Back pain is just that - pain in the back. The pain can stay localized to the spine or it may radiate into the buttocks and/or legs below the knee (sciatica). Most episodes of back pain are caused by mechanical disorders. Inactivity including prolonged sitting and standing often aggravate back symptoms. Rarely, back pain can be the result of over 60 more serious illnesses and can result in serious disability and escalating medical bills.The good news is about half of individuals with low back pain improve within a week or two, and 90% recover within eight weeks.
Most episodes of back pain are caused by mechanical disorders associated with accidents and lifting incidents, or the gradual changes associated with aging. In about 10% of the cases, back pain is caused by a systemic illness.
The disorders affecting the lower back can be divided into mechanical and systemic disorders. Mechanical disorders that can result in back pain include:
Systemic disorders that can lead to back pain and may include ankylosing spondylitis, osteoporosis, tumors, spinal infections, and osteoporosis resulting in compression fractures.
Typically, medical history, physical examination, and standard radiology studies are required to diagnose low back pain. In some cases, individuals who do not respond to initial physical therapy may undergo specialized radiographic tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT) to screen for additional involvement of soft tissues, ruptured discs, spinal stenosis, tumors or nerve injuries.
When treating back pain bed rest should be kept to a minimum. Instead, patients should continue their activities of daily living, as tolerated. Referral to a physical therapist to develop an individualized exercise program and receive low back education will be beneficial for patients with back pain.
While excessive exercise should be discontinued until the pain is relieved, there are exercises that can help reduce pain. Pain management exercises may include flexion exercises (bending forward) and extension exercises (bending backwards), stretching, and strengthening.
Five to ten-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain. Heat may help to relax the muscles. Heat should also be used to treat back pains that last longer than 48 hours. Over-the-counter pain relievers such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) are frequently adequate to control episodes of back pain, and muscle relaxants may help those with limited motion secondary to muscle tightness.
Massage therapy has proven helpful for those with chronic muscular pain, and some patients with mechanical back pain of the cervical, thoracic and/or lumbar spine have been known to benefit from manipulation of the spine.
A small minority of low back pain patients, particularly those with leg pain due to a herniated intervertebral disc, spinal stenosis, or tumors affecting structures in the spine may require surgery.
In most instances, individuals with low back pain will improve over a two- to six-week period. The goal is to minimize recurrences and, while being in good physical condition does not prevent all back pain episodes, it will make the resolution of those episodes easier. Lifestyle changes may be necessary. Be sure to pay attention to your body, exercise, eat right and maintain a healthy lifestyle. If you smoke, stop. Smoking is a predisposing factor for back pain. Obesity does not cause back pain, but it is a factor that makes it more difficult to heal. If you are overweight, try to increase your activity level and eat healthier to get into shape. No particular diet is known to prevent episodes of low back pain.
Updated December 2020 by Robert W. Richardson, PT, FAPTA, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
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