Lower Back Pain: Symptoms, Causes, and Treatments
Most people have had or will experience lower back pain at some point in their lives. It’s a common reason to call in sick to work. And if you think it’s reserved for older people, think again. It’s not unheard of for children to suffer from a bad back.
The severity of back pain varies. It may be a dull ache or a sharp pain. The pain may last a few days, or it might continue over a year.
Types of Lower Back Pain
There are two kinds of back pain, acute and chronic. Acute back pain is a short-term condition that may last as little as a handful of days or as long as a few weeks or even a few months.
Some differentiate between shorter and longer cases of temporary back pain by using the term subacute. Back pain that resolves in 4 weeks or fewer is considered acute, while subacute low back pain takes between 4 to 12 weeks to disappear.
Normally, self-care at home is all that’s needed to treat acute pain, and there should be no long-lasting damage or functional loss.
Chronic lower back pain affects a person past the 12-week mark. This persistent pain does not always have a clear cause. Sometimes treatment eases chronic back pain, but in other cases, the pain continues even after serious treatments such as surgery.
Symptoms of Lower Back Pain
Common symptoms of back pain include:
- Aching muscles
- A shooting or stabbing pain
- Pain that increases when you bend over, lift an object, or walk
- Pain that decreases when you recline back
- Pain that runs down one of your legs
These symptoms may not require a doctor’s visit and will likely improve with time. However, you should see a doctor if:
- You unexpectedly lose weight.
- Your back pain does not improve.
- Your pain continues down one or both legs.
- You experience bowel or bladder problems.
- You develop a fever.
Causes of Lower Back Pain
There are a wide variety of causes when it comes to lower back pain. When it comes to acute back pain, most are the result of something upsetting or obstructing how the various parts of your back work together. Your back is made up of your spine, muscle, nerves, and intervertebral discs, which are fluid-filled discs that absorb shock from movement and cushion your spinal bones. Not to mention, repetitive motion (repeating the same task over and over again) can also be a contributing factor to back pain.
Causes can be sorted into congenital, degenerative issues, injury-related problems, and whether or not they occur because of the spine.
Skeletal irregularities are one example of a congenital cause. These irregularities include:
- Scoliosis, which is an abnormal curve to the spine shaped like an “S” or a “C.”
- Excessive lordosis, when the spine has an exaggerated arch in the lower back area.
- Excessive kyphosis, when the spine excessively curves outward.
Another congenital cause is spina bifida. This occurs when the bones around the spinal cord or the spinal cord itself doesn’t properly form in utero.
Traumatic injuries can include sports injuries, damage from a car accident, or just a simple fall. Anything that can damage tendons, ligaments, or muscles or that can compress the spine or rupture discs. Ligament sprains, strained muscles or tendons, and muscle spasms are another set of injury-related causes.
Nerve and spinal cord problems include:
- Sciatica, which occurs when the sciatic nerve becomes pinched. The sciatic nerve extends down your legs, which is why you may feel pain down your leg along with lower back pain.
- Spinal stenosis, which occurs when the spinal column narrows and increases pressure on the spinal cord.
- A herniated, slipped, or ruptured disc. This is when one of the discs that cushion your vertebrae move out of alignment, which can increase pressure on the spinal nerves and result in irritation of the nerves.
- Osteoporosis, a condition where your bones deteriorate and become more brittle.
Degenerative diseases that can cause back pain include:
- Arthritis, a joint inflammation disorder.
- Disc degeneration, where the jelly-like discs in your spine wear down.
- Spondylosis, common in older people as the spine undergoes wear and tear.
Back pain can be caused by things unrelated to your spine or back muscles, including:
- Kidney stones. Often, you feel the pain of a kidney stone on one side of your lower back.
- Fibromyalgia, which is a chronic disorder that causes fatigue and muscle pain.
- Endometriosis, which is when the soft tissue that lines a womb grows outside of the uterus.
- Pregnancy. Back pain firing pregnancy is typically caused by postural changes (increased lumbar lordosis), which can resolve after pregnancy but can remain postpartum.
Risk Factors for Lower Back Pain
You can develop back pain at almost any point in your life, even as a young child. But some factors can increase your chances of back pain:
- Age: Back pain grows more common with age, with the first incidence commonly occurring between ages 30 to 50. This is because the risk of spine and bone-related conditions increases as we grow older, while the discs that cushion our vertebrae also lose their fluid and flexible nature.
- Genetics: Some causes of back pain have a genetic component, such as certain forms of arthritis.
- Body weight: If you’re overweight or you gain a significant amount of weight in a short period, the added weight can stress your back, causing pain.
- Poor physical condition: Back pain is a more common ailment for those who aren’t physically in shape. Low-impact aerobic exercise and abdominal strengthening exercises can help your spine stay healthy. You’re also more likely to suffer back pain if you try to squeeze in a week’s worth of physical activity over the weekend, rather than exercise moderately throughout the week.
