Back Pain

1 What is Back Pain?

Back pain may be felt as a dull, continuous ache or as a sudden, severe pain that causes movement to be difficult.

It can start if you fall or lift a heavy object and sometimes it just gradually increases in severity.

Back pain is one among the many common reasons people are unable to work, and is a primary cause of disability all around the world.

We are fortunate enough to have methods that prevent or relieve most episodes of back pain.

If prevention is unsuccessful, there are a few home remedies and proper body mechanics that can be followed to heal your back within a few weeks and keep it functional for a long period of time.

Surgery is seldom required in the treatment of back pain.

2 Symptoms

The signs and symptoms associated with back pain include:

  •    Muscle aches
  •    Shooting or stabbing pain
  •    Radiating pain down your leg
  •    Limited ability to move or decreased range of motion in the back

 Most episodes of back pain usually get better within 2 weeks after home treatment and self-care. If your back pain is persistent, you should consult your doctor.

Rarely, back pain may be a sign of an underlying serious medical problem. Seek immediate medical attention if your back pain:

  •     Causes new bowel or bladder problems such as trouble passing urine
  •     Is associated with fever
  •     Occurs following a fall, blow to your back or other types of trauma
  •     Is severe and not relieved from rest
  •     Radiates down one or both legs, specially if the pain extends below the knee
  •     Causes weakness and tingling or a feeling of numbness in one or both legs
  •     Is associated with sudden, unexplained weight loss, when not on a diet plan

 Also, it is important to consult your doctor if you get back pain for the first time after the age of 50 or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

3 Causes

Back pain may occur suddenly and last for less than six weeks in which case it is termed as, 'acute', which may be caused due to a fall or lifting of heavy weights.

Back pain that persists for more than three months is termed as chronic back pain, and is less common than acute back pain.

Back pain commonly develops without any specific cause that your doctor is able to identify with a diagnostic test or imaging study.

The conditions that are linked to back pain include:

  •  Muscle or ligament strains
  •  Repeated lifting heavy objects or a sudden awkward movement. Constant strain on your back may lead to painful spasms of the back muscles.
  •  Bulging or ruptured disks: Disks normally act as cushions in between the two bones (vertebrae) of your spine. Sometimes, the soft material within a disk may bulge or rupture exerting pressure on a spinal nerve. However, all bulging or ruptured disks may not cause back pain. Disk disease is often identified while undergoing spine X-rays for some other reason.
  • Arthritis: Osteoarthritis can occur in the lower back. In some cases, spinal arthritis may cause narrowing of the space around the spinal cord, which is termed as spinal stenosis.
  • Skeletal irregularities: Back pain may occur if there are abnormal curves present in your spine. Scoliosis is a condition in which the spine tends to curve to one side. This may cause back pain, when the scoliosis is severe.
  • Osteoporosis: Osteoporosis results in brittle or porous bones, which may predispose the spinal vertebrae to develop compression fractures.

4 Making a Diagnosis

Making a diagnosis of back pain is done during physical examination.

If your back pain does not improve even after few days, make an appointment with your doctor. The following information may help you get ready for your appointment:

  • Make a note of your key personal information, including the mental or emotional stressors in your life.
  • List your important medical information, including other conditions for which you are under treatment and the names and dosages of your current medications including vitamins and other herbal supplements.
  • Note the recent injuries you have had on your back.
  • Let a family member or friend accompany you, if possible, as they can remind you of something you have missed or forgotten.

Make a list of the questions to be asked to your doctor.

Some basic questions you can ask your doctor include:

  •  What is most likely the reason for my back pain?
  •  Do I need to undergo any diagnostic tests?
  •  What treatment approach will you advise?
  •  If you are prescribing medications, what are their possible side effects?
  •  I have other medical conditions too. Will I be able to handle them altogether?
  •  How long will the treatment last?
  •  What self-care remedies can I try?
  •  What can I do to prevent a recurrent back pain?

Your doctor may also ask you certain questions to know more about your condition, such as:

  • When did start getting pain in your back?
  • Is the pain continuous?
  • Does the pain affect your activities? If so, to what extent?
  • Do you have any other signs or symptoms aside from back pain?
  • Do you perform heavy physical work?
  • Do you exercise regularly?
  • What kind of activities do you involve yourself in?
  • Do you feel depressed or anxious at any time?
  • Do you get enough sleep?
  • Have you tried any treatments or self-care measures so far? Has anything been beneficial?

During an appointment with your doctor, he or she will perform a physical examination which involves examination of your back and assessment of your ability to sit, stand, walk and lift your legs.

Your doctor may ask you to rate the intensity of pain on a scale of zero to 10 and will then explain about how well you are capable of functioning with your pain.

These assessments help to find out the origin of pain, your ability to move before the pain forces you to stop, and whether you have muscle spasms.

In addition, these tests help preclude more serious causes of back pain.

When your doctor suspects an underlying condition to be the cause of your back pain, certain diagnostic tests may be ordered, such as:

  • X-ray: These images reveal the bone alignment, the presence of arthritis or bone fractures.
  • MRI or CT scans: These scans can help to visualize herniated disks or defects in bones, muscles, tissues, tendons, nerves, ligaments, and blood vessels.     
  • Blood tests: These can help to identify if there is an infection or other conditions causing your pain
  • Bone scan: Rarely, a bone scan may be done to check for bone tumors or compression fractures caused by osteoporosis.
  • Nerve studies (electromyography, or EMG) These tests are done to measure the nerve's electrical impulses and the responses of your muscles. This test helps to confirm the presence of nerve compression as a result of disk herniation or narrowing of your spinal canal (spinal stenosis).

5 Treatment

Most conditions of acute back pain improve within a few weeks of home treatment.

Over-the-counter painkillers and the application of heat or ice may be sufficient in some cases.

Bed rest is not recommended usually. It is necessary to be active and continue performing your activities as long as you can bear.

Try doing light activity, such as walking and your daily chores.

Discontinue activities that aggravate your pain, but you should not avoid activity because of fear of pain.

If home treatments are not effective even after several weeks, your doctor may recommend stronger medications or other therapies.

  • Medications: Depending on the severity of your back pain, your doctor may prescribe the following:
  • Over-the-counter (OTC) pain relievers: Acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) may relieve acute back pain. Take these medications as suggested by your doctor as their overuse may lead to serious adverse reactions. If OTC painkillers do not help relieve your pain, your doctor might suggest prescription NSAIDs.
  • Muscle relaxants: If mild to moderate back pain does not get relieved with OTC painkillers, your doctor may also add a muscle relaxant. Muscle relaxants can cause dizziness.
  • Topical pain relievers: These are available as creams or ointments that can be applied to your skin locally, at the site of your pain.
  • Narcotics: Certain drugs such as codeine or hydrocodone may be prescribed for a short period under close supervision by your doctor.
  • Antidepressants: Lower doses of certain classes of antidepressants — tricyclic antidepressants such as amitriptyline have been shown to improve some types of chronic back pain.
  • Injections: If other treatment methods do not help with your pain and if the pain radiates down your leg, your doctor may suggest an epidural injection of cortisone — an anti-inflammatory medication or an anesthetic medication directly into the space surrounding your spinal cord. A cortisone injection reduces the inflammation around the nerve roots, but the pain relief achieved is temporary and usually lasts for less than a few months.
  • Education: No commonly accepted program is available to spread awareness among people with back pain about the ways to manage their condition effectively. Generally, education might mean a class, a discussion with your doctor, written material or a patient education video. Education stresses the need and importance of staying active, managing stress and anxiety, and teaching ways to stay safe by preventing injuries in the future.
  • Physical therapy and exercise: Physical therapy plays an important role in the conservative treatment of back pain. A physical therapist can perform a wide array of treatments that include heat, ultrasound, electrical stimulation and muscle-release techniques to the back muscles and soft tissues to relieve pain. As the pain decreases, the therapist will teach you exercises that increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of such techniques help to prevent pain from recurring.
  • Surgery: Surgical treatment is considered as a last resort when all the conservative methods are not effective. Some patients with persistent pain associated with radiating leg pain or progressive muscle weakness as a result of nerve compression may benefit from spinal surgery. Otherwise, surgery is usually performed for conditions of pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that has not responded to other therapies.

6 Prevention

You may try to avoid back pain or prevent its recurrence by improving your physical condition, and practicing proper body mechanics.

In order to keep your back healthy and strong:

  • Exercise regularly: Regular low-impact aerobic exercises, meaning those that do not strain your back, can increase the strength and endurance in your back and allow better functioning of your back muscles. Walking and swimming are good options. Discuss the activities most suitable for you with your doctor.
  • Build muscle strength and flexibility: Performing abdominal and back muscle exercises or core-strengthening exercises can condition these muscles so that they function together. Flexibility in your hips and upper legs maintain proper alignment of your pelvic bones and thus improve how your back feels. Your doctor or physical therapist can advise the right exercises for you.
  • Maintain a healthy weight: Being overweight strains the back muscles. Consider weight loss programs to prevent back pain.

Learn proper body mechanics:

  • Correct way of standing: Maintain a neutral pelvic position. If you need to stand for longer periods, place one foot on a low footstool to take some load off your lower back.
  • Alternate feet when standing: Good posture can greatly reduce the stress on back muscles.
  • Sit in a correct position: Choose a seat which has adequate lower back support, proper armrests and a swivel base. Consider keeping a pillow or rolled towel in the small area of your back to maintain its normal curve.
  • Keep your knees and hips level: Change your position frequently, at least once in every half-an-hour.
  • Lifting technique: Avoid lifting heavy weight, if possible, but if you need to lift something heavy, use your legs for the work.
  • Keep your back straight, do not twist, and bend your legs only at the knees. Hold the weight as close to your body as possible. Ask someone to help you lift the object if it is too heavy or awkward.

As back pain is a very common problem, several products that assure relief from back pain are available.

However, there is still no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs really help.

7 Alternative and Homeopathic Remedies

Various types of alternative remedies are available to ease the symptoms of back pain.

It is better to discuss the benefits and risks of the following methods with your doctor before choosing any new alternative therapy:    

  • Chiropractic care: Chiropractic care involves different types of spinal manipulations. A chiropractor will hand-manipulate your spine to relieve your pain.
  • Acupuncture: An acupuncturist inserts sterilized stainless steel needles into the skin at specific areas identified on your body. This technique has helped to relieve lower back pain in some patients.
  • Massage: Massage therapy involves gentle kneading of your muscles. This may help if your back pain is due to tense or overstressed back muscles.
  • Yoga: Yoga involves performing specific poses or postures along with breathing exercises and meditation or relaxation techniques. It involves stretching and muscle strengthening exercises to improve posture. You may need to modify some poses if they exacerbate your pain or other symptoms.

8 Risks and Complications

There are several risks and complications associated with back pain.

Back pain can occur in anybody. It can even develop in children and teenagers.

Research has yet to prove what exactly is the contributing factor to back pain.

However, these predisposing factors may increase your risk of developing back pain:

  • Age: Back pain occurs more frequently as one gets older. Back pain may first develop around the age of 30 to 40.
  • Lack of exercise or poor fitness: Weak or unused back muscles may lead to back aches.
  • Being obese or overweight: Too much body weight can put excessive stress on your back.
  • Disease conditions: Some types of cancer and arthritis can cause back pain.
  • Improper lifting technique: Using your back instead of your legs while lifting heavy objects from the floor can eventually lead to back pain.
  • Psychological conditions: Individuals who are more prone to depression and anxiety have a greater risk of developing back pain.
  • Smoking: If you are chronic smoker, your body does not get sufficient nutrients to nourish the disks in your back. In addition, smoker’s cough is known to cause back pain. Healing becomes slow in people who smoke which means back pain may last for a longer period.
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