What is low back pain?

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Almost everyone has low back pain at one time or another. The lower
back is the connection between your upper and lower body, and it bears
most of your body's weight. Because of these roles, it is easily
injured when you lift, reach, or twist.

The good news is that most low back pain will go away in a few weeks
with some basic self-care. However, if your pain is severe or lasts
more than a couple of weeks, see your doctor.

What causes low back pain?
Low back pain is often caused by overuse, strain, or injury. For
instance, you may hurt your back by playing sports or working in your
yard, taking a jolt in a car accident, or lifting something too heavy
for you.

Aging plays a part too. Your bones and muscles tend to lose strength as
you age, which increases your risk of injury. The spongy discs between
the bones of the spine (vertebrae) may suffer from wear and tear and
may no longer provide enough cushion between the bones. A disc that
bulges too much or that breaks open (herniated disc) can press on
nerves, causing back pain.

Less often, low back pain is the result of arthritis, compression
fractures caused by bone loss (osteoporosis), illness, or a spine
problem that you may have had since you were born.

Your state of mind has an effect on your level of pain and whether it
becomes long-lasting (chronic). People who are depressed, under stress,
or unhappy in their work are more likely to have chronic back pain.

Often we don't really know the cause of low back pain.

What are the symptoms?
The term "low back pain" is used to describe a range of symptoms.
Depending on the cause, low back pain may be dull, burning, or sharp,
and it may be felt at a single point or over a broad area. It can come
on gradually or suddenly and may occur with muscle spasms or stiffness.

Leg symptoms can be caused by lower spine problems that place pressure
on a nerve that leads to the leg. The symptoms can occur on their own
or along with low back pain. Leg symptoms can include pain, numbness,
or tingling, often extending below the knee.

Weakness and/or numbness in both legs, along with loss of bladder
and/or bowel control, are symptoms of cauda equina syndrome, which
requires immediate medical attention.

Back pain can be:

Acute (short-term), which lasts less than 3 months. Most people gain
relief after 4 to 6 weeks of home treatment.
Recurrent, which is a repeat episode of acute symptoms. Most people
have at least one episode of recurrent low back pain.
Chronic, which lasts longer than 3 months.
How is low back pain diagnosed?
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 the exam can help him or her
rule out a serious cause for your pain. For most people with low back
pain, the doctor will be able to recommend treatment after the first
exam.

Imaging tests such as X-rays, CT scans, and MRIs are not helpful for
diagnosing most episodes of low back pain. They are usually limited to
cases in which the doctor suspects a serious problem such as a broken
bone, cancer, or infection, or if surgery is being considered or
planned. You might also have imaging tests if workers' compensation or
a lawsuit is involved.

How is it treated?
Most low back pain will improve if you take the following steps:

Apply ice for 5 to 15 minutes every 2 or 3 hours. You can use an ice
pack or a bag of frozen vegetables wrapped in a thin towel. After a few
days of ice, switch to heat for 15 to 20 minutes every 2 or 3 hours.
You can take a hot shower or use a heating pad or hot water bottle.
Take pain medicine, such as ibuprofen (Advil or Motrin, for example),
aspirin, or acetaminophen (Tylenol, for example). These medicines
usually work best if you take them on a regular schedule instead of
waiting until the pain is severe.
For the first day or two, rest in a comfortable position. Try lying on
your side with a pillow between your knees. Or lie on your back on the
floor with a pillow under your knees.
As soon as possible, get back to your normal activities. Movement helps
your muscles stay strong. Staying in bed for more than 1 or 2 days can
actually make your problem worse.
Walking is the simplest and perhaps the best exercise for the lower
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 lower
your chance of injury.

If your symptoms are severe or you still have them after 2 weeks of
self-care, see your doctor. You may need stronger pain medicines, or
you might benefit from physical therapy. Some people find relief from
pain by using massage, chiropractic, acupuncture, pain management
techniques, or another type of treatment. Certain treatments work for
some people but not for others. You may need to try different things to
see which works best for you.

Only a few people with low back pain need surgery. Surgery may help if
you have a herniated disc or back pain along with symptoms of nerve
damage, such as numbness in your legs. Even in these cases, most people
will improve without surgery. Having surgery does not guarantee that
all your pain will go away. Before you have surgery, it is a good idea
to get a second opinion.

How can I prevent low back pain from returning?
Once you have had low back pain, you are likely to have it again. To
help keep your back healthy and avoid further back pain:

Practice good posture when you sit, stand, and walk.
Get regular, low-impact exercise. Walk, swim, or ride a stationary
bike. Stretch before you exercise.
Wear low-heeled shoes with good support.
Sleep on your side. A medium-firm mattress may be easiest on your back.

Don't try to lift things that are too heavy for you. When you must
lift, bend your knees and keep your back straight, keep the object you
are lifting close to your belly button, and avoid lifting and twisting
at the same time.
Watch your weight. Being too heavy, especially around your waist, puts
extra stress on your back.
If you smoke, quit. Smoking decreases blood flow and prevents healing.
If you sit or stand for long periods at work:

Pay attention to your posture. Sit or stand up straight, with your
shoulders back.
Make sure your chair has good back support.
Take regular breaks to walk around.
If your work involves a lot of bending, reaching, or lifting:

Talk to your human resources department to see if there are other ways
you can do your work.
Don't depend on a "back belt" to protect your back. Studies have
not shown these belts to be effective in reducing back injuries. The
most they can do is to help remind you to use good techniques for
lifting