Mayuri Bhakta, FNP-BC
Did you know that an estimated 84% of adults experience low back pain at some point in their lives? Low back pain can range from mild to severe and can be disabling for some.
What is low back pain and what causes it?
Your back is made up of bones, nerves, muscles, tendons, ligaments, and other tissues. The bones in your back that make up your spine are known as vertebrae. Your spinal cord passes through the vertebrae, taking nerves from the brain all the way down to the lower body. Between each vertebra, you have discs that act as cushions to help protect them.
Most cases of back pain are known as nonspecific, meaning it is not clearly defined by a disease, abnormality, or serious trauma to the back. You may have heard of people “throwing out” their backs by doing ordinary things, like picking up an object off the ground. This would be categorized as nonspecific back pain.
Nonspecific back pain is usually caused by a strain to the muscles of the lower back. Nonspecific back pain can occur with improper lifting, straining, poor ergonomics, or accidents. It can be acute, lasting less than 4 weeks; subacute, lasting 4 – 12 weeks; or chronic, lasting more than 12 weeks. For most people, low back pain resolves in a relatively short timeframe, and they recover within a few weeks.
Some low back pain is caused by specific conditions including:
- Degenerative disc disease: caused by wear and tear of the discs
- Bulging or herniated discs
- Spondylolisthesis: slipping of one vertebra in front of another
- Spinal stenosis: narrowing of the space between vertebrae
- Occupational back pain
- Vertebral fracture
Less common, but more serious causes of low back pain include:
- Cancerous tumors or masses
- Cauda equina syndrome: caused by compression of the spinal cord
- Abdominal aneurysm
What are risk factors for developing low back pain?
Risk factors for developing low back pain include:
- Increased age
- Strenuous work
- Strenuous exercise or lifting
- Psychologic disorders
- Prior history of back pain
- Poor posture and/or poor ergonomics
What are symptoms of back pain?
Symptoms of back pain can include the following:
- Dull, aching pain
- Sharp pain
- Pain that moves down one or both legs
- Pain that moves into the hips or buttocks
- Pain that improves with resting
- Pain that worsens with movement
Symptoms of a serious cause of back pain include:
- Loss of sensation or numbness in the lower extremities
- Loss of bowel or bladder function
- Abdominal pain
- Chest pain
- Unexplained weight loss
Fact or fiction? I will need to make sure my healthcare provider gets X-rays and an MRI for my back pain.
Fiction. Most cases of back pain are self-limited and do not need lab work or diagnostic imaging. If you have low back pain that lasts more than 4 weeks or if you have signs or symptoms that are concerning for a more serious problem, your healthcare provider will order tests appropriate for you.
Fact or fiction? It is likely that my low back pain will recur.
Fact. Many people who have experienced back pain will have recurrent episodes of back pain, but there are things you can do to help prevent back pain in the future. These include exercising, strengthening and stretching your muscles, maintaining a healthy weight, using good ergonomics when lifting or moving heavy objects, quitting smoking, and maintaining a good posture.
What kind of treatment should I expect?
If your low back pain prevents you from participating in your normal activities; if the pain becomes worse or spreads to your legs, hips, or thighs; or if your pain medication is no longer helping you, see your healthcare provider. Your provider will ask you to give a detailed medical history, history of the onset and duration of your pain, and any history of pain you have had in the past. Based on your history and a physical examination, your healthcare provider may prescribe medications or recommend over-the-counter medications for pain relief, recommend applying heat to the area, and may recommend activity modification. Your provider may recommend stretching or other exercises to prevent the muscles in your lower back from becoming stiffer.
If your pain lasts more than 4 weeks, your provider may recommend diagnostic imaging such as an X-ray, CT, or MRI, and may prescribe physical therapy.
If you believe your low back pain is work-related, your healthcare provider may need to obtain information about your job tasks to help determine work-relatedness. If your pain is subacute or chronic and you have a physically demanding job, your healthcare provider may recommend a work conditioning or work hardening program.
Christopher L. Knight, Richard A. Deyo, Thomas O. Staiger, Joyce E. Wipf, “Treatment of acute low back pain,” UpToDate, updated March 19, 2020.
Johns Hopkins Medicine, “Low Back Pain,” https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/low-back-pain
Mayo Clinic, “Back pain,” https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
Michael Erdil, “Occupational low back pain: Evaluation and management,” UpToDate, updated November 3, 2018.
Stephanie G. Wheeler, Joyce E. Wipf, Thomas O. Staiger, Richard A. Deyo, Jeffrey G. Jarvik, “Evaluation of low back pain in adults,” UpToDate, updated June 25, 2019.