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Common causes of low back pain (lumbar backache) include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.

2016 — Science update: Some fresh citations that strongly reinforce the main point of the section, and a few entertaining new examples of weird placebo effects. [Section: The back surgery placebo problem, and how it limits our knowledge of the effectiveness of back surgeries.]

2017 — Science update: Updated references for debunking of TENS for back pain. Added ultrasound to the section. [Section: A few more snack-sized reality checks: brief comments on other treatments to avoid.]

Spines haven’t changed in the last century,20 and yet modern civilization suffers from a great plague of low back pain.2122 Yet the real causes of most back pain are obscured by medical mythology and misunderstanding.23 Before I discuss what does cause most low back pain, it’s important to talk about what does not cause it. In this section, I will challenge the mythology in just a few paragraphs, supported by over thirty references to the best scientific information available — references you can check for yourself. This is quite different than most sources of patient-focused low back pain information, which tend to avoid discussing the evidence.

Some people seem to benefit from the use of ice or heat. Their use, although not proven effective, is not considered to be harmful. Take care: Do not use a heating pad on high or place ice directly on the skin.

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Discography may be used when other diagnostic procedures fail to identify the cause of pain. This procedure involves the injection of a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection. Discography may provide useful information in cases where people are considering lumbar surgery or when their pain has not responded to conventional treatments.

One-factor repeated measures ANCOVAs (baseline VAS measure as covariate) were used to identify any effect of condition (standing, lumbar support and standard chair) on VAS scores for each group separately (healthy individuals and patients with LBP).

Some spinal difficulties, however, require more sizable intervention. Herniated discs, fractured vertebrae and other severe complications can often be mitigated or removed completely by minimally invasive surgery.

MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs aren’t actually that big a deal,2 most back pain goes away on its own,3 and trigger points (“muscle knots”) are common and can be alarmingly intense but aren’t dangerous.4 Most patients are much better off when they feel confident about these things; the power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs.6

Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back.[4] Pain can vary from a dull constant ache to a sudden sharp feeling.[4] Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).[3] The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.[5] The symptoms of low back pain usually improve within a few weeks from the time they start, with 40-90% of people completely better by six weeks.[2]

Type of chair: chairs with padding or built in lumbar support usually require thinner lumbar support cushions that provide support without forcing you too far forward. Moreover, make sure you make a note of the dimensions of the cushion and compare it with your chair before ordering to make sure it will fit.

Forseen, SE; Corey, AS (Oct 2012). Clinical decision support and acute low back pain: evidence-based order sets. Journal of the American College of Radiology : JACR. 9 (10): 704–712.e4. doi:10.1016/j.jacr.2012.02.014. PMID 23025864.

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Meanwhile, it’s extremely common for non-life-threatening low back pain to be alarmingly severe and persistent — to have a loud bark! Your doctor may not appreciate how true this is, and may over-react to all persistent low back pain, even without other red flags. In most cases, you shouldn’t let them scare you. Being “freaked out” about persistent back pain is the real threat: it can make low back pain much worse, and much more likely to last even longer (a tragic irony).

Qaseem, Amir; Wilt, Timothy J.; McLean, Robert M.; Forciea, Mary Ann (14 February 2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 166: 514–530. doi:10.7326/M16-2367. PMID 28192789.

Twenty eight male participants with and without a history of low back pain sat in a standard office chair and in a chair with the lumbar support pillow for 30 minutes. Lumbar and thoracolumbar postures were measured through electromagnetic markers. Comfort was determined based on the least squares radius of centre of pressure shifting, measured at the buttock-chair interface as well as reported discomfort through visual analog scales. Chair support effects were assessed through ANOVA methods. The study was approved by the Canadian Memorial Chiropractic College research ethics board.

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There is moderate quality evidence that suggests the combination of education and exercise may reduce an individual’s risk of developing an episode of low back pain.[24] Lesser quality evidence points to exercise alone as a possible deterrent to the risk of the onset of this condition.[24]

Jansson C, Mittendorfer-Rutz E, Alexanderson K. Sickness absence because of musculoskeletal diagnoses and risk of all-cause and cause-specific mortality: A nationwide Swedish cohort study. Pain. 2012 May;153(5):998–1005. PubMed #22421427. BACK TO TEXT

^ Jump up to: a b c d e f g h Marlowe D (September 2012). Complementary and alternative medicine treatments for low back pain. Prim. Care. 39 (3): 533–46. doi:10.1016/j.pop.2012.06.008. PMID 22958563.

Self-help measures are often very helpful in people with back pain. If your back pain is severe or chronic your GP may prescribe appropriate medicines or refer you for manual (physical) therapies. If an underlying cause of back pain is suspected, your GP may refer you to a back or pain specialist or clinic for diagnosis and specialised treatments (such as spinal injections).

A lumbar support pillow with a cut-out for the posterior pelvic tissues improved an objective measure of comfort in healthy individuals and patients with low back pain. Lumbar flattening was decreased and thoracolumbar curvature was increased. However, angular changes were small and future work is required determine clinical relevance over the long term.

ankylosing spondylitis inflammatory arthritis of spine and pelvis, mostly Long term back pain starting well before middle age and progressing slowly and erratically, improves with activity but not rest, prolongued morning stiffness, possible involvement of other areas. More common in men.

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2011 — Major science update: Detailed reporting on some new yoga science. Significant re-writing of the section ensued. Sometimes new science does not back up my preconceptions: I’ve changed my tune here somewhat. [Section: Yoga and meditation are still an option, of course.]

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Surgery is seldom considered for acute back pain unless sciatica or the cauda equina syndrome is present. Surgery is considered useful for people with certain progressive nerve problems caused by herniated discs.

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Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.[45]

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