- Mental health and psychological factors: Anxiety, depression, stress, or even just a low mood can affect your perceptions of pain. Stress can also cause your muscles to tense. It can even become a vicious cycle, with chronic pain changing your mental health for the worse.
- Part of the job: If your job has you lifting, pushing, or pulling heavy objects or spending a lot of the day twisting your spine, it can result in back pain. The opposite, a desk job that has you sitting for most of the day, can be just as bad, especially if you have poor posture or sitting in a chair with improper back support.
- Heavy backpacks: Carrying a lot on your back weighs your back and shoulders down, causing soreness and putting you at risk of straining their lower back muscles. Plus, heavy purses or carrying a purse constantly on one side can cause back pain.
Diagnosing Back Pain
For a proper diagnosis, your doctor may review your complete medical history and give you a physical exam. Some tests may be conducted to determine causes and treatments. Possible tests include:
- Blood tests to check for signs of inflammation, infection, arthritis, and cancer.
- Bone scans can find an infection, fracture, or bone disorder.
- Imaging tests are a noninvasive way to rule out specific causes, such as spinal stenosis or tumors. Aside from the traditional X-ray imaging, there’s also magnetic resonance imaging (MRI) scans that create computer-generated images of your bones and soft tissues.
Treatment Options for Lower Back Pain
Treatments for back pain often depend on its severity. Milder cases can be easily resolved by at-home care and various therapies, while more serious cases may require surgical treatment. Speaking with your doctor can help you chart out an appropriate treatment plan.
Avoid too much bed rest; most experts recommend no more than 48 hours of rest. It’s linked with a longer recovery period.
Though you shouldn’t spend too much time lying in bed, you might want to consider if your mattress is causing or worsening your back pain. When you sleep on a too-soft or unsupportive mattress, your spine may bow into the mattress while resting. The best mattresses for back pain typically have a medium-firm feel, according to a 2015 study.
If you’re a side sleeper, try placing a pillow between your legs for more comfort. A body pillow is also helpful for people who sleep on their sides, as it can be placed between the knees and the upper arm for support.
Back sleepers can try elevating their knees with a wedge pillow or adjustable base to keep pressure off their lower back. Also, avoid sleeping on your stomach as this can cause back pain.
Over-the-counter pain medications and skeletal muscle relaxants can make it easier to continue your day normally. However, the American College of Physicians recommends first non-drug treatments such as heat treatments and massages.
If you use heat pads and ice packs to reduce pain, take care that you don’t use the heat pad on a high setting, and do not place ice directly on your skin. Also, you should take care not to use heat/ice for greater than 15-20 minutes at a time. Heat should be used prior to activity and ice should be utilized after activity.
Complementary therapy may be used alongside more traditional medicine to treat lower back pain. It may involve exercising or manipulating muscles or using a machine to relax and change your perception of pain.
If you’re looking to become more active or are recovering from an accident, it might help to sign up for physical therapy. Working with a physical therapist can help you strengthen the core muscles that support your lower back. A physical therapy program can also improve your mobility, flexibility, and posture.
“After examination, the physical therapist will design a program for your specific diagnosis which can include manual therapy (joint mobilizations, joint manipulations, and massage as indicated), postural re-education, strengthening, stretches, and more,” says Dr. Jennifer Miller, physical therapist. “It’s important to follow the guidelines that your PT has provided, as not all diagnoses are created equal. For example, if you have spinal stenosis, your PT will instruct you to avoid activities that extend (arch) your back. Performing your exercises and being mindful about posture is very important but your PT will ask you about your daily activities and sleep patterns to determine how those areas might be contributing to your back pain. After all, we spend a great deal of time at work and sleeping.”
Chiropractors use their hands to manipulate, massage, and stimulate your spine and back tissue. These treatments can provide short-term relief for people with chronic back pain. There are two types of chiropractic care, spinal manipulation and spinal mobilization:
- Manipulation involves rapid movements.
- Mobilization has slower adjustments.
However, chiropractic care may not be an appropriate treatment if your back pain is the result of a condition such as osteoporosis, spinal cord compression, or arthritis.
Behavioral treatment can take the form of cognitive therapy and biofeedback:
- Cognitive therapy teaches you relaxation techniques to ease the pain.
- Biofeedback is when electrodes are attached to your skin, allowing a machine to measure your breathing, muscle tension, heart rate, and skin temperature. You use relaxation techniques to manage your response to pain.
When at-home treatments and physical therapy fail, surgery may be considered. Some options include:
- Spinal laminectomy, sometimes called spinal decompression, treats symptoms of a narrowed spinal canal. The bony walls of the vertebrae and any bone spurs are removed during surgery, relieving pressure on the spinal nerves.
- Discectomy is when a herniated disc is removed through a small cut in the back. It may be performed with a laminectomy.
- Artificial disc replacement is just what it sounds like. When one of the discs that cushions your vertebrae is damaged, a surgeon removes the disc and replaces it with a synthetic version.
