Back pain can range from a simple sprain that quickly heals to a chronic condition that can make everyday tasks almost impossible. The symptoms of back pain send millions of people to the doctor every year. And while it can be difficult to pinpoint the exact causes of back pain, there are ways to prevent and treat it. Gain a better understanding of your back pain by learning more about the different types and the possible underlying causes.
Back Pain Symptoms
Different types of back pain can have distinct symptoms.
The term back pain covers a wide range of symptoms that include shooting and stabbing pain, tingling or burning sensations, or pain that radiates from the back into the buttocks, thighs, and down the leg. The pain can be intense and short-lived or can rumble on at a less intense level for weeks or even months.
Back Pain Symptoms: A Wide Range
Back pain often begins simply enough and then develops into a larger, longer-term problem. Kathy Griffin, 47, a researcher from Toronto, for example, spent months carrying a clingy toddler on her hip. When she went back to work at her desk job, she almost immediately developed back pain that began on her left side, the one favored by her daughter for being carried.
“It started in my upper back and neck, and sent an ache all the way down my arms to my fingers,” she recalls. “I’d been twisting my spine all those months to support my increasingly heavy daughter’s weight, but the problem began at my keyboard.”Griffin subsequently felt pain in her back and arms when she typed for a long period of time, drove long distances, played the piano, or carried her daughter, but the pain went away when she stopped doing any of these activities. After several months of physical therapy, she finally recovered.
In fact, this was not Griffin’s first run-in with back pain. “Even before I had children, if I spent too long slaving over my computer keyboard and didn’t remember to get up, move around, and do some stretches, I would get lower back pain that felt like everything was pushing down on my lower spine and that the arch of my back was giving out,” she says. Occasionally this would turn into a bout of sciatica(where parts of the sciatic nerve that travels down the back of the leg get squeezed or irritated), which sent shooting pains from her lower back down her leg. “It felt like someone had driven a nail into my spine, and the pain went all the way to my feet,” she says. “The pain was intense. It felt like the leg was paralyzed.”
Culprits of Back Pain
Like Griffin, you might experience a wide range of back pain symptoms. Some common back pain culprits include:
- Back strains and sprains. When you make a too-sudden movement or overdo it by trying to lift or move objects that are too heavy, a back strain or sprain can occur. This type of back injury typically causes pain that gets worse with movement.
- Sciatica. The symptoms of sciatica are distinctive: Sharp, shooting pains originating in the back travel down through the buttocks into the legs. Sciatica usually affects only one side of your body.
- Chronic conditions. Some kinds of back pain come on more slowly and build up over time. This is the case with the various kinds of arthritis and other chronic conditions, such as degenerative disk disease, where the disks that serve as cushions between the bones of the spine break down over time.
Back Pain: Chronic or Acute?
When your back pain comes on quick and strong, this is known to doctors as acute back pain. This is most commonly caused by an injury or by an event that jars the structures of the back, such as overdoing it while participating in a sport or exercising.
Though most acute back pain symptoms typically begin to improve after a few days, often the condition continues beyond the initial phase and becomes chronic back pain.
Take comfort in knowing that there is help for most kinds of back pain, and talk to your doctor to come up with the best treatment plan for your back pain symptoms.
Causes of Back Pain
The common symptoms of back pain can be related to an injury, an underlying problem, or issues in your lifestyle.
The typical image that often springs to mind when one thinks about back pain is of a person lifting a heavy object and then wincing in agony. It’s true that trauma caused by heavy lifting, injury, or accident can all lead to back pain, but there are also many underlying problems and health conditions that can cause pain as well.
Typical Causes of Back Pain
The kind of back pain experienced by the majority of people is typically falling into one of the following areas:
- Mechanical back pain. A mechanical cause of back pain means that the problem is in the mechanics of the back: the bones, ligaments, disks, joints, nerves, or meninges (the outer membranes that surround the spinal cord). This is the most common type of back pain.
- Sprains or strains. A type of mechanical back injury sprained/strained muscles or tendons (tough, fibrous tissue that connects muscle and bone) account for 85 percent of lower back pain cases in the U.S.
- Sciatica. The symptoms of sciatica are distinctive: Sharp, shooting pains originating in the back that travels down through the buttocks into the legs. Sciatica usually affects only one side of the body.
Underlying Conditions That May Cause Back Pain
While a sudden jolt or other forms of stress to the back can result in pain, there may be an underlying cause that weakens your back, making it more vulnerable to trauma.
Often, however, there is no single explanation for back pain. According to the American Academy of Orthopedic Surgeons, common causes of back pain include:
- Aging of the spine, ligaments, and discs. As your spine ages, the discs can protrude or even collapse, which can cause pain and can also put pressure on the nerves that run through the spine. According to Andrew Sherman, MD, head of medical rehabilitation at the Spine Institute at the University of Miami Miller School of Medicine. Spinal problems are the most common reason why middle-aged people develop pain and even disability.
- Arthritis. The lower back is one of the areas most commonly affected by arthritis which can lead to spinal stenosis or a narrowing of the space around the spinal cord.
- A poorly aligned spine. Some people have back pain because of their spine curves in an exaggerated or irregular way, or even curves to the side, a condition known as scoliosis.
- Osteoporosis. If your bones are weak and brittle from osteoporosis, a condition in which the bones become fragile and brittle due to loss of minerals, the vertebrae of the spine are more vulnerable to fractures.
- Being overweight or obese. Excess weight can put a constant strain on your back, resulting in pain.
Back Pain: Chronic or Acute?
When your back pain comes on quick and strong, this is known to doctors as acute back pain. This is most commonly caused by an injury or by an event that jars the structure of the back.
While most acute back pain symptoms typically begin to improve after a few days, for some people the pain continues beyond the initial phase and becomes chronic.
Other Conditions That Can Lead to Back Pain
There are also other conditions that have nothing to do with the back but can still cause lower back pain, including bladder infections, kidney stones, and other kidney diseases, ovarian cysts and ovarian cancer, endometriosis, and twisted testicles.
In rare cases, back pain can be caused by more serious ailments, including:
- Cancer or infection in the spine. If a tumor or infection is present in the spine, it can cause the symptom of back pain. Usually, you would also have other symptoms, such as weight loss with cancer or a fever with infection.
- Cauda equina syndrome. This serious neurologic condition results from an acute loss of function of the bundle of nerve roots of the spinal canal, known as the cauda equina. It causes weakness in the legs, numbness in the groin area, and loss of bladder or bowel control.
Back Pain Diagnosis
Whether your back pain is acute and unbearable or chronic and just doesn’t seem to go away, the first step is to see your doctor, who may refer you to a spine specialist. The specialist will take your medical history, perform some basic exams, and possibly order tests to better understand what may be making your back hurt.
Exams and Tests for Back Pain
If you have back pain that persists more than a few days or is severe and accompanied by other symptoms, you should make an appointment to see a spine specialist. Both sudden and persistent back pain can indicate a spinal condition that is more serious than a muscle sprain or strain, which should heal itself within a few weeks.
During your visit, your spine specialist will ask you questions and perform some basic exams. This is to try to identify the cause of your back pain and develop a treatment plan for you — a way to manage your pain and other symptoms and to help you recover.
Tests for Back Pain: Medical History and Physical Exam
First, your spine specialist will ask about your back pain and remedies you have already tried. He or she will ask some typical questions, such as:
- When did the pain start?
- What activities did you recently do?
- What have you done for your back pain?
- Does the pain radiate or travel to other parts of your body (e.g., down your leg — that would be sciatica)?
- Does anything reduce the pain or make it worse?
Your spine specialist will also perform physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion (how well and how far you can move certain joints), and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. This exam often involves some patient participation. For example, you may be asked to bend in various directions and to move your arms and legs — perhaps even lie on a table and raise your legs.
During the neurological exam, your spine specialist will test your reflexes, muscle strength, other nerve changes, and pain spread (that is — does your pain travel from your back and into other parts of your body?).
Tests for Back Pain: Imaging Tests
To diagnose the cause of your back pain, you may need to undergo some imaging tests.
- X-rays: You may have an X-ray, which can help your doctor “see” the bones in your spine. X-rays are effective at showing narrowed spinal channels (spinal stenosis), fractures, bone spurs (osteophytes), or osteoarthritis.
