helped, your doctor may recommend another medicine. In some cases an antidepressant such as duloxetine can help. If pain is very bad, your doctor may have you try a week or two of an opioid pain reliever such as tramadol. Be sure to discuss the risks and the possible benefits of all medicines with your doctor.
There is no clear evidence that you can prevent low back pain. But there are some things you can do that may help prevent it. And they can prepare you for faster recovery if you do have low back pain.
To learn more, see Living With Low Back Pain.
Almost everyone has low back pain at some time. The good news is that most low back pain will go away in a few days or weeks with some basic self-care. This includes first aid, self-massage and using heat or ice.
Basic self-care can also help prevent back problems from coming back.
One Man's Story:
"Some people get better fast, but others take a lot of time. That was my case. If you have back pain, do what you can for it, but don't be in a hurry. It usually gets better."— Jack
Read more about how Jack learned that he didn't need surgery.
Some people are afraid that doing too much may make their pain worse. In the past, people stayed in bed, thinking this would help their backs. Now experts think that, in most cases, getting back to your normal activities is good for your back, as long as you avoid things that make your pain worse.
Body mechanics are the way you use your body. Posture is the way you sit or stand.
When you no longer have acute pain, you may be ready for gentle strengthening exercises for your stomach, back, and legs, and perhaps for some stretching exercises. Exercise may not only help decrease low back pain but also may help you recover faster, prevent reinjury to your back, and reduce the risk of disability from back pain.
Walking is the simplest and perhaps the best exercise for the low back. Your doctor or a physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and decrease your chance of injury.
"I discovered that what you have to do is this: You do as much as you can."— Robert
Read more about how Robert controls his back pain by staying active.
Stress and low back pain can create a vicious circle. You have back pain, and you begin to worry about it. This causes stress, and your back muscles begin to tense. Tense muscles make your back pain worse, and you worry more ... which makes your back worse ... and so on.
There are lots of ways to teach yourself to relax.
"I had too much to do and too little time. That means stress. And when I start stressing, my back starts aching. Before I knew it, my back was screaming at me."— Cathy
Read more about how Cathy made time to deal with her stress.
Extra body weight, especially around the waist, may put strain on your back.
If you want to get to a healthy weight and stay there, lifestyle changes will work better than dieting.
Here are the three steps to reaching a healthy weight:
People who smoke take longer to heal—from any injury, not just back pain. If you stop smoking, you may feel better sooner.
People who smoke are also much more likely to have back pain than people who don't smoke. This is because the nicotine and other toxins from smoking can keep spinal discs from getting all the nutrients they need from the blood, making disc injury more likely. These discs cushion the bones in your spine. An injured disc can cause low back pain.
Smoking also increases your risk of bone loss (osteoporosis).
Medicine can decrease low back pain and reduce muscle spasms in some people. But medicine alone isn't an effective treatment for low back pain. It should be used along with other treatments, such as walking and using heat or ice.
There are several medicines your doctor may recommend, depending on how long you have had pain, what other symptoms you have, and your medical history. Be safe with medicines. Read and follow all instructions on the label.
The medicines recommended most often are:
Other medicines sometimes used for low back pain are:
Medicines that work for some people don't work for others. Let your doctor know if the medicine you are taking doesn't work for you. You may be able to take another medicine for your back pain.
When you're in a lot of pain, you might wonder if you need surgery to fix what's wrong so that you can feel better.
Every case is different. But most people don't need surgery for low back pain.
Most back surgeries are done to treat nerve pain from herniated discs. Surgery might be an option when a disc problem causes pain in your leg that prevents you from doing everyday tasks. You may have pain, numbness, or tingling through your buttock and down the back of your leg (sciatica) or in the front of your thigh.
Other problems that may require surgery include:
Having surgery for a herniated disc or another back problem is a big decision. Talk to your doctor about it.
There are several types of back surgery. Some, like a discectomy, can help people who have severe symptoms. Others have not been proved to work.
If you do need surgery, you and your doctor will decide which type is best for you. Types of surgeries include:
A comprehensive rehabilitation program is very important after most back surgery. As you regain flexibility, recondition your back and stomach muscles, and increase your endurance for activity, you increase your chances of treatment success.
If you are unable or unwilling to commit to physical therapy after surgery, you may not be a good candidate for surgery.
If you and your doctor are considering surgery, get as much information as you can about possible results, and consider whether you will be willing to do physical therapy after surgery.
Back surgery isn't always successful. Depending on the condition, you may still have back pain after surgery.
You can choose from a number of treatments for your low back pain. Because some of these treatments are new or not yet well researched, they may not be covered by health insurance.
The following complementary treatments are often used for low back pain.
Here are some other treatment choices to think about:
New and experimental treatments are constantly being developed and offered to people who have low back pain. If you are considering such a treatment, be sure to ask your doctor for two things:
Experimental treatments include:
Low back pain can take a toll on your mental health. You may feel fear, frustration, and anger or have depression and anxiety because of ongoing pain. Those common reactions can make your pain last even longer. If pain is starting to get you down:
"I started feeling sad and angry a lot. I didn't want to do anything. My back was hurting more. I was having trouble focusing on my work. My life just started feeling smaller and smaller."— Ravi
Read more about how Ravi learned he had depression and how he fought back.
You may have to lean on friends and family when facing difficult situations caused by chronic pain or other problems. Your loved ones can play an important role in supporting your recovery. Your doctor and community also may give you extra support.
Asking for support from others is not always easy. It can be hard to tell someone about your problems. But don't be afraid to ask for help.
Where you can get support
"I really work at finding the good things in my day. It helps me get through the day, and I think it makes my pain not bother me as much."— Patty
Read more about how Patty used positive thinking to help her back pain.
How friends and family can help
Your loved ones can offer support by:
Having trouble getting support from friends and family? There are steps you can take to make your social support stronger.
Having chronic back pain can make exercising—even walking—difficult. Being active is often the last thing you want to think about.
But the truth is that easing back into daily activity and physical therapy exercises can help relieve back pain and can lead to long-term improvement for low back pain.footnote 6
So be as active as you can. Take short walks as often as you can. Talk to a physical therapist, chiropractor, osteopathic doctor, or physiatrist about exercises you can do.
Furlan AD, et al. (2005). Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews (1).
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Tilbrook HE, et al. (2011). Yoga for chronic low back pain: A randomized trial. Annals of Internal Medicine, 155(9): 569–578.
Sherman KJ, et al. (2011). A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Archives of Internal Medicine, 171(22): 2019–2026.
Gagnier JJ, et al. (2016). Herbal medicine for low back pain: A Cochrane review. Spine, 41(2): 116–133. DOI: 10.1097/BRS.0000000000001310. Accessed June 17, 2016.
Chou R (2010). Low back pain (chronic), search date April 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
Agency for Healthcare Research and Quality (2010). Complementary and Alternative Therapies for Back Pain II (Evidence Report/Technology Assessment No. 194). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://www.ahrq.gov/downloads/pub/evidence/pdf/backpaincam/backcam2.pdf.
American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons (2009). Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57(8): 1331–1346.
Carragee EJ (2005). Persistent low back pain. New England Journal of Medicine, 352(18): 1891–1898.
Carragee EJ, Hannibal M (2004). Diagnostic evaluation of low back pain. Orthopedic Clinics of North America, 35(2004): 7–16.
Chaiamnuay S, et al. (2006). Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs. American Journal of Health-System Pharmacy, 63(19): 1837–1851.
Chaparro LE, et al. (2014). Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane review. Spine, 39(7): 556–563. DOI: 10.1097/BRS.0000000000000249. Accessed February 6, 2015.
Chou R, et al. (2009). Imaging strategies for low-back pain: Systematic review and meta-analysis. Lancet, 373(9662): 463–472.
Chou R, et al. (2009). Interventional therapies, surgery and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10): 1066–1077.
Chou R, et al. (2011). Diagnostic imaging for low back pain: Advice for high-value health care from the American College of Physicians. Annals of Internal Medicine, 154(3): 181–189.
Deyo RA, et al. (2004). Spinal-fusion surgery—The case for restraint. New England Journal of Medicine, 350(7): 722–726.
Furlan AD, et al. (2015). Massage for low-back pain. Cochrane Database of Systematic Reviews (9). DOI: 10.1002/14651858.CD001929.pub3. Accessed October 30, 2015.
Garra G, et al. (2010). Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Academic Emergency Medicine, 17(5): 484–489.
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Modic MT, et al. (2005). Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology, 237(2): 599–604.
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Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156–229. New York: McGraw-Hill.
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Current as of: June 26, 2019
Author: Healthwise StaffMedical Review: William H. Blahd Jr. MD, FACEP - Emergency MedicineAdam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family Medicine
Current as of:
June 26, 2019
Medical Review:William H. Blahd Jr. MD, FACEP - Emergency Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine
To learn more about Healthwise, visit Healthwise.org.
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