Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and sometimes even debilitating.

Back pain can result from injury, activity, and some medical conditions. It can affect people of any age and for different reasons. As people get older, the likelihood of developing lower back pain increases due to factors such as previous occupation and degenerative disk disease.

Lower back pain may be relating to the bony lumbar spine, disks between the vertebrae, ligaments around the spine and disks, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, or the skin around the lumbar area.

Pain in the upper back may be due to disorders of the aorta, tumors in the chest, or spine inflammation.

Causes

The human back consists of a complex structure of muscles, ligaments, tendons, disks, and bones that work together to support the body and enable movement.

The segments of the spine are cushioned with cartilage-like pads called disks.

Problems with any of these components can lead to back pain. In some cases of back pain, however, the cause remains unclear.

Damage can result from strain, medical conditions, or poor posture, among other things.

Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:

• strained muscles or ligaments
• a muscle spasm
• muscle tension
• damaged disks
• injuries, fractures, or falls

Strain

Activities that can lead to strains or spasms include:

• lifting something improperly
• lifting something that is too heavy
• making an abrupt, awkward movement

Structural problems

A number of structural problems may also result in back pain:

• Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures, there will be more pressure on a nerve, resulting in back pain.
• Bulging disks: Much in the same way as ruptured disks, a bulging disk can lead to more pressure on a nerve.
• Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg. This may occur when a bulging or herniated disk presses on a nerve or when a muscle pushes specifically on the sciatic nerve.
• Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other areas in the body. In some cases, the space around the spinal cord narrows. Health experts call this spinal stenosis.
• Unusual curvature of the spine: If the spine curves in an unusual way, back pain can occur. An example of this is scoliosis, in which the spine curves to the side.
• Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
• Kidney problems: Kidney stones or kidney infection can cause back pain.

Movement and posture

Adopting a hunched sitting position when using a computer can lead to increased back and shoulder problems over time.

Back pain can also result from some everyday activities or poor posture.

Examples include:

• twisting
• coughing or sneezing
• overstretching
• bending awkwardly or for long periods
• pushing, pulling, lifting, or carrying something
• standing or sitting for long periods
• straining the neck forward, such as when driving or using a computer
• driving for lengthy periods without taking a break, even when not hunched
• sleeping on a mattress that does not support the body or keep the spine straight

Other causes

Some medical conditions can lead to back pain:

• Cauda equina syndrome: The cauda equina is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms of this syndrome include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. Sometimes, bowel and bladder function disturbances occur.
• Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain. The structural damage to the bone itself can also be painful when there are tumors or metastasis to the bone.
• Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
• Other infections: Pelvic inflammatory disease and kidney or bladder infection may also lead to back pain.
• Sleep disorders: Individuals with sleep disorders are more likely to experience back pain than others.
• Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves have become affected. A rash will follow the back pain.

Symptoms

The main symptom of back pain is an ache anywhere in the back and sometimes all the way down to the buttocks and legs.

Some back issues can cause pain in other parts of the body, depending on the nerves affected.

The pain often goes away without treatment. However, if it occurs with any of the following, a person should contact a doctor:

• unexplained weight loss
• fever
• inflammation or swelling on the back
• persistent back pain where lying down or resting does not help
• pain down the legs
• pain that reaches below the knees
• a recent injury, blow, or trauma to the back
• urinary incontinence
• difficulty urinating
• fecal incontinence, or loss of control over bowel movements
• numbness around the genitals
• numbness around the anus
• numbness around the buttocks

When to contact a specialist

A person should seek medical help if they experience any numbness or tingling or if they have back pain:

• that does not improve with rest
• after an injury or fall
• with numbness in the legs
• with weakness
• with fever
• with unexplained weight loss

Treatment

Back pain usually resolves with rest and home remedies, but sometimes, medical treatment is necessary.

Home treatments

Over-the-counter (OTC) pain relief medication — usually, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen — can relieve discomfort. Applying a hot compress or an ice pack to the painful area may also reduce pain.

Resting from strenuous activity can help, but moving around will ease stiffness, alleviate pain, and prevent muscles from weakening.