- CT scan or MRI: A Computerized Axial Tomography scan (a CT or CAT scan) or a Magnetic Resonance Imaging test (an MRI) may be required. These tests are more effective than X-rays at showing the soft tissues in your spine, and can help to identify problems such as a bulging disc or a herniated disk.
- Bone scan: To help your doctor detect spinal problems such as osteoarthritis, fractures, or infections, you may have a bone scan. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your bloodstream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity — such as an inflammation. A scanner can detect the amount of radiation in all your bones and show the “hot spots” (the areas with more radioactive material) to help your doctor figure out where the problem is.
- Discogram: This is a procedure that confirms or denies the disk(s) as the source of your pain. You will have a harmless dye injected into one of your discs. If there’s a problem with your disc — like it’s herniated — the dye will leak out of the disk. The doctor will be able to see that on an x-ray, and that will show him/her that there’s something wrong with your disk.
- Myelogram: To see if you have a spinal canal or spinal cord disorder — perhaps nerve compression causing pain and weakness — you may have a myelogram. In this test, you’ll have a special dye injected into the area around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you’ll have an x-ray or a CT scan. The image will provide a detailed anatomic picture of your spine, especially of the bones, that will help your doctor to identify any abnormalities.
Tests for Back Pain: Bottom Line
It isn’t always a quick and simple process to diagnose back pain. Your spine specialist will need to narrow down the causes and perhaps run several rounds of tests to confirm the diagnosis. Be a good patient — and be patient. Once there is a diagnosis, your spine specialist will be better able to develop a treatment plan that fully meets your needs.
Back Pain Management
Day-to-day management of back pain can be a challenging process. In the past, people with chronic back pain were forced to view life from the sidelines, but today, a combination of innovative treatments and lifestyle changes make it possible to cope with the pain and live an active life. Adapting your living and working environments and educating loved ones about your unique needs will help you manage existing problems more successfully and avoid making your condition worse.
Choosing a Chair
Whether your day is spend sitting in an office or hanging out at home, the type of chair that you sit in can make your back feel better — or worse. When shopping for seating, check out the various parts of the chair — the base, seat pan, backrest, and armrests — and be sure that chair is adjustable so you can customize the fit.
Finding the Perfect Chair for Your Lower Back
Here are specific features to look for when you’re buying a chair that will reduce your risk of lower back pain:
- Chair base. Choose a strong, five-legged base to minimize the chances of tipping over. The base should be on casters, to allow you to scoot around and limit the muscle strain and fatigue associated with pushing, reaching, and bending.
- Seat pan. The pan should have some cushioning without being too soft, Dr. Shamie says. It should feature a rounded “waterfall” front edge that slopes slightly down. Be sure to get a chair that allows the height of the seat pan to be adjusted. Tilt adjustment is also a valuable feature.
- Backrest. The lumbar support supplied by a good backrest is one of your best tools for avoiding lower back pain. The backrest should feature an outward curve and be height-adjustable so it fits into the small of the back. The backrest should also be able to move forward and back so that short and tall people will be able to sit comfortably, and the angle should be adjustable.
- Armrests. They should be at least two inches wide to provide proper support and made of soft material to reduce irritation to the nerves and blood vessels in the forearm. Choose armrests that are adjustable in height and width.
Back Pain Relief for the Just Injured
Witnessing someone hurt their back can be a scary experience. That moment of watching someone go from full mobility to practical paralysis can leave you with a lot of questions: Should you be rush them to the ER? Should you apply ice or heat? What position is best for achieving back pain relief? How long will it take to recover? These are all common concerns.
Back Pain Relief: When Is Emergency Care Warranted?
In most cases, there’s no need to rush to the emergency room to achieve back pain relief. “The person doesn’t need emergency care unless they can’t feel their legs or have severe numbness going down their legs,” says Cynthia Gormezano, MPT, owner of Cynergy Physical Therapy in New York City. Another case in which a hospital visit is warranted is if there is stinging nerve pain running down the leg. People with that type pain may need magnetic resonance imaging (MRI) to rule out serious injury. In severe cases, a herniated disc that has bulged out of place may be pressing on the spinal cord, requiring emergency surgery. However, says Gormezano, “that is very rare.”
