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What Is It?
Many illnesses and conditions can lead to back pain:
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Stress or injury of the back muscles, such as…
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back sprain or strain
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overload of the back muscles caused by obesity
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short term overload of the back muscles caused by lifting or pregnancy
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Disease or injury, including injury to the…
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back bones (vertebrae), such as a fracture (for example, after trauma or as a result of osteoporosis)
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spinal nerves, including injury caused by a protruding disk (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)
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Arthritis, including…
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Degenerative arthritis, which is caused by wear and tear
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Inflammatory arthritis, including ankylosing spondylitis and related conditions
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A spinal tumor or cancer that has spread to the spine from elsewhere in the body
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Infection, which may be in the disk, bone, abdomen, pelvis or bloodstream
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Kidney stones or a kidney infection (pyelonephritis).
Symptoms
Your symptoms and prior medical problems may raise your doctor's suspicion that your back pain is due to a serious or even life-threatening cause. These symptoms include fever, recent trauma, weight loss and a history of cancer, as well as numbness, weakness or the loss of bladder control (incontinence). Usually, other symptoms can help to point to the cause of your back pain. For example:
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Back sprain or strain — Back pain typically begins on the day after heavy physical activity. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.
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Fibromyalgia
— In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. Typically, patients also complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful, called tender points.
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Degenerative arthritis of the spine — Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.
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Inflammatory arthritis, including ankylosing spondylitis and related conditions — In these disorders, there is pain in the lower back, together with morning stiffness in the back, hips or both. There also can be pain and stiffness in the neck or chest or an extremely tired feeling. Other features may include psoriasis, eye pain and redness, or diarrhea, depending on the specific disorder causing back pain. This group of diseases is a relatively rare cause of back pain.
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Osteoporosis — This common condition is characterized by thinned, weakened bones, which fracture easily, and is most common in postmenopausal women. When vertebrae become compressed because of fracture, posture may become stooped over or hunched along with back pain. Osteoporosis is not painful unless a bone fractures.
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Cancer in the spinal bones or nearby structures — There is persistent back pain, which may be worse when you are lying down, sometimes with numbness, weakness or tingling of the legs that continues to get worse. If cancer spreads to spinal nerves affecting the bladder and bowel, there may be bowel or bladder incontinence (loss of control).
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Protruding disk — People with significant disk disease sometimes have severe pain in the lower back. If a disk compresses a nerve, the pain may spread down one leg and there may be associated weakness in that leg. The pain gets worse during bending or twisting.
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Spinal stenosis — Pain, numbness and weakness affects the back and legs. Symptoms get worse when standing or walking, but are relieved by sitting or leaning forward.
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Pyelonephritis — Patients with a kidney infection typically develop sudden, intense pain just beneath the ribs on one side of the back that may travel toward the lower abdomen or sometimes down to the groin. There also can be a high fever, shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul smelling. There may be additional bladder related symptoms, such as the need to urinate more often than normal or pain or discomfort during urination.
Diagnosis
Your doctor will ask about your symptoms and your medical history. He or she will examine your back muscles and spine and will move you certain ways to check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg.
Your symptoms and the physical examination may give your doctor enough information to diagnose the problem. However, with back pain, your doctor may only be able to tell you that the problem is not serious. If your doctor determines that your back pain is caused by muscle strain, obesity, pregnancy or another cause that is not urgent, you may not need any additional tests. However, if he or she suspects a more serious problem involving your vertebrae or spinal nerves, especially if your back pain has lasted longer than 12 weeks, you may need one or more of the following tests:
Expected Duration
How long back pain lasts depends on its cause. For example, if your pain is caused by strain from overexertion, you may be able to return to your normal activities gradually over a period of several days or weeks. However, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back gets better.
Women who have back pain caused by the added weight of pregnancy almost always will get better after delivery. However, patients who are obese may need to lose weight before back pain eases.
People with back pain caused by pyelonephritis often begin to feel better within days after they start taking antibiotics, although they usually need to continue taking antibiotics for up to two weeks. People with more serious forms of back pain caused by problems with the vertebrae or spinal nerves usually have back pain that lasts at least 12 weeks and may last for years, depending on the specific cause and the treatment.
Prevention
You can help prevent some forms of back pain by strengthening your back with appropriate exercises and by avoiding activities that lead to back injury. This means:
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Practice good posture.
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Sleep on your side or on your back with a pillow under your knees if you can.
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Exercise regularly, but stretch before and after.
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Practice abdominal crunches to strengthen abdominal muscles, which support your lower back. Also, walk or swim regularly to strengthen your lower back.
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Lift objects safely. Always lift from a squatting position, using your hips and your legs to do the heavy work. Avoid lifting, twisting and bending at the same time.
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Avoid sitting or standing for extended periods of time.
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Wear soft soled shoes with heels that are less than 1½ inches high.
To help prevent osteoporosis, make sure your daily calcium intake meets dietary requirements for your age group. Also, follow a routine program of weight bearing exercise, avoiding smoking and limit your alcohol consumption. If you are a woman who has entered menopause, speak with your doctor about testing for osteoporosis and medications that can help to prevent it.
Treatment
Most episodes of back pain are not serious and are treated with:
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Limited bed rest (no more than two days)
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Acetaminophen (Tylenol and others) for pain or oral anti-inflammatory drugs, such as aspirin, ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn), for pain and inflammation
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Muscle relaxants or prescription pain relievers, if necessary, for a short period of time
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Hot or cold compresses
People with back pain are encouraged to return to their normal activities gradually, and to temporarily avoid heavy lifting, prolonged sitting or sudden bending or twisting.
If you are recovering from back pain, your doctor may ask you to call or return to his or her office for a follow-up office visit in about two weeks to confirm that your symptoms are gone and that you can safely resume all of your normal activities.
If your back pain is related to more serious disorders of the vertebrae or spinal nerves or if it is not improving over a few weeks, you may be referred to a specialist, such as an orthopedic surgeon (a doctor who specializes in diseases of the bones), a neurologist (a doctor who specializes in diseases of the nerves and brain) or a rheumatologist (an arthritis specialist).
When To Call A Professional
Contact your doctor if:
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Severe back pain makes it impossible for you to perform your normal daily activities.
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Your back pain follows significant trauma.
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Mild back pain gets worse after a few days or persists more than a week or two.
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Back pain is accompanied by weight loss, fever, chills or urinary symptoms.
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You develop sudden weakness, numbness or tingling in a leg.
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You develop numbness in the groin or rectum or difficulty controlling bladder or bowel function.
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You have had cancer previously, and you develop persistent back pain.
Prognosis
More than 90 percent of people with back pain get better after conservative treatment. Only five percent of people with back pain will have symptoms for more than 12 weeks and for most of these people, the cause is not serious.
Additional Info
American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd.
Rosemont, IL 60018-4262
Phone: (847) 823-7186
Toll-Free: (800) 346-2267
Fax: (847) 823-8125
http://www.aaos.org/
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: (404) 633-3777
Fax: (404) 633-1870
E-Mail: acr@rheumatology.org
http://www.rheumatology.org/
Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357-0669
Phone: (404) 872-7100
Toll-Free: (800) 283-7800
http://www.arthritis.org/
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
Phone: (301) 495-4484
Toll-Free: (877) 226-4267
Fax: (301) 718-6366
TTY: (301) 565-2966
E-Mail: niamsinfo@mail.nih.gov
http://www.niams.nih.gov/
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