- Spinal fusion is an alternative to disc replacement and can treat degenerative disc disease or spondylolisthesis. A disc is removed, and the vertebrae are then attached through bone grafts or metal devices. This treatment can result in a loss of flexibility.
- Interspinous spacers treat spinal stenosis. These small devices are placed into your spine to open up the spinal canal, keeping the nerves from being pinched.
Preventing Back Pain
As the saying goes, an ounce of prevention is worth a pound of cure. Taking steps to keep your back in good condition is better than having to alleviate back pain.
One important measure is maintaining a healthy weight. If you’re overweight, it places more stress on your back muscles.
You should also take the time to exercise, to keep your weight down and to strengthen your muscles. Walking and swimming are good low-impact exercises that can increase the endurance of your back muscles. Talk to your doctor or physical therapist about other exercise ideas that can strengthen your core muscles and improve your leg’s flexibility for better pelvic alignment.
Wear low-heeled shoes and watch how you stand and move. Avoid slouching. If you’re going to stand for a long time, try to use a footstool to take the stress off your back. Place one foot on the stool, and then after a time, let the other foot have a turn.
When you’re sitting, keep your hip and knees at a 90-degree angle. Use a swivel chair with good back support and armrests. Try to move around or change position every 30 minutes. Keeping a tiny pillow under the small of your back can help your spine maintain its natural curve.
When it comes to carrying heavy objects, let your legs do the lifting. Keep your back straight, bending only at your knees. Hold the object close to you as you carry it.
Make sure your diet includes plenty of calcium and vitamin D. Ingesting these two keeps your bones strong, preventing osteoporosis. When osteoporosis has weakened your bones, you’re more likely to experience a spine fracture that can cause back pain.
How much calcium is right for you? Men up to age 70 and women up to age 50 should ingest 1,000 milligrams of calcium daily. People past these ages should ingest 1,200 milligrams of calcium every day. Remember to always check with your doctor for supplement and medication guidelines.
Frequently Asked Questions
If your back pain is mild enough for you to treat it at home, one of the most important things you can do is remain relatively active. Too much bed rest can stretch out your recovery time. You can alleviate your pain with over-the-counter painkillers, heat pads, and cold packs.
Has your back pain continued or even worsened over a few weeks? Then you might need to take more severe measures and should consult your primary care physician about the specifics.
Sitting for too long can cause or worsen existing lower back pain, for the simple reason that our bodies cannot maintain one position for long without pain. Our bodies operate on the idea that we’ll move around throughout the day. So our muscles start to waste away if we sit uninterrupted for hours on end.
Just moving around or standing up every half hour can limit the harmful effects of a sedentary lifestyle.
If you have a herniated disc, you may feel pain when you bend over and straighten back up. Back pain from muscle strain tends to hurt less when you lean forward and more when you resume standing. You’re also more likely to experience numbness and pain down one of your legs if you have a herniated disc. Pain from muscle strain is usually restricted to your lower back.
Walking can be a good way to ease back pain, as are other aerobic, low-impact exercises. It strengthens muscles, including those that maintain good posture, and improves circulation. It can also toughen up your bones and prevent bone density loss.
However, some people may find that walking only aggravates their back pain. If that happens, you might want to consider water-based exercises such as water aerobics.
Most of us experience back pain at some point in our lives, and often simple home treatments and life adjustments can ease symptoms. However, if you experience any of the following symptoms, you’ll want to seek immediate medical attention:
- You experience fever, along with your back pain.
- You have bowel or bladder problems.
- Your back pain is the result of a fall, blow to your back, or another injury.
You should also see a doctor if:
- Your back pain doesn’t improve or worsens after several weeks.
- You’re more than 50 years old.
- The pain spreads down one leg, possibly down to your toes.
- Your legs feel weak or numb.
- You experience unexplained weight loss.
- You have a history of cancer or osteoporosis.
A memory foam bed can leave you waking up with back pain if it’s the wrong firmness for you. Otherwise, it’s an excellent material for pressure and pain relief, which is why we recommend a memory foam mattress for back pain. When you’re choosing a mattress firmness, consider your body weight and sleeping position.
Your body weight affects how much pressure you place on the mattress. Firmer mattresses need more pressure from your body to feel conforming than a soft mattress does. If you’re under 130 pounds, you should look for a softer mattress, while anyone who weighs more than 230 pounds might want to consider a firmer bed.
Your sleeping position affects the support you need to keep your spine in a neutral position. Side sleepers should look for a soft to medium mattress that will conform to their hips and shoulders; a firmer mattress may raise their spine out of alignment. Back and stomach sleepers need a medium-firm to firm mattress to prevent their spine bowing into the bed.
Did We Help?
Back pain is a common ailment that can often be resolved at home. Therapy can make a chronic case of back pain more comfortable to manage. In the most severe cases, surgery may be required for you to resume your normal life.
If your back pain does not feel better within a few weeks, you should reach out to your doctor to discuss potential causes and treatments. And if bladder issues or a fever accompanies your back pain, you should seek immediate medical attention.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.