Back Pain Relief: First Steps
Everyone’s pain threshold is different, and some people may feel the need to visit the hospital to get prescription pain medications. But the majority of people can be treated at home with a generous dose of ice and over-the-counter anti-inflammatory medications, such as naproxen (Aleve) or ibuprofen (Advil, Motrin). The best thing to do immediately after someone throws out their back is to have them lie down on a firm surface and apply ice to the sore area. “Ice is absolutely key,” says Gormezano.
For those who are able to move around without further injuring themselves, it’s okay to do so. But “don’t force it,” says Gormezano, noting that pain can get worse if it is not addressed properly in the initial days after injury. After a couple days of rest and ice, the person should start to feel better. If after three to five days there is still no back pain relief, it’s a good idea to take the person to the doctor.
“When I hurt my back a few years ago, I tried to get back up and moved too fast, too early, which left me with lingering soreness for over six months,” recalls Christine Primavera, a Massachusetts resident who recently re-injured her back while playing golf. “This time, I made sure to rest and ice the injury until I was really ready to return to normal activity. And, after the fifth day, I had full mobility again.”
Back Pain Relief: Initial Exercises
Assuming the person is on the mend, it’s appropriate to begin applying heat instead of ice and to help them start performing some slow pelvic-tilt exercises. Before beginning any exercise regimen, however, Gormezano recommends that the person perform a self-assessment. “First, have them stand up and evaluate their pain.” she says. “They should ask themselves, ‘Does bending forward make me feel better, or does extending backward feel better?’ If the extension feels better, the person should sit down and lean backward for sets of six repetitions. If moving forward brings back pain relief, the person should lie on his back and bring his knees to the chest. This is a great way to start stretching the back.
In addition to performing these exercises, those recovering from a recent injury can speed their path to recovery by sleeping on a firm surface and using “log rolling” when getting out of bed. Log rolling means moving the body as one unit opposed to bending or twisting. Twisting motions in general should be avoided, and heavy lifting of any kind is discouraged.
Back Pain With Baby on Board
Pregnancy can place additional stress on the back — and make a preexisting back condition even worse. Relief can come in the form of exercise, a back brace, comfortable shoes, proper sleep positioning, and cautious use of medications.
- Lifting techniques. Always lift with your legs, not with the more vulnerable muscles in your back.
- Footwear. Wear sensible, low-heeled, comfortable shoes. This will help your posture and the alignment of your spine.
- Targeted exercise. Try this pelvic exercise: While on your hands and knees on the floor, arch your back like a cat. Hold the position while you count slowly to 10 and then relax. Repeat 5 to 10 times. Do this every day to help stretch and relax your back.
- Professional advice. Ask your doctor or midwife for other exercises you can do to help relieve pregnancy back pain.
- Sleeping position. Don’t sleep on your back, which puts a strain on your lower back. Always try to sleep on your side.
- Medications. Drugs to relieve back pain should be used with caution and with your physician’s knowledge. The usual pain reliever recommended is acetaminophen (Tylenol). In some cases, other medications could make the pain worse. “I tried to take pain relievers with Benadryl to help my pain at night, like Tylenol PM, but it made my pain worse,” Penna says. “It had something to do with the Benadryl’s effect on the inflammatory process in the joints.”
There is some good news, though. Pregnancy back pain usually goes away not long after the delivery, most often within six months. At that point, though, just make sure you use proper lifting techniques when toting around your toddler (or toddlers)!
Back Pain Treatment
The first and most common questions people who suffer from Back Pain ask is Will Medications Relieve my Back Pain?
Over-the-counter drugs are often the first line of defense in treating back pain — and while they work for some, others with severe or chronic back pain may need to consider muscle relaxers, narcotic painkillers, steroids, and other medications. Each option comes with pros and cons and should be discussed with your doctor before use
When seeking back pain relief, medication might be one of the first steps you try. Many different types of medications have been proven to be successful for back pain treatment, and the type you need depends on the type of pain you have.
