Back Pain

Backaches are one of the most common reasons people visit a doctor.

Causes

Back pain can be caused by inflammation of joints, muscles, or ligaments. Poor posture, obesity, or lifting something the wrong way can cause back pain. Pain also can develop after you sit or stand too long or when you are under physical or mental stress. Some back pain can be caused by problems in other parts of your body. Pain in your hip or leg, for example, can make you feel back pain as well. This is called referred pain . Pain in the lower back is very common. It can be caused by inflammation of structures in the back, such as the joints, muscles, or discs.

Most often it is made worse by certain activities. It can also be affected by physical or psychological stress. Uncommonly, back pain can be caused by serious problems such as infection or other conditions your doctor can distinguish from the more common types of back pain.

Acute low back pain is also called lumbar muscle strain or backache. It is described as low back pain you’ve had for 6 weeks or less that does not reach below the knees. Although quite painful, it usually improves after a few days of simple treatment.

Acute sciatica is known as disc pain or radiating leg pain. Acute sciatica is described as low back pain you’ve had for 6 weeks or less where the pain reaches below the knee. Sciatica pain is often caused by nerve irritation from discs in the lower back.

Chronic low back pain and sciatica are conditions of long-lasting back pain.

If you have pain for more than 6 weeks, more medical evaluation is needed. Back pain is sometimes a sign of a more serious health problem, so tell your doctor right away if you have any of these symptoms along with low back pain:

• Unexplained weight loss

• Constant night pain • Fever

• Trouble urinating

• Leg weakness

Self-Care

• Moderate activity is most helpful, but avoid anything that makes the pain much worse. Staying in bed for more than 2 days can make back pain worse.

• Use ice or cold packs for 20 minutes 3 or 4 times a day during the first few days of a muscle sprain or spasm.

• A hot bath or heating pad can help reduce pain and stiffness. Use heat only after the first few days you feel pain.

• Take a medication for pain and inflammation.

• Maintain good posture to keep your body’s weight aligned and reduce stress on the back muscles.

•  Lying on your back with a pillow under your knees or lying on your side with a pillow between your lower legs can ease pain so you can sleep.

•  Weight loss is important to prevent future problems.

•  Return to work or your usual daily activities within a few days, with lighter duties or limited hours. This prevents your back from becoming weak and stiff.

•  Avoid lifting heavy objects and repeated bending and twisting. Change positions often during the day and use a chair with good lower back support.

•  Learn to accept and deal with stress. If you have particular stress in your life, discuss it with your doctor.

Treatment

• Muscle relaxers can be used during the first few days to ease muscle spasms, but they often cause drowsiness.

• In some instances, steroid medications may be injected directly into the epidural space (the space surrounding the nerves within the spinal canal) to ease sciatica pain.

• Physical therapy may be prescribed by your doctor if you have severe incapacitating pain for more than 1 week, no improvement after 2 weeks of home therapy, or you are unable to return to work (limited activity) within 1 week.

•  Surgery is rarely needed for back pain or sciatica. It is considered only after months of treatment.

Prevention

• Good posture is important for keeping the spine healthy. Stand straight. Keeping your body aligned takes stress off your back muscles.

• Avoid lifting heavy objects. When you do lift, bend your knees and keep your back straight.

• When working while seated, choose a chair that has good support for your lower back.

• Maintain a healthy weight. If you are overweight, you will put more stress on your lower back.

• Try not to reach for objects that are above your head. Use a step stool or a device that helps you reach objects on higher shelves. Store items that you use often on lower shelves.

• Avoid repeated bending or twisting.

Exercise

 To help in your recovery and prevent further back problems, it is important to keep yourself in the best physical condition you can and to keep your back, abdominal muscles, and legs strong. You should plan regular daily walking as soon as you can. Adding other activities to your routine, such as swimming and biking, can also be good for the low back. The exercises shown should be started at home or with the help of a physical therapist and should be started as soon as they can be performed comfortably. Don’t do any exercises that make the pain significantly worse.   

Before you lift, test the load. Ask yourself, "Is the path clear. Can I lift this alone?" Get help if the load is too heavy. If you determine you can lift the load, follow the steps shown above.

Pelvic Tilt

Lie flat on your back or stand with your back to a wall, knees bent, feet flat on the floor, body relaxed. Tighten abdominal muscles and tilt pelvis so that the curve of the small of the back is flat against the floor or wall. Hold 10 seconds and then relax (see illustration above).

Knee Raise

Lie flat on your back, knees bent, and bring one knee slowly to your chest as shown (see illustration above). Hug knee gently, then lower your bent leg. Do not straighten your legs. Repeat exercise with other leg.

Partial Press-up

First, lie face down on a soft, firm surface with your arms and head positioned as shown (see illustration above). Rest for a few minutes, relaxing completely. Second, staying in the same basic position, raise your upper body enough to lean on your elbows. Let your lower back and your legs relax as much as you can. Hold this position for 30 seconds at first, gradually working up to 5 minutes, or do slow press-ups holding for 5 seconds and repeating five or six times, whichever is most comfortable.