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Back Pain

Overview

Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide.

Fortunately, you can take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional. Surgery is rarely needed to treat back pain.

When to see a doctor

Most back pain gradually improves with home treatment, self-care and gentle wellness care, usually within a few weeks. Contact your doctor right away if your back pain:

  • Persists past a few weeks
  • Is severe and doesn't improve with rest
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

  • Causes new bowel or bladder problems
  • Is accompanied by a fever
  • Follows a fall, blow to your back or other injury

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Causes

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:

  • Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you're in poor physical condition, constant strain on your back can cause painful muscle spasms.
  • Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
  • Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  • Osteoporosis. Your spine's vertebrae can develop painful fractures if your bones become porous and brittle.

Risk factors

Anyone can develop back pain, even children and teens. These factors might put you at greater risk of developing back pain:

  • Age. Back pain is more common as you get older, starting around age 30 or 40.
  • Lack of exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
  • Excess weight. Excess body weight puts extra stress on your back.
  • Diseases. Some types of arthritis and cancer can contribute to back pain.
  • Improper lifting. Using your back instead of your legs can lead to back pain.
  • Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
  • Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.

Prevention

You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics.

To keep your back healthy and strong:

  • Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities you might try.
  • Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
  • Maintain a healthy weight. Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.
  • Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

Avoid movements that twist or strain your back. Use your body properly:

  • Stand smart. Don't slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
  • Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
  • Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Buyer beware

Because back pain is so common, numerous products promise prevention or relief. But there's no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs can help. These products may help relieve back pain in some patients but it is best to be evaluated by a trained professional to discover the best course of care for you. 

In addition, there doesn't appear to be one type of mattress that's best for people with back pain. It's probably a matter of what feels most comfortable to you.

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