Back pain describes any pain or discomfort in the back. There is a wide variety of back pain types which differ in their time of onset, persistence, location in the back, type and severity of the pain, and in their cause.
Back pain is incredibly common, affecting an estimated four out of every five people at some point in their lives and nearly half of all adults each year. It is the fifth most common reason for doctor visits and is estimated to cost $50 billion each year in medical bills and lost productivity.
The pain can affect the upper or lower back, although lower back pain is more common. It can range from a dull, persistent ache to a sudden stabbing pain.
The pain can come on suddenly and last for just a few days (called acute pain) or for months (chronic pain). It can be present all the time, or it can come and go. Back pain can be due to problems with the muscles, nerves, bones, joints or other structures in the spine.
Also called a pulled muscle or tendon, a strain often occurs during heavy lifting or after a sudden awkward movement of the back. Another common cause of back pain is connective tissue injuries to the ligaments and soft tissues around the spine. All these types of injuries tend to cause acute pain that heals with time.
Nerve injury is another cause of back pain. The nerves that provide sensory information from the back must all pass through a small hole close to the site where each pair of vertebrae meets. In between each vertebra is a disk made of cartilage. One common back injury called a herniated or ruptured disc occurs when one of these discs is damaged and pushes into the small hole occupied by the nerve. When this type of injury occurs in a specific portion of the lower spine, it can pinch the sciatic nerve that goes down the leg, causing shooting pain through the buttock and back of the leg. Nerve pain may heal with time or it may require surgery to correct.
Bone and joint problems can also cause back pain. These include osteoarthritis, in which the vertebrae rub against each other and cause pain, and osteoporosis, which weakens bones to the point where the vertebrae can fracture easily. Abnormal spinal curvature such as scoliosis can also lead to back pain.
There are also some rare causes of back pain that can be very serious. These include a cancerous tumor in the spine that can press on a nerve causing back pain, an infection of the spine, or a blood clot in the protective membranes surrounding the spinal cord.
Men and women tend to be affected by back pain equally, although it becomes more common in women as they age. It can occur at any age but is uncommon before puberty and most common between the ages of 30 and 50. The risk of back pain related to spinal degeneration and osteoporosis increases with age.
If you experience unexplained back pain you should consult a medical professional for advice.
What to expect at the doctor: The diagnosis of back pain includes a physical examination and a lot of questions about the conditions that produced pain initially and what movements currently cause pain. To test your range of motion, you may be asked to sit, stand, walk around, bend over, and lift your legs. Many cases of back pain that are caused by a soft tissue injury (muscle and connective tissues like ligaments) can be diagnosed on the basis of your description of the pain and the physical exam. However, to rule out other more serious causes of back pain, the doctor may order some tests.
Testing, testing: The tests that are commonly used to illuminate the cause of back pain are imaging tests that produce a picture of your spine and surrounding tissues. An X-ray is the simplest of these, while a computerized tomography (CT) scan provides more detail and magnetic resonance imaging (MRI) even greater detail. These can reveal things like tumors and disc injuries that can put pressure on the spinal nerves. Occasionally, electroneurography (ENG) is performed to test if the nerves are conducting information to the muscles properly.
Contrary to the conventional wisdom, bed rest beyond a day or two is not usually recommended and can actually do more harm than good. Low-impact exercise and specialized stretches are commonly recommended and physical therapy can also help. Most back pain improves within a few weeks with over-the-counter pain relievers and self-care. If it does not, other medications or therapies may be needed.
Keep fit: when your back and stomach muscles are strong, it reduces your chances of several types of back pain.
Don't smoke: smoking increases the risk of back pain and also delays the recovery if a back injury does occur.
Maintain a healthy weight: in addition to strong muscles, carrying less weight, especially belly weight, reduces the strain on your back muscles.
Maintain proper posture: standing with a neutral pelvic position (not tilted), sitting with back support and knees and hips at the same level, and lifting with your legs without twisting can all help reduce the chance of back injuries.
Learn about ergonomics: especially if you work in a physically demanding job, employing principles of ergonomics (designing furniture and tools that conform to the natural contours of the body) can greatly reduce the risk of back injury and help maintain a healthy back. There are also support devices that can assist you with maintaining proper posture and other devices which encourage proper ergonomic movement.
Generally, back pain goes away on its own with self-care and may not require a trip to the doctor. But if you experience sudden back pain, it may be a good idea to consult a doctor or a consulting nurse over the phone or to visit a walk-in clinic to make sure nothing serious is wrong (and to get tips on self-care).
If your back pain does not improve at all within three days, or if it seems to be getting worse, see the doctor to be examined.
Certain signs should warrant a trip to the doctor right away. Do not wait or try to treat yourself, and see a doctor immediately if you experience any of the following:
Some other risk factors for back pain include: