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Low back pain - acute

Definition

• Low back pain - chronic
• Sciatica

Alternative Names

Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term

Causes, incidence, and risk factors

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body's weight.

Low back pain is the number two reason that Americans see their doctor -- second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

You'll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But before that injury or accident, the structures in your back were losing strength or changing.

Acute low back pain is most often caused by a sudden injury to the muscles, ligaments, bones, and nerves in the spine. The source of the pain may be:

Symptoms

You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. Depending on the cause, you also may have weakness in your legs or feet.

Low back pain can vary widely. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or bottom of your foot. See: Sciatica

Signs and tests

When you first see your doctor, you will be asked questions about your back pain, including how often it occurs and how severe it is. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

Questions will include:

• Is your pain on one side only or both sides?
• What does the pain feel like? Is it dull, sharp, throbbing, or burning?
• Is this the first time you have had back pain?
• When did the pain begin? Did it start suddenly?
• Did you have a particular injury or accident?
• What were you doing just before the pain began? Were you lifting or bending? Sitting at your computer? Driving a long distance?
• If you have had back pain before, is this pain similar or different? In what way is it different?
• Do you know the cause of previous episodes of back pain?
• How long does each episode of back pain usually last?
• Do you feel the pain anywhere other than your back, like your hip, thigh, leg or feet?
• Do you have any numbness or tingling? Any weakness or loss of function in your leg or elsewhere?
• What makes the pain worse? Lifting, twisting, standing, or sitting for long periods of time?
• What makes you feel better?
• Are there any other symptoms present? Weight loss? Fever? Change in urination? Change in bowel habits?

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. While walking, your doctor may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways.
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs into different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will ask you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

Most people with back pain recover within 4 - 6 weeks. Therefore, your doctor will probably not order any tests during the first visit. However, if you have any of the symptoms or circumstances below, your doctor may order imaging tests even at this initial exam:

• Accident or injury
• Fever
• Muscle weakness
• Numbness
• Pain that has lasted longer than one month
• Weight loss
• You are over 65
• You have had cancer or have a strong family history of cancer

In these cases, the doctor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present. The presence of a tumor, infection, fracture, or serious nerve disorder will change how your back pain is treated.

Tests that might be ordered include an x-ray, CT scan of the lower spine, or MRI of the lower spine.

Hospitalization, traction,or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

Many people benefit from physical therapy. Your doctor will determine whether you need to see a physical therapist and can refer you to one in your area. The physical therapist will begin by using methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again.

If your pain lasts longer than one month, your primary care doctor may send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist).

Treatment

To get better quickly, take the right steps when you first get pain.

Here are some tips for how to handle pain early on:

• Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
• Apply heat or ice to the painful area. Try ice for the first 48-72 hours, then use heat.
• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
• While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

A common misbelief about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended.

You may want to reduce your activity only for the first couple of days. Then, slowly start your usual activities after that. Do not perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2 - 3 weeks, you should gradually resume exercise.

• Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.
• Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

AVOID the following exercises during initial recovery unless your doctor or physical therapist says it is okay:

• Ballet
• Football
• Golf
• Jogging
• Leg lifