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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
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
Often doctors don't really know what causes low back
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.
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
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.
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
Strengthening the muscles in your trunk can improve your posture, keep your
body in better balance, and lower your chance of injury.
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
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,
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
If your work involves a lot of
bending, reaching, or lifting:
Learning about low back pain:
Health Tools help you make wise health decisions or take action to improve your health.
The most common causes of low back pain
Less common spinal conditions that can
cause low back pain include:
Symptoms of low back pain depend on the
Symptoms typically include:
of the spine usually
causes pain that:
Symptoms of diseases that affect the spine depend on the disease. They may
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.
(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. Without
special treatment, you may get chronic
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.
other emergency services immediately if:
Call your doctor now if:
For more information, see the topic
Back Problems and
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
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.
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
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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
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.
for low back pain include:
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
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 manual
therapy or stronger pain medicine.
If your pain is very
bad, your health care provider may recommend short-term use of an
opiate painkiller or a
muscle relaxant. Some
people consider epidural steroid
Answers From an
"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
"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
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
To learn more, see
Living With Low
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.
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
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.
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
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.
One Woman's Story:
"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
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.
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
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
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
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
Having surgery for a
herniated disc or another back problem is a big decision. Talk to your doctor
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. It is also a good
idea to get a second
opinion before you decide to have surgery.
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
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
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.
"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
more about how Patty used positive thinking to help her back
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
Having chronic back pain can make exercising—even
walking—difficult. Being active is often the last thing you want to think
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 5
So be as active as you can. Take short walks as often as you can. Talk to a
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).
Hsieh LL, et al. (2006). Treatment of low back pain by acupressure and physical therapy: Randomised controlled trial. BMJ, 333(7543): 696–700.
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.
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.
Kanayama M, et al. (2007). A minimum 10-year follow-up of posterior dynamic stabilization using Graf artificial ligament. Spine, 32(18): 1992–1996.
Kovacs FM, et al. (2003). Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial. Lancet, 362(9396): 1599–1604.
Mercier LR (2008). The back. In Practical Orthopedics, 6th ed., pp. 143–184. Philadelphia: Mosby Elsevier.
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.
Roelofs PDDM, et al. (2008). Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews (1).
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.
Thorson DC, et al. (2010). Health Care Guideline: Adult Low Back Pain, 14th ed., pp. 1–74. Bloomington, MN: Institute for Clinical Systems Improvement.
U.S. Preventive Services Task Force (2004). Primary Care Interventions to Prevent Low Back Pain in Adults: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsback.htm.
Urquhart DM, et al. (2008). Antidepressants for non-specific low back pain. Cochrane Database of Systematic Reviews (1).
ByHealthwise StaffPrimary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineSpecialist Medical ReviewerRobert B. Keller, MD - Orthopedics
Current as ofMay 23, 2016
Current as of:
May 23, 2016
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Robert B. Keller, MD - Orthopedics
To learn more about Healthwise, visit Healthwise.org.
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