Back Pain Treatment: Explore Your Medication Options
“Generally, for the treatment of back pain, a stepwise approach should be considered,” says Bradley Hein, PharmD, an assistant professor of pharmacy at the James L. Winkle College of Pharmacy, University of Cincinnati. “Often, patients will try over-the-counter pain relievers before seeking further treatment from a physician. It is important to establish what a patient has tried as well as what has and has not worked.”
Medications for back pain relief include:
- Acetaminophen: “It is reasonable to initiate treatment with acetaminophen (Tylenol),” Hein says. “Acetaminophen is widely available, effective for many, safe in recommended doses, and cheap. There are very few side effects. One concern is consistent use of greater than 4,000 milligrams a day can lead to liver toxicity.”
- Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs are most effective in treating pain that affects the bones or muscles, and therefore are effective for back pain relief. “Non-steroidal anti-inflammatory medications are also widely available without prescription and effective for the treatment of back pain,” Hein says. “NSAIDs provide an additional anti-inflammatory component that acetaminophen does not provide.””NSAIDs include medications such as ibuprofen (Motrin, Advil) and naproxen (Alleve),” he adds. “For short-term use (less than seven days), these medications are pretty safe. However, there is the possibility of serious side effects with long-term use, such as kidney failure and stomach ulceration and bleeding. NSAIDs can also worsen pre-existing conditions, such as high blood pressure and heart failure.”
- Narcotic painkillers: These medications are typically prescribed by a doctor, and include codeine, oxycodone, hydrocodone, and morphine. There are many common side effects with narcotic medications, including “constipation, sedation, confusion, nausea, decreased respirations, urinary retention, and allergic reactions,” Hein says. “Also, each of these medications can be habit-forming and therefore it is important to use these medications for a short time period and treat the underlying cause.”
- Muscle-relaxing medications: These medications are directed at the muscles rather than the central nervous system as a whole. Some commonly prescribed muscle relaxants are carisoprodol (Soma, Vanadom) and cyclobenzaprine (Flexeril). There is a risk of forming a habit with these medications as well, so use them only under the close supervision of your doctor.
- Adjuvant medications: Adjuvant medications are those not typically prescribed as pain relievers but which might be prescribed in combination with other drugs as a back pain treatment. For back problems, they are often prescribed for pain that is related to the nerves. Adjuvant medications can include antidepressants, anticonvulsants, and beta blockers (commonly used to treat high blood pressure).
- Anesthetics: These medications provide back pain relief by blocking an affected nerve surrounding the spinal cord. Over-the-counter creams might be used to anesthetize the area, or local anesthetics such as lidocaine and procaine hydrochloride (Novocaine) may be administered.
- Steroids: These anti-inflammatory medications can treat back pain caused by inflammation. Though safe when taken for short periods of time, side effects and complications can occur when steroids are taken for longer than two weeks. Side effects can include decreased production of the hormone cortisol, which can lead to more infections, weight gain, and swelling. Other complications from steroids might include higher blood sugar levels in diabetics, and osteoporosis.
“There are various medications that may be helpful, depending on the source of the pain,” says William O. Witt, MD, pain specialist at the University of Kentucky and director of UK HealthCare’s Interventional Pain Associates. “Often, medications useful in treating arthritis are also beneficial in treating back pain due to degeneration. Tylenol is often helpful and can be used along with other analgesics. The narcotics have not been shown to be useful in controlled studies, although there may be individuals who benefit. Their use remains highly controversial.”
Remember that any drug might interact with another drug you are taking — or even with a vitamin or other supplement. Always talk to your doctor before starting any new medications to treat back pain, and always follow your doctor’s prescription orders for taking your medications.
Alternative Treatments for Back Pain
If you have back pain, you have many treatment options to choose from, including alternative treatments. Your doctor may even suggest treatments such as acupuncture, herbs, or massage as part of your treatment plan. These options are called “alternative” because they’re an alternative to “traditional” medicine, which generally means medications, injections, and surgery.
