Most of us (about 8 in 10 people) will have a bout of nonspecific low back pain at some point in our lives. The severity can vary. However, it is difficult to quote exact figures as to outlook. This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:
Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor’s office or a hospital’s emergency department. It is the second most common neurologic complaint in the United States, second only to headache.
In most cases of low back pain, medical consensus advises not seeking an exact diagnosis but instead beginning to treat the pain. This assumes that there is no reason to expect that the person has an underlying problem. In most cases, the pain goes away naturally after a few weeks. Typically, people who do seek diagnosis through imaging are not likely to have a better outcome than those who wait for the condition to resolve.
Blood tests are not routinely used to diagnose the cause of back pain; however in some cases they may be ordered to look for indications of inflammation, infection, and/or the presence of arthritis. Potential tests include complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Blood tests may also detect HLA-B27, a genetic marker in the blood that is more common in people with ankylosing spondylitis or reactive arthritis (a form of arthritis that occurs following infection in another part of the body, usually the genitourinary tract).
Following any period of prolonged inactivity, a regimen of low-impact exercises is advised. Speed walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility. Yoga also can help stretch and strengthen muscles and improve posture. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
^ Jump up to: a b c d * Consumer Reports; American College of Physicians; Annals of Internal Medicine (April 2012), tests for lower-back pain: Why you probably don’t need them. (PDF), High Value Care, Consumer Reports, retrieved 23 December 2013
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Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are many different types of pain. Acute back pain is defined as severe but lasting a short period of time. Chronic back pain usually occurs every day. It can be severe, but may be characterized as mild, deep, achy, burning, or electric-like. Back pain that travels into another part of the body, such as the leg may be consider radicular pain, particularly when it radiates below the knee. This scenario is commonly called a lumbar radiculopathy. Fortunately, not all occurrences of back pain include leg pain!
Compression fracture. A fracture that occurs in the cylindrical vertebra, in which the bone essentially caves in on itself, can cause sudden pain. This type of fracture is most common due to weak bones, such as from osteoporosis, and is more common in older people.
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There are many additional sources of pain, including claudication pain (from stenosis) myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates from another part of the body and presents in the lower back (such as kidney stones, or ulcerative colitis).
Magnetic resonance imaging (MRI) scans are a highly detailed test and are very expensive. The test does not use X-rays but very strong magnets to produce images. Their routine use is discouraged in acute back pain unless a condition is present that may require immediate surgery, such as with cauda equina syndrome or when red flags are present and suggest infection of the spinal canal, bone infection, tumor, or fracture.
The use of lumbar supports in the form of wide elastic bands that can be tightened to provide support to the lower back and abdominal muscles to prevent low back pain remains controversial. Such supports are widely used despite a lack of evidence showing that they actually prevent pain. Multiple studies have determined that the use of lumbar supports provides no benefit in terms of the prevention and treatment of back pain. Although there have been anecdotal case reports of injury reduction among workers using lumbar support belts, many companies that have back belt programs also have training and ergonomic awareness programs. The reported injury reduction may be related to a combination of these or other factors. Furthermore, some caution is advised given that wearing supportive belts may actually lead to or aggravate back pain by causing back muscles to weaken from lack of use.
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2012 — Minor update: Added an intriguing quote about evolution and the lack of back pain in hunter gatherers. [Section: Are you crooked? The alignment theories: short legs, pelvic tilts, and spinal curves.]
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Most people have experienced back pain sometime in their lives. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms.
^ Jump up to: a b c Katonis, P.; Kampouroglou, A.; Aggelopoulos, A.; Kakavelakis, K.; Lykoudis, S.; Makrigiannakis, A.; Alpantaki, K. (July 1, 2011). Pregnancy-related low back pain. Hippokratia. 15 (3): 205–210. ISSN 1108-4189.
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Jump up ^ Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P (2008). Injection therapy for subacute and chronic low-back pain. The Cochrane Database of Systematic Reviews (3): CD001824. doi:10.1002/14651858.CD001824.pub3. PMID 18646078.
It’s much the same story with back pain: We don’t really know what to do about it. There aren’t good treatments for it, Vos said, and some of the things that people use to try to manage it—like prescription opioids—have only morphed into health crises in their own right.
While past authors have commonly measured comfort through subjective means , objective measures such as changes in posture (or ‘micro movements’) may be good indicators of discomfort [18-21], as small movements are necessary to alleviate pain caused by static postures. While several past studies have examined the effects of various lumbar support pads, few have quantified the level of comfort through ‘in chair movements’, and most studies have been restricted to healthy individuals. The purpose of this study was to examine for differences in lordotic curvature and comfort between a support device that accounts for pelvic tissue bulk against a typical chair in healthy individuals and patients with LBP. Comfort was measured through subjective and objective means. The hypothesis underlying this work postulates that there will be differences in comfort and lordotic angulation for healthy individuals and patients with pain between the support conditions.
Continue with normal activities as much as possible. This may not be possible at first if the pain is very bad. However, move around as soon as you are able, and get back into normal activities as soon as you can. As a rule, don’t do anything that causes a lot of pain. However, you will have to accept some discomfort when you are trying to keep active. Setting a new goal each day may be a good idea. For example, walking around the house on one day, a walk to the shops the next, etc.
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2017 — New subsection: Added content inspired by decades-old evidence of reduced spinal degeneration in “primitive” cultures where squatting is common. Some light editing of everything else in the chapter. [Section: Are you crooked? The alignment theories: short legs, pelvic tilts, and spinal curves.]
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Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These changes in the disc and the joints produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.
Non-steroidal anti-inflammatory drugs (NSAIDs) are typically tried first. NSAIDs have been shown to be more effective than placebo, and are usually more effective than paracetamol (acetaminophen).