Back Pain

man with back pain

Fast Facts

  • Approximately 80% of the world's population develops back pain at some point during their life.
  • Low back pain is a common problem and rarely associated with a severe illness. Nevertheless, it causes disability in 5.4 million Americans and costs at least $90 billion in medical and non-medical expenses.
  • The diagnosis of low back pain is determined by a medical history and physical examination, and rarely requires expensive or uncomfortable tests.
  • The vast majority of individuals heal from back pain by remaining active and exercising while occasionally taking pain-relieving drugs.
  • Lifestyle changes are beneficial in successful management of back pain.

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.

What causes back pain?

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:

  • Muscle strains usually related to sustained physical activity such as shoveling snow, gardening or prolonged driving. Acute strain may also occur when completing a common task from a twisted or rotational posture.
  • Osteoarthritis and degenerative disc disease causes narrowing of the intervertebral discs located between the vertebrae of the spine. This narrowing is a common occurrence as a result of aging. The adjacent vertebrae grow spinal joint spurs in response to the increasing pressure placed on them. The bony growths can cause localized pain in the back or leg pain related to nerve impingement.
  • A herniated intervertebral disc may cause back pain associated with muscle spasms, as well as severe leg pain as the disc presses on a nerve in the low back. The pain radiating down the leg is called sciatica. Disc herniation may cause a loss of function of the nerve that may include a loss of reflex, sensation, or muscle strength.
  • Spinal stenosis is a narrowing of the canal that the spinal cord occupies. This narrowing has many causes including bone spurs growing around the spinal joints, thickening of spinal ligaments, or bulging of a disc. The narrowed canal squeezes the nerve roots causing leg pain, numbness, or weakness. The pain is increased by standing, bending, and sitting, and may be relieved by changing posture and positions.
  • Diffuse Idiopathic Skeletal Hyperostosis (DISH), resulting from excessive bone growth can affect the vertebrae from the neck to the lower back causing pain and stiffness.

Systemic disorders that can lead to back pain and may include ankylosing spondylitis, osteoporosis, tumors, spinal infections, and osteoporosis resulting in compression fractures.

How is back pain diagnosed and treated?

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.

Living with back pain

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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