Many patients have reported that alternative treatments have helped relieve their back pain. You may want to try:
Acupuncture or Acupressure:
These alternative treatments developed in China. Practitioners believe that you have an energy force called your Chi (it can also be spelled Qi, but both forms are pronounced “chee”). When this force is blocked, you can develop physical illness, such as back pain. Therefore, you need to free up your body’s Chi channels, which practitioners call your meridians. Acupuncture and acupressure work to restore a healthy, energetic flow of Chi.
Acupuncture uses very fine needles, and practitioners insert them into precise points in your body’s meridians — exactly where is determined by your symptoms. The needles, which contain no medication, are left in for 20-40 minutes. Research has shown that the presence of the needles causes your body to release certain neurochemicals, such as endorphins, and they help in the healing process.
Acupressure works along the same principles as acupuncture, except practitioners, use their thumbs, fingers, and elbows to target the specific Chi points.
Before trying any herbal remedies, do your research and talk to your doctor. There may be side effects that you’re unaware of — an herbal remedy could interfere with a prescribed medicine you’re taking, for example. Some herbal remedies you may want to consider for your back pain are:
- Capsaicin Cream: Capsaicin is what makes chili peppers hot, and it can also relieve your pain. It just temporarily reduces your pain, though, so you’ll need to keep re-applying, probably around 4-5 times a day. It may take several weeks for you to feel significant relief from capsaicin cream, so just because it doesn’t work right away, don’t give up.
- Devil’s Claw: Devil’s claw comes from southern Africa, where it has been used for centuries to treat fever, arthritis, and gastrointestinal problems. It works as an anti-inflammatory. Today, it’s used for conditions that cause inflammation and pain, like osteoarthritis. You can take it in a capsule.
- White Willow Bark: The white willow led to the development of aspirin in Europe. If you don’t want to take the synthetic version (aspirin can irritate the stomach), use white willow bark. It’s for conditions that cause pain or inflammation, like osteoarthritis. It also provides relief for acute back pain.
A SpineUniverse survey in early 2008 showed that back pain patients are very satisfied with massage as a treatment option. It actually had the second highest patient satisfaction rating. Considering that many cases of back pain are caused by muscle strain and overuse, it’s wonderful news that massage is a worthwhile treatment option. A massage can help release muscle tension and relieve muscle inflammation and pain.
Prevent Back Pain
Want to keep your spine healthy and avoid back pain? Here’s how:
Top 5 Tips for a Healthier Spine
- Keep Moving! No matter what age you are, regular physical activity is an important way to stay healthy. Try to incorporate these 3 types of exercise into your exercise routine:
- Range of motion exercises, such as stretching and bending. Do these every day to keep joints flexible and relieve stiffness.
- Strengthening exercises, such as with weights or machines. Make sure to get instruction in the proper use of exercise equipment to avoid injury. Do these every day to increase muscle strength. Strong muscles help support and protect the spine.
- Aerobic exercises, activities such as walking, biking, tennis, swimming. Do these 2 to 3 times a week.
- Lose that Weight!
The more you weigh, the greater the stress on your spine. If you are overweight, losing even 10% to 15% of your body weight can help keep your spine healthy. Losing weight will also make you feel better, reduce back pain, and help you maintain a healthier lifestyle. If you are severely overweight, talk to your doctor about a weight loss program that will allow you to safely lose weight.
- Sleep Well (zzz)
We all know it’s important to get plenty of rest. But what we rest on is also important. A mattress that does not offer enough support for your spine can lead to muscle fatigue and a poor night’s sleep. A good mattress allows you to rest in a neutral position; muscles are relaxed and sleep is more refreshing. If you are having trouble sleeping or find that you wake in the morning more tired than when you went to bed, take a good look at where and how you sleep.
- Listen to Your Mother
Our mothers have been telling us for years not to slouch, but now it’s time to really listen. Good posture keeps your body in balance and helps avoid excessive stress on your spine. Here’s what good posture looks like when standing:
- Feet slightly apart
- Knees straight
- Chin slightly tucked in
- Shoulders back
- Take a good look at yourself in the mirror. Are your ears, shoulders, hips, knees, and ankles aligned in one straight line?
- Checks and Balances
See your doctor regularly for check-ups. If you are experiencing neck and back pain, be sure to get it checked out. Left untreated, some spinal conditions will continue to worsen and may have serious health consequences.
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