Medical treatment

If home treatments do not relieve back pain, a doctor may recommend the following medication, physical therapy, or both:

Medication

Back pain that does not respond well to OTC pain relief medication may require a prescription NSAID.

Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by a doctor. In some cases, doctors may also recommend muscle relaxants.

Antidepressants, such as amitriptyline, may be prescribed, but research into their effectiveness is ongoing, and the existing evidence is conflicting.

Physical therapy

Applying heat, ice, ultrasound, and electrical stimulation, as well as some muscle release techniques, to the back muscles and soft tissues may help alleviate pain.

As the pain improves, a physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help.

It is advisable to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence.

Cortisone injections

If other options are not effective, these may be injected into the epidural space, around the spinal cord.

Cortisone is an anti-inflammatory drug. It helps reduce inflammation around the nerve roots. Injections may also be used to numb areas thought to be causing the pain.

Botox

According to research, botox reduces pain by paralyzing sprained muscles in spasm. These injections are effective for about 3–4 months.

Traction

Pulleys and weights are used to stretch the back. This may result in a herniated disk moving back into position. It can also relieve pain but only while traction is applied.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) can help manage chronic back pain by encouraging new ways of thinking. It may include relaxation techniques and ways of maintaining a positive attitude.

Studies have found that people receiving CBT tend to become more active and do exercise, which lowers the risk of back pain recurrence.

Surgery

Surgery for back pain is very rare. If an individual has a herniated disk, surgery may be an option, especially if there is persistent pain and nerve compression, which can lead to muscle weakness.

Examples of surgical procedures include:

• Fusion: A surgeon joins two vertebrae and inserts a bone graft between them. The vertebrae are splinted together with metal plates, screws, or cages. There is a significantly greater risk of arthritis to subsequently develop in the adjoining vertebrae.
• Artificial disk: A surgeon inserts an artificial disk that replaces the cushion between two vertebrae.
• Diskectomy: Surgeons may remove a portion of a disk if it is irritating or pressing against a nerve.
• Partially removing a vertebra: A surgeon may remove a small section of a vertebra if it is pinching the spinal cord or nerves.

Injecting cells to regenerate spinal disks: Scientists from Duke University in Durham, NC, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effectively eliminating pain resulting from degenerative disk disease.

Complementary therapies

Complementary therapies may be used alongside conventional therapies or on their own.

Chiropractic, osteopathy, shiatsu, and acupuncture may help relieve back pain and encourage a person to feel relaxed.

• An osteopath is a physician who specializes in treating the skeleton and muscles.
• A chiropractor treats joint, muscle, and bone problems. The main focus is the spine.
• Shiatsu, or finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with the fingers, thumbs, and elbows.
• Acupuncture, which originated in China, involves inserting fine needles into specific points in the body. Acupuncture can help the body release its natural pain relievers — endorphins — and stimulate nerve and muscle tissue.
• Yoga involves specific physical poses, movements, and breathing exercises. Some of these may help strengthen the back muscles and improve posture. Care must be taken that exercises do not make back pain worse.

Studies on complementary therapies have given mixed results. Some people have experienced significant benefits, while others have not. When considering alternative therapies, it is important to seek guidance from a qualified and registered therapist.

Transcutaneous electrical nerve stimulation (TENS) is a popular therapy for individuals with chronic back pain. The TENS machine delivers small electric pulses into the body through electrodes placed on the skin.

Experts believe TENS encourages the body to produce endorphins and may block pain signals returning to the brain. Studies on TENS have provided mixed results. Some showed no benefits, while others indicate that it could be helpful for some people.

A TENS machine should be used under the direction of a healthcare professional.

A person should avoid TENS if they:

• are pregnant
• have a history of epilepsy
• have a pacemaker

TENS is considered “safe, noninvasive, inexpensive, and patient friendly,” and it appears to reduce pain. However, more evidence is necessary to confirm its effectiveness in improving activity levels.

Risk factors

The following factors are linked to a higher risk of developing low back pain:

• occupational activities
• pregnancy
• a sedentary lifestyle
• not enough exercise
• older age
• obesity
• smoking
• strenuous physical exercise or work, especially if done incorrectly
• genetic factors
• medical conditions, such as arthritis and cancer

Lower back pain also tends to be more common in females than in males, possibly due to hormonal factors. Additionally, health experts associate back pain with stress, anxiety, and mood disorders.

Diagnosis

A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination.

An imaging scan and other tests may be necessary if:

• back pain appears to result from an injury
• there is an underlying cause that requires treatment
• the pain persists over a long period

An X-ray, an MRI scan, or a CT scan can give information about the state of the soft tissues in the back:

• X-rays can show the alignment of the bones and reveal signs of arthritis or broken bones, but they cannot reveal damage in the muscles, spinal cord, nerves, or disks.
• MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
• Bone scans can detect bone tumors or compression fractures resulting from osteoporosis. A radioactive substance, or tracer, is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera. Doctors use these for bone conditions and difficult-to-detect fractures.
• Electromyography measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.

A doctor may also order a blood test if they suspect an infection.

Other types of diagnosis

• A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
• An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
• A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.

Chronic or acute pain?

Health experts distinguish two types of back pain: acute and chronic.

Acute pain starts suddenly and lasts for up to 6 weeks.

Chronic, or long-term, pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.

If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.

Prevention

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise

Regular exercise helps build strength and manage body weight. Guided, low impact aerobic activities can boost heart health without straining or jerking the back.

Before starting any exercise program, a person should consult a healthcare professional.

There are two main types of exercise that people can do to reduce the risk of back pain:

• Core-strengthening exercises work the abdominal and back muscles, helping strengthen muscles that protect the back.
• Flexibility training aims at improving core flexibility, including the spine, hips, and upper legs.

Diet

A person’s diet should include sufficient amounts of calcium and vitamin D, as these are crucial for bone health.

A balanced diet also helps manage body weight.

Smoking

A significantly higher percentage of people who smoke have back pain incidences, compared with individuals who do not smoke and who are of the same age, height, and weight.

Body weight

The weight people carry and where they carry it affects the risk of developing back pain.

People with obesity are at considerably higher risk of experiencing back pain than those with a moderate body weight.

Moreover, people who carry excessive weight in the abdominal area rather than in the buttocks and hip area are also at greater risk.

Posture when standing

Make sure you have a neutral pelvic position. Stand upright, with the head facing forward and a straight back, and balance your weight evenly on both feet. Keep your legs straight and your neck in line with the rest of the spine.

Posture when sitting

A good seat for working should have good back support, arm rests, and a swivel base.

When sitting, try to keep your knees and hips level and keep your feet flat on the floor or use a footstool. You should be able to sit upright with support in the small of your back.

If you are using a keyboard, make sure that there is a 90-degree angle between the upper arm and forearm.

Lifting

When lifting things, use your legs, not your back, to do the lifting.

Maintain a long spine and keep your feet apart, with one leg slightly forward so that you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.

Bending your back initially is unavoidable, but when you bend your back, try not to stoop and be sure to draw your low belly in so that your pelvis stays neutral and supported. Most importantly, do not straighten your legs before lifting, or you will be using your back for most of the work.

Avoid lifting and twisting at the same time

If something is particularly heavy, see whether you can lift it with someone else. While you are lifting it, keep looking straight ahead, not up or down, so that the neck is in alignment with the rest of the spine.

Moving things

It is safer for the back to push, not pull, things across the floor, as that way, you will be using your leg strength.

Shoes

Shoes with a low heel place less of a strain on the back. However, some flat shoes with minimal support, such as flip-flops, can also contribute to back pain.

Driving

It is important to have proper support for your back when driving.

Make sure the wing mirrors are properly positioned so that you do not need to twist. The pedals should be squarely in front of your feet.

If you are driving for a long time, have many breaks. Get out of the car and walk around.

Bed

You should use a mattress that keeps the spine properly aligned and supports the weight of the shoulders and buttocks. Also, use a pillow that does not force your neck into a steep angle.