The low back supports most of our bodyweight, so it comes as no surprise that most people in the United States will experience back aches and pains to various degrees. In fact, it is one of the most common reasons that people visit the doctor and miss work. Americans spend at least 50 billion dollars per year treating back pain. Luckily, taking proper precautions can help prevent or alleviate most back pain episodes. Low back pain is separated into two categories, acute and chronic. Acute back pain lasts anywhere from a few days to a few weeks. Pain lasting three months or longer is classified as chronic.

Causes

The lower back, or lumbosacral region, is a complex structure made up of bones, ligaments, tendons, muscles, disks, the spinal cord, and very sensitive nerves. Because of the back’s complexity, it is often difficult to diagnose the exact cause of pain, especially if it is a symptom of different compounded problems. One common cause of pain is caused by using back muscles to do things they are not used to doing, including participating in rigorous sports after lengthy sedentary periods or acquiring injuries from falls and car crashes. Common types of low back pain include:

• Sprains & Strains: these painful injuries can occur as a result of improper lifting, poor posture, or reaching for a box that was just a little too high. Sprains occur when ligaments in the back are torn, usually suddenly, from their attachments. The ligaments are the bands of tissue that hold the bones together. Strains happen when the muscles are abnormally stretched.

 

• Spasms: this spontaneous muscle contraction can be very painful. Spasms are prone to occur when muscles are inflamed, tender, or already strained. A spasm is the body’s defense mechanism to prevent the area from further injury, even though it certainly does not feel that way to someone having a back spasm attack.

 

• Herniated Disks: spinal disks are important because they act as cushions between the spine’s vertebrae. When disks are weakened, the outer layer of the lower spine (annulus) may rupture; as a result, the inner material of the lower spine (nucleus) can bulge out, causing a herniated disk. This bulging results in pressure and irritation to the nearby nerves which are very sensitive. Herniated disks can occur when people are lifting, pulling, bending, or twisting.

 

• Sciatica: this shooting leg pain originates in the lower back and travels through the buttocks and down the sciatic nerve in the back of the leg. It is usually the symptom of an underlying back problem such as a herniated disk.

 

• Osteoarthritis: low back pain can also be attributed to osteoarthritis of the spine. As we get older, the disks between the vertebrae become flatter and less flexible; they lose their ability to act as a cushion. Once this cushioning is lost, the facet joints between the vertebrate begin to press against each other. This type of “wear and tear” arthritis causes stiffness and pain and can lead to further issues such as spinal stenosis (narrowing of the spinal canal).

Other causes of low back pain can include osteoporosis, obesity, poor muscle tone in the back, fibromyalgia (a chronic condition characterized by body-wide pain), spinal curvatures, and compression fractures. Rarely, low back pain may indicate a more serious condition such as an infection, kidney disease, cancer, or diabetes.

Make an appointment with your doctor if you experience low back pain in the following ways:

• The pain was caused by injury or trauma such as a car accident or a fall

• The discomfort does not subside within a few weeks

• Your pain is getting progressively worse

• You feel numbness in any areas of your leg, foot, or buttocks

• You lose control over bathroom functions

• The pain is radiating down your leg

• Your low back pain is accompanied by abdominal pain

• You notice any neurological impairments like weakness, tingling, or numbness in your arms or legs

There are many possible causes of back pain including symptoms that seem to indicate arthritis but may turn out to another condition. It is essential to determine what is or is not causing your problem. A doctor will usually begin by taking a medical history and doing a physical exam that includes testing sensation along your neck, back, arms, and legs, assessing muscle strength, and eliciting reflexes.

An X-ray, MRI (magnetic resonance imaging), or CAT (computer assisted tomography) scan may be ordered by your doctor to examine bones and cartilage.


 

Treatment for Acute Low Back Pain

If you recently started experiencing low back pain, there’s a good chance that it will improve with proper at home care. Back pain lasting less than a few weeks is considered acute and is usually treatable.

The majority of low back pain gets better quickly as a result of steps you can take yourself. These steps include using cold and hot packs to relieve discomfort, a minimal amount of bed rest (too much can cause stiff joints and muscle weakness), restricting your activity for a few days until symptoms and inflammation subside, and taking over-the-counter pain medication. Avoid any activities that involve heavy lifting or twisting, but make an effort to stay as active as possible after relaxing for a few days. Once a few weeks have passed, you should be getting light exercise to help strengthen the muscles in your back and stomach.

Treatment for Chronic Low Back Pain

If your back pain has persisted for more than a few months, it is considered chronic. Your doctor may recommend physical therapy during which a therapist will try to reduce your pain using stretching and other muscle release techniques. You will also be shown ways to strengthen your back muscles to help prevent further injury. For many people, spinal manipulation by a chiropractor or osteopathic physician may be very effective. Try wearing a back brace to help support your back while you are at work (the most common is a corset-type that is wrapped around your stomach and back). If over-the-counter pain relievers are not helping, your doctor may, under close supervision, prescribe a muscle relaxant or narcotic such as codeine. Certain antidepressants have shown to be effective in relieving chronic back pain, independent of their effects on depression. If the pain is very severe, an injection of steroids into the space around your spinal cord may be considered; this will reduce inflammation in the affected area and can provide relief for up to a few months.

Additional Treatment Options

Some patients find relief in massage therapy, as it can improve blood flow and reduce stiffness. Acupuncture is also an effective pain management tool for many people with low back pain, and it is a treatment without the side effects of medications. Biofeedback is used to help alleviate low back pain. It involves teaching the patient how to gain control over involuntary bodily processes such as muscle tension, heart rate, and skin temperature. The goal is to change your response to pain through relaxation techniques and to regain control over your body.

The osteopathic approach is typically used in the early stages of low back pain and is aimed primarily at preventing the problem from evolving. Typically, osteopathic manipulation techniques (OMTs) for low back pain only take two to six minutes. A type of quick, short thrust known as a high-velocity low-amplitude (HVLA) is frequently used to decompress vertebrae thereby correcting spinal alignment problems. The OMT options may include a massage, soft-tissue techniques that stretch muscles around the spine, myofascial release techniques that apply pressure to tight muscles, muscle energy techniques wherein the patient stretches against an applied force, and pushing of joints beyond their typical range of motion.

The Importance of Exercise

Consistent exercise is an important tool for increasing flexibility and improving overall muscle stamina; it is thought to be one of the best ways to a speed up recovery from low back pain and to reduce the severity of future episodes. The goal is to improve endurance and strength without causing strain to the low back. Low-impact aerobic exercises such as swimming, walking, and yoga are all great choices to help strengthen the back and abdominal muscles. In fact, a National Institute of Health study has shown that people with chronic low back pain greatly benefit from practicing Iyengar yoga. The importance of maintaining a healthy weight should not be underestimated; carrying less weight reduces extra strain on your back muscles.

Prevention

When lifting heavy objects, always bend with your knees and not with your back; try to keep your back straight and keep the object close to your body. It is important to never lift things by bending over or twisting. When moving heavy objects, push instead of pull if at all possible – it is easier on your muscles.

The Best Way to Sit

Countless Americans spend hours each day sitting in a chair or in their cars. Avoid low back pain by sitting upright with a slight arch to your back. If the chair you sit in does not have built-in lower back support, use a towel or pillow to help maintain the back’s normal curve and minimize strain on the back. Keep your head and shoulders upright and try to limit the amount of twisting and turning; position objects such as your desk, keyboard, and phone at a correct distance so that you are not forced to lean forward. If you are seated throughout most of the day, make an effort to take frequent breaks that incorporate stretching.

The Best Way to Stand

Good posture is a good habit to maintain as it helps to sustain the natural curves in the back; poor posture can cause stress on the back’s muscles. When standing, it is important to keep your shoulders back and in a relaxed position, pull in your abdomen and buttocks, stand so that your feet are parallel, and distribute your weight evenly on both feet. Do not lock your knees, and be sure that your head, shoulders, and hips are all even. Sometimes low back pain can be helped or prevented by something as simple as wearing a supportive pair of shoes, especially if you spend a lot of time walking or standing. Shoes with high heels can throw off your posture and place unnecessary strain on your back.

The Best Way to Sleep

As a general rule, elevating the knees by placing a pillow under them can alleviate many types of low back pain. Sometimes people find that rolling up a small towel and placing it behind their back helps to support the lower back during rest. If you are a side sleeper, try sleeping with a pillow between your legs. This helps to maintain the natural curve in your spine. Sleeping on your stomach is not ideal; it stresses the neck and exaggerates the lower back’s natural curve. If your low back pain feels worse when standing, you might benefit from resting in a reclining chair or an adjustable bed where you can put your head and knees up (called the semi-fowler position). When you are ready to stand up after lying down, turn on your side, bring up your knees, and swing your legs around to the side of the bed. Bring yourself to the seated position using your hands.

Low back pain is a common complaint and can be a very disabling ailment with many causes. The good news is that if you have low back pain and take steps to treat it early, you will likely decrease your pain quickly and will be back on your feet in no time. People with chronic back pain do not have to “learn to live with it.” By taking proactive steps with the guidance of your doctor, leading an active and pain-free life is not out of reach.