Guide to Lower Back Pain

Part 1 of 10 - Acute Versus Chronic Low Back Pain

Man body discomfort, lower back pain
Lower back pain.. htu / Getty Images

Low Back Pain: A Common Problem

Back pain is a common neurological ailment. Men and women are equally affected. It occurs most often between ages 30 and 50, due in part to the aging process but also as a result of sedentary lifestyle.

Job Disability

Lower back pain is a common cause of job-related disability and missed work. Most occurrences of lower back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

Acute Low Back Pain

Acute back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature, the result of trauma to the lower back or a disorder such as arthritis.

Pain from trauma may be caused by:

  • sports injuries
  • work around the house
  • other stressors on the spine


Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight.

  • Pain felt in one part of the body may radiate from a problem elsewhere in the body.
  • Some acute pain syndromes can become more serious if left untreated.

Lower back pain unrelated to injury or other known cause is unusual in pre-teen children, although, heavy backpacks can strain the back.

Chronic Low Back Pain

Chronic back pain is measured by duration, pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.

Risks of lower back pain from disc disease or spinal degeneration increase with age.

Part 2 of 10 - What Structures Make Up the Lower Back?

Spinal Column

The centerpiece is the spinal column, which supports the upper body’s weight and houses and protects the spinal cord. Stacked on top of one another are more than 30 bones (the vertebrae) that form the spinal column or spine. Each of these bones contains a roundish hole that, when stacked in register with the others, creates a channel that surrounds the spinal cord.

Spinal Cord

The spinal cord descends from the base of the brain to just below the rib cage. Small nerves (roots) enter and emerge from the spinal cord through spaces between the vertebrae.

Cauda Equina

Because the bones of the spinal column continue growing after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This bundle of nerve roots is known as the cauda equina, or the "horse’s tail".

Other Structures of The Back

Spaces between the vertebrae contain round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Four Regions

Starting at the top, the spine has 4 regions:

  • 7 cervical (neck) vertebrae
  • 12 thoracic (upper back) vertebrae
  • 5 lumbar vertebrae
  • the sacrum and coccyx (tailbone)

The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.

Part 3 of 10 - What Causes Low Back Pain?

Aging Process

As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.

Injury & Trauma

Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back.

If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

Low back pain may also reflect:

  • nerve irritation
  • muscle problems
  • bone lesions

Other Causes

Most low back pain follows injury or trauma to the back, but pain may also be caused by:

  • osteoarthritis
  • osteoporosis or other bone diseases
  • viral infections
  • irritation to joints and discs
  • congenital abnormalities in the spine
  • scar tissue

Other Factors

Other factors that contribute to low back pain include:

Serious Problems

Low back pain may also indicate a more serious medical problem. People with back pain along with fever, loss of bowel or bladder control, pain when coughing, progressive weakness or pain radiating into the legs should contact a doctor immediately to help prevent permanent damage.

Part 4 of 10 - What Conditions Are Associated With Low Back Pain?

Associated Conditions

Conditions that may cause low back pain and require treatment by a doctor or health specialist include:

  • Bulging discs (also called protruding, herniated, or ruptured discs) As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain.
  • Cauda equina syndrome occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
  • Sciatica a condition in which a herniated or ruptured disc presses on the sciatic nerve.
  • Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. Those with spinal degeneration may experience back stiffness upon awakening or may feel pain after walking or standing for a long time.
  • Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.
  • Skeletal irregularities such as scoliosis, kyphosis, lordosis, back extension and flexion can produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues.

Other Conditions

Other conditions associated with low back pain include:

  • osteoporosis (a progressive bone disease)
  • fibromyalgia (a chronic disorder with widespread musculoskeletal pain)
  • ankylosing spondylitis (a chronic spine arthritis)
  • osteomyelitis (a bone infection)
  • sacroiliitis (inflamed sacroiliac joints)

Part 5 of 10 - How is Low Back Pain Diagnosed?


A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes:

  • the onset, site, and severity of the pain
  • duration of symptoms and any limitations in movement
  • history of previous episodes or any health conditions that might be related to the pain

The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Blood tests may also be ordered. Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.

Diagnostic Methods

Diagnostic methods that may be used include:

  • X-rays (imaging methods that help diagnose the cause and site of back pain)
  • Discography (involves the injection of a contrast dye into a spinal disc thought to be causing low back pain)
  • Computerized Tomography (CT) (a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain)
  • Magnetic Resonance Imaging (MRI) (used to evaluate the lumbar region)
  • Electrodiagnostic Procedures (including electromyography (EMG), nerve conduction studies and evoked potential (EP) studies)
  • Bone Scans (used to diagnose and monitor infections, fractures, or disorders in the bone)
  • Thermography (uses infrared sensing devices to measure small temperature changes)
  • Ultrasound Imaging (uses high-frequency sound waves to obtain images inside the body)

Part 6 of 10 - How Is Low Back Pain Treated?


Most low back pain can be treated without surgery. Treatment often involves:

  • medications
  • reducing inflammation
  • restoring proper function and strength
  • prevention

Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is no noticeable improvement after 72 hours of self-care.


Cold and hot packs for some, may help reduce pain and inflammation and allow greater mobility. Apply a cold compress to the tender spot several times a day for up to 20 minutes. After a few days of cold treatment, apply heat for brief periods to relax muscles and increase blood flow. Warm baths may also help. Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.


Bed rest? Experts suggest only 1 to 2 days at most. You should resume activities as soon as possible.


Exercise may be an effective way to speed recovery from low back pain and help strengthen muscles. This is particularly important for persons with skeletal irregularities.

Physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process.

These may include:

  • stretching exercises
  • swimming
  • walking
  • tai chi or other movement therapy
  • yoga

Mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 min. during exercise, patients should stop and contact a doctor.

Part 7 of 10 - What Medications Are Used to Treat Low Back Pain?

Medications are often used to treat acute and chronic low back pain.

Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking any drugs for pain relief.

OTC Drugs

Over-the-counter NSAIDs are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. These drugs include:


Topical counter-irritants applied to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Many topical analgesics can also reduce inflammation and stimulate blood flow. The topical salicylates also contain salicylate, the same ingredient found in oral pain medications containing aspirin.


Anticonvulsants may be useful in treating certain types of nerve pain and may also be prescribed with analgesics


Some antidepressants have been shown to relieve pain (independent of their effect on depression) and assist with sleep.

Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many newer antidepressants are also being studied for their effectiveness in pain relief


Painkillers (opioids) are prescribed to treat severe acute and chronic back pain but should be used only for a short period of time and under a doctor’s supervision. These include:

Part 8 of 10 - What Are Other Treatment Options for Low Back Pain?

When back pain does not respond to more conventional approaches, patients may consider the following treatment options:

Spinal Manipulation

Spinal manipulation uses a hands-on approach in which licensed chiropractics use adjustments and a series of exercises to restore back mobility.


Acupuncture involves the insertion of needles the width of a human hair along precise points throughout the body.


Biofeedback is used to treat many acute pain problems. Using a special electronic machine, a patient may learn how to effect a change in response to pain.


Traction involves using weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms.

TENS Units

Transcutaneous electrical nerve stimulation (TENS) is given by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves.

Other Treatments

  • Ultrasound Therapy (ultrasound is a noninvasive therapy used to warm the body’s internal tissues)
  • Vertebroplasty and Kyphoplasty (minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis)
  • Interventional Therapy (can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain)

Part 9 of 10 - What Are the Surgical Procedures for Low Back Pain?

Surgical Procedures

In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries. Surgical procedures can include:

  • Discectomy
  • Foraminotomy
  • IntraDiscal Electrothermal Therapy (IDET)
  • Nucleoplasty
  • Radiofrequency Lesioning
  • Spinal Fusion
  • Spinal Laminectomy

Some surgical procedures may be performed in a doctor’s office under local anesthesia, while others require hospitalization.

It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.

Since invasive back surgery is not always successful, it should be performed only in patients with progressive neurologic disease or damage to the peripheral nerves.

Surgical Procedures for Severe Chronic Pain

Other surgical procedures to relieve severe chronic pain include:

  • Rhizotomy (a procedure in which the nerve root close to where it enters the spinal cord is cut to block nerve transmission and all senses from the area of the body experiencing pain)

  • Cordotomy (where bundles of nerve fibers on one or both sides of the spinal cord are intentionally severed to stop the transmission of pain signals to the brain)
  • DREZ (dorsal root entry zone operation) (a procedure in which spinal neurons transmitting the patient’s pain are destroyed surgically)

Part 10 of 10 - Can Low Back Pain Be Prevented?


Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. A combination of exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.

Many injuries are caused or aggravated by stressors such as:

  • heavy lifting
  • contact stress (repeated or constant contact between soft body tissue and a hard or sharp object)
  • vibration
  • repetitive motion
  • awkward posture

Ergonomics in the Home and Workplace

Applying ergonomic principles designing furniture and tools to protect the body from injury can greatly reduce the risk of back injury and help maintain a healthy back.

To reduce the risks of musculoskeletal injury and pain, more companies are promoting better ergonomically designed:

  • tools
  • products
  • workstations
  • living spaces

Back Belts

The use of wide elastic belts that can be tightened to pull in lumbar and abdominal muscles to prevent low back pain is controversial. A study of the use of back support belts worn by persons who lift or move merchandise found no evidence that the belts reduce back injury or back pain.

Although there have been anecdotal case reports of injury reduction among workers using back belts, many companies that have back belt programs also have training and ergonomic awareness programs. Injury reduction may be related to a combination of these or other factors.

Source: NIH Publication No. 03-5161

Continue Reading