Back Pain
|
Medical Encyclopedia
|
Other encyclopedia topics:
|
|
Back pain - low
Illustrations
Backache; Low back pain; Lumbar pain; Pain - back
Pain felt in your lower back may come from
the spine, muscles, nerves, or other structures in that region. It may also
radiate from other areas like your mid or upper back, a hernia in the groin, or
a problem in the testicles or ovaries.
You may feel a variety of symptoms if you've
hurt your back. You may have a tingling or burning sensation, a dull aching, or
sharp pain. You also may experience weakness in your legs or feet.
It won't necessarily be one event that
actually causes your pain. You may have been doing many things improperly --
like standing, sitting, or lifting -- for a long time. Then suddenly, one simple
movement, like reaching for something in the shower or bending from your waist,
leads to the feeling of pain.
If you are like most people, you will have at
least one backache in your life. While such pain or discomfort can happen
anywhere in your back, the most common area affected is your low back. This is
because the low back supports most of your body's weight.
Low back pain is the #2 reason that Americans
see their doctor -- second only to colds and flus. Many back-related injuries
happen at work. But you can change that. There are many things you can do to
lower your chances of getting back pain.
Most back problems will get better on their
own. The key is to know when you need to seek medical help and when self-care
measures alone will allow you to get better.
Low back pain may be acute (short-term),
lasting less than one month, or chronic (long-term, continuous, ongoing),
lasting longer than three months. While getting acute back pain more than once
is common, continuous long-term pain is not.
You'll usually first feel back pain just
after you lift a heavy object, move suddenly, sit in one position for a long
time, or have an injury or accident. But prior to that moment in time, the
structures in your back may be losing strength or integrity.
The specific structure in your back
responsible for your pain is hardly ever identified. Whether identified or not,
there are several possible sources of low back pain:
 |
Small fractures to the spine from osteoporosis
|
Muscle spasm (very tense muscles that remain contracted)
|
|
Degeneration of the disks
|
Poor alignment of the vertebrae
|
Spinal
stenosis (narrowing of the spinal canal)
|
Strain
or tears to the muscles or ligaments supporting the back
|
Spine curvatures (like scoliosis
or kyphosis)
which may be inherited and seen in children or teens
|
Other medical conditions like fibromyalgia
|
| | | | | | | |
Low back pain from any cause usually involves
spasms of the large, supportive muscles alongside the spine. The muscle spasm
and stiffness accompanying back pain can feel particularly uncomfortable.
You are at particular risk for low back pain
if you:
|
Work in construction or another job requiring heavy lifting, lots of
bending and twisting, or whole body vibration (like truck driving or using a
sandblaster)
|
Have bad posture
|
Are pregnant
|
Are over age 30
|
Smoke, don't exercise, or are overweight
|
Have arthritis or osteoporosis
|
Have a low pain threshold
|
Feel stressed or depressed
|
| | | | | | |
Back pain from organs in the pelvis or elsewhere include:
Many people will feel better within one week
after the start of back pain. After another 4-6 weeks, the back pain will likely
be completely gone. To get better quickly, take the right steps when you first
get pain.
A common misconception about back pain is
that you need to rest and avoid activity for a long time. In fact, bed rest
is NOT recommended.
If you have no indication of a serious
underlying cause for your back pain (like loss of bowel or bladder control,
weakness, weight loss, or fever), then you should reduce physical activity only
for the first couple of days. Gradually resume your usual activities after that.
Here are some tips for how to handle pain early on:
|
Stop normal physical activity for the first few days. This helps calm
your symptoms and reduce inflammation.
|
Apply heat or ice to the painful area. Try ice for the first 48-72
hours, then use heat after that.
|
Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB)
or acetaminophen (Tylenol).
|
| |
While sleeping, try lying in a curled-up,
fetal position with a pillow between your legs. If you usually sleep on your
back, place a pillow or rolled towel under your knees to relieve pressure.
Do not perform activities that involve heavy
lifting or twisting of your back for the first 6 weeks after the pain begins.
After 2-3 weeks, you should gradually resume exercise.
Begin with light cardiovascular training.
Walking, riding a stationary bicycle, and swimming are great examples. Such
aerobic activities can help blood flow to your back and promote healing. They
also strengthen muscles in your stomach and back.
Stretching and strengthening exercises are
important in the long run. However, starting these exercises too soon after an
injury can make your pain worse. A physical therapist can help you determine
when to begin stretching and strengthening exercises and how to do so.
AVOID the following exercises during initial
recovery unless your doctor or physical therapist says it is okay:
|
Jogging
|
Football
|
Golf
|
Ballet
|
Weight lifting
|
Leg lifts when lying on your stomach
|
Sit-ups with straight legs (rather than bent knees)
|
| | | | | |
Call your health care provider if
Return to top
Call 911 if you have lost bowel or bladder
control. Otherwise, call your doctor if you have:
|
Unexplained fever
with back pain.
|
Back pain after a severe blow or fall.
|
Redness or swelling on the back or spine.
|
Pain traveling down your legs below the knee.
|
Weakness or numbness in your buttocks, thigh, leg, or pelvis.
|
Burning with urination or blood in your urine.
|
Worse pain when you lie down or pain that awakens you at night.
|
Very sharp pain.
|
| | | | | | |
Also call if:
|
You have been losing weight unintentionally
|
You use steroids or intravenous drugs.
|
You have never had or been evaluated for back pain before.
|
You have had back pain before but this episode is distinctly different.
|
This episode of back pain has lasted longer than four weeks.
|
| | | |
If any of these symptoms are present, your
doctor will carefully check for any sign of infection (like meningitis, abscess,
or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer,
kidney stone, twisted testicle, or other serious problem.
What to expect at your health care provider's
office Return
to top
When you first see your doctor, you will be
asked questions about your back pain, including how often it occurs and how
severe it is. Your doctor will try to determine the cause of your back pain and
whether it is likely to quickly get better with simple measures such as ice,
mild painkillers, physical therapy, and proper exercises. Most of the time, back
pain will get better using these approaches.
Questions will include:
|
Is your pain on one side only or both sides?
|
What does the pain feel like? Is it dull, sharp, throbbing, or burning?
|
Is this the first time you have had back pain?
|
When did the pain begin? Did it start suddenly?
|
Did you have a particular injury or accident?
|
What were you doing just before the pain began? Were you lifting or
bending? Sitting at your computer? Driving a long distance?
|
If you have had back pain before, is this pain similar or different? In
what way is it different?
|
Do you know the cause of previous episodes of back pain?
|
How long does each episode of back pain usually last?
|
Do you feel the pain anywhere other than your back, like your hip,
thigh, leg or feet?
|
Do you have any numbness or tingling? Any weakness or loss of function
in your leg or elsewhere?
|
What makes the pain worse? Lifting, twisting, standing, or sitting for
long periods of time?
|
What makes you feel better?
|
Are there any other symptoms present? Weight loss? Fever? Change in
urination? Change in bowel habits?
|
| | | | | | | | | | | | |
During the physical exam, your doctor will
try to pinpoint the location of the pain and figure out how it affects your
movement. You will be asked to:
|
Sit, stand, and walk. While walking, your doctor may ask you to try
walking on your toes and then your heels.
|
Bend forward, backward, and sideways.
|
Lift your legs straight up while lying down. If the pain is worse when
you do this, you may have sciatica,
especially if you also feel numbness or tingling in one of your legs.
|
| |
Your doctor will also move your legs in
different positions, including bending and straightening your knees. All the
while, the doctor is assessing your strength as well as your ability to move.
To test nerve function, the doctor will use a
rubber hammer to check your reflexes. Touching your legs in many locations with
a pin, cotton swab, or feather tests your sensory nervous system (how well you
feel). Your doctor will instruct you to speak up if there are areas where the
sensation from the pin, cotton, or feather is duller.
Most people with back pain recover within
four to six weeks. Therefore, your doctor will probably not order any tests
during the first visit. However, if you have any of the symptoms or
circumstances below, your doctor may order imaging tests even at this initial
exam:
|
Pain that has lasted longer than one month
|
Numbness
|
Muscle weakness
|
Accident or injury
|
Fever
|
If you are over 65
|
You have had cancer or have a strong family history of cancer
|
Weight loss
|
| | | | | | |
In these cases, the doctor is looking for a
tumor, infection, fracture, or serious nerve disorder. The symptoms above are
clues that one of these conditions may be present. The presence of a tumor,
infection, fracture, or serious nerve disorder change how your back pain is
treated.
Tests that might be ordered include an X-ray,
a myelogram
(an X-ray or CT
scan of the spine after dye has been injected into the spinal column), a CT
of the lower spine or MRI
of the lower spine.
Hospitalization, traction,
or spinal
surgery should only be considered if nerve damage is present or the
condition fails to heal after a prolonged period.
Many people benefit from physical therapy.
Your doctor will determine if you need to see a physical therapist and can refer
you to one in your area. The physical therapist will begin by using methods to
reduce your pain. Then, the therapist will teach you ways to prevent getting
back pain again.
If your pain lasts longer than one month,
your primary care doctor may send you to see either an orthopedist (bone
specialist) or neurologist (nerve specialist).
Exercise is important for preventing future
back pain. Through exercise you can:
|
Improve your posture
|
Strengthen your back and improve flexibility
|
Lose weight
|
Avoid falls
|
| | |
A complete exercise program should include
aerobic activity (like walking, swimming, or riding a stationary bicycle) as
well as stretching and strength training.
To prevent back pain, it is also very
important to learn to lift and bend properly. Follow these tips:
|
If an object is too heavy or awkward, get help.
|
Spread your feet apart to give a wide base of support.
|
Stand as close to the object you are lifting as possible.
|
Bend at your knees, not at your waist.
|
Tighten your stomach muscles as you lift the object up or lower it down.
|
Hold the object as close to your body as you can.
|
Lift using your leg muscles.
|
As you stand up with the object, DO NOT bend forward.
|
DO NOT twist while you are bending for the object, lifting it up, or
carrying it.
|
| | | | | | | |
Other measures to take to prevent back pain
include:
|
Avoid standing for long periods of time. If you must for your work, try
using a stool. Alternate resting each foot on it.
|
DO NOT wear high heels. Use cushioned soles when walking.
|
When sitting for work, especially if using a computer, make sure that
your chair has a straight back with adjustable seat and back, armrests, and
a swivel seat.
|
Use a stool under your feet while sitting so that your knees are higher
than your hips.
|
Place a small pillow or rolled towel behind your lower back while
sitting or driving for long periods of time.
|
If you drive long distance, stop and walk around every hour. Bring your
seat as far forward as possible to avoid bending. Don't lift heavy objects
just after a ride.
|
Quit smoking.
|
Lose weight.
|
Learn to relax. Try methods like yoga, tai chi, or massage.
|
| | | | | | | |
Rakel D. Low Back Pain. In:Integrative
Medicine. Elsevier; 2003:423-431.
Sierpina VS, Curtis P, Doering J. An
Integrative Approach To Low Back Pain. Clin Fam Pract. 2002; 4(4); 817.
US Preventative Services Task Force. Primary
Care Interventions to Prevent Low Back Pain: Brief Evidence Update.
Rockville, MD: Agency for Healthcare Research and Quality; February 2004.
Updated by: Kevin B. Freedman, MD, MSCE, Sports
Medicine, Orthopaedic Speclalists, Bryn Mawr, PA. Review provided by VeriMed
Healthcare Network.
|
A.D.A.M., Inc. is
accredited by URAC, also known as the American Accreditation HealthCare
Commission (www.urac.org). URAC's accreditation
program is the first of its kind, requiring compliance with 53
standards of quality and accountability, verified by independent audit.
A.D.A.M. is among the first to achieve this important distinction for
online health information and services. Learn more about A.D.A.M.'s editorial
process. A.D.A.M. is also a founding member of Hi-Ethics
(www.hiethics.com) and subscribes to the principles of the Health on the
Net Foundation (www.hon.ch).
|
The information provided should not be used during any
medical emergency or for the diagnosis or treatment of any medical condition. A
licensed physician should be consulted for diagnosis and treatment of any and
all medical conditions. Call 911 for all medical emergencies. Adam makes no
representation or warranty regarding the accuracy, reliability, completeness,
currentness, or timeliness of the content, text or graphics. Links to other
sites are provided for information only -- they do not constitute endorsements
of those other sites. Copyright 2005, A.D.A.M., Inc. Any duplication or
distribution of the information contained herein is strictly prohibited.
Follow links in this link rack to read about aspects of your health which
might be an issue for you. Use your back button to return to this page as
needed. This same link rack is reproduced at the bottom of each page in this
section.
|
