Overview

Most people will have a minor back problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreational activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

• The bones and joints of the spine (vertebrae).
• The discs that separate the vertebrae and absorb shock as you move.
• The muscles and ligaments that hold the spine together.

Back injuries are the most common cause of back pain. Injuries frequently occur when you use your back muscles in activities that you do not do very often, such as lifting a heavy object or doing yard work. Minor injuries also may occur from tripping, falling a short distance, or excessive twisting of the spine. Severe back injuries may result from car crashes, falls from significant heights, direct blows to the back or the top of the head, a high-energy fall onto the buttocks, or a penetrating injury such as a stab wound.

Although back pain is often caused by an injury to one or more of the structures of the back, it may have another cause. Some people are more likely to develop back pain than others. Things that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting for long periods, lifting or pulling heavy objects, and having a degenerative disease such as osteoporosis.

Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.

Low back pain may occur in children and teenagers, but children and teens are less likely to see a doctor for low back pain. Although most back problems occur in adults ages 20 to 50, back problems in children younger than 20 and adults older than 50 are more likely to have a serious cause.

Sudden (acute) injuries

Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Pain from an acute injury usually does not last longer than 6 weeks. Acute injuries include:

• An injury to the ligaments or muscles in the back, such as a sprain or a strain.
• A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis.
• A torn or ruptured disc. If the tear is large enough, the jelly-like material inside the disc may leak out (herniate) and press against a nerve. See a picture of a herniated disc.
• An injury that causes the compression of nerves in the lower back (cauda equina syndrome).

Overuse injuries

You may not remember a specific injury, especially if your symptoms began gradually or during everyday activities. These injuries occur most often from improper movement or posture while lifting, standing, walking, or sitting, or even while sleeping. Symptoms can include pain, muscle spasms, and stiffness. The pain often goes away within 4 weeks without any treatment.

Conditions that may cause back problems

Back pain or problems may not be related to an injury.

• Conditions that weaken the spine, such as ankylosing spondylitis, osteoarthritis, osteoporosis, spinal stenosis, or Paget's disease, can cause back pain. These conditions are most common in older adults. In rare cases, tumours or infections can develop in or around the spine.
• Some medical conditions can cause pain to spread to the back from other parts of the body (referred pain). Many health problems that can cause back pain have nothing to do with the bones, joints, muscles, or ligaments of the back.
• Spinal deformities such as scoliosis, kyphosis (Scheuermann's disease), and spondylolisthesis can cause back pain.
• Chronic pain syndrome caused by a previous injury or degenerative disease with aging can cause back pain.

Treatment

Most back pain will get better and go away by itself in 1 to 4 weeks. Home treatment will often help relieve back pain that is caused by minor injuries. It is usually a good idea to continue your regular activities while your back is healing. Avoid heavy lifting and activities that seem to make your back problems worse.

Other treatments for a back problem or injury may include first aid measures, Physiotherapy, manipulative therapy (such as chiropractic), medicine, and, in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Home Treatment

Home treatment may help relieve pain, swelling, and stiffness related to a back problem.

• Return to your normal daily activities and work as soon as you can, although you may need to modify or limit some work tasks.
• Avoid bedrest. Bedrest is not an effective treatment for back pain and may cause you to heal more slowly.
• There isn't strong evidence that heat or ice helps. But you can try using them to see if they help you.
  • Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours. Try a warm shower in place of one session. You can also buy single-use heat wraps that last up to 8 hours.
  • You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours.
• Change position every 30 minutes. Gently massage or rub the area to help relieve pain and to encourage blood flow. Do not massage the injured area if it causes pain.
• Avoid sitting up in bed, sitting on soft couches, and twisting or sitting in other positions that make your symptoms worse.
• Try one of the following sleep positions if you have trouble sleeping at night:
  • Lie on your back with your knees bent and supported by large pillows, or lie on the floor with your legs on the seat of a sofa or chair.
  • Lie on your side with your knees and hips bent and a pillow between your legs.
  • Lie on your stomach if it does not increase your pain.
• Begin moderate aerobic exercise. Take short walks (3 to 5 minutes every 3 hours) on level surfaces as soon as you can to help keep your muscles strong. Avoid hills and stairs. Walk only distances that you can manage without pain, especially pain in your legs. Add to your exercise program every week to continue your progress.
• Do pelvic tilt exercises to gently move the spine and stretch the lower back. Lie on your back with your knees bent and feet flat on the floor. Slowly tighten your stomach muscles and press your lower back against the floor. Hold the position for 10 seconds. Do not hold your breath. Slowly relax.

More home treatment for a tailbone (coccyx) injury

• A warm sitz bath for 20 minutes, 3 to 4 times per day after the first 48 to 72 hours, can be soothing to the tailbone area. Sitting in a hot tub or warm bath may also feel good, as long as you are not sitting directly on your tailbone.
• Do not sit on hard, unpadded surfaces.
• Sit on a C-shaped pillow with the open space under your tailbone to take pressure off the tailbone area.
• Avoid constipation. Straining to have a bowel movement will increase tailbone pain. For more information, see the topic Constipation, Age 12 and Older.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.

Home treatment 2 to 3 days after the injury

• Continue with daily walks, increasing the walks to 5 to 10 minutes 3 to 4 times a day.
• Try swimming, which is good for your back. It may be painful immediately after a back injury, but lap swimming or kicking with swim fins often helps prevent back pain from coming back.
• Take a yoga class or get a massage.

Back pain often gets better when you gradually increase your physical activity. Try to get back to your normal routines and activities as soon as possible. Resting and not doing anything may actually increase back pain or make it last longer.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

• One or both legs become weak or numb.
• You lose control of your bowels or bladder.
• Back pain does not improve or gets worse.
• Fever develops.
• Symptoms become more severe or frequent.

Prevention

There is no clear evidence that you can prevent back pain. But there are some things you can do that may help prevent it. And they can prepare you for faster recovery if you do have back pain.

• Exercise to keep your back healthy and strong.
  • Fitness: Increasing Core Stability.
  • Low Back Pain: Exercises to Reduce Pain.
• Learn how to lift objects safely to protect your back.
  • Back Problems: Proper Lifting.
• Think about your posture, whether you are sitting or standing.
• Try different sleeping positions that protect your back.
• Wear low-heeled shoes.
• Stay at a healthy weight to avoid excess strain on your lower back. For more information, see the topic Weight Management.
• If you're a smoker, quit.
• Eat a healthy diet.
• Manage stress.
• Make sure children and teenagers use school bags and backpacks correctly.

Exercises to avoid

Some exercises actually increase the chances of causing of low back pain. Avoid:

• Straight-leg sit-ups.
• Bent-leg sit-ups during acute back pain (may be safe if back is kept in neutral position).
• Leg lifts (lifting both legs while lying on your back).
• Lifting heavy weights above the waist (military press or biceps curls while standing).
• Any stretching done while sitting with the legs in a V position.
• Toe touches while standing.

Work comfort and design

Most back problems that occur in the workplace are caused by physical stress, such as being in an awkward position for a long time, making the same motions over and over, and simply using your back too much. These injuries can cause stress and strain on muscles, nerves, tendons, joints, blood vessels, or spinal discs.

Arrange your work to help prevent work-related injuries. It is important to position yourself so that you can sit comfortably and minimize stress on any one area of your body. Change your positions and tasks as often as possible, and match tools to your size and preferences. If you are doing a job or task that requires you to sit for long periods, get up and stretch and move around at least once an hour.

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms?
• How long have you had your symptoms?
• If you were injured, how and when did the injury occur? How was it treated?
• What were you doing at the time the back pain started?
• Have you been in a fight or been punched or kicked in the back?
• Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
• If you have chronic back pain, has the pain changed significantly?
• Do you have leg weakness; numbness in the buttocks, genitals, or legs; or loss of bladder or bowel control?
• Do you have any other symptoms, such as belly pain, urinary problems, or fever?
• Have you recently been treated for a kidney or bladder infection or other problem?
• Have you had any recent, unexplained weight loss?
• Do you have a fever?
• What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
• Do you think that activities related to your job or hobbies caused your symptoms?
• What home treatment measures have you tried? Did they help?
• What non-prescription medicines have you taken? Did they help?
• Do you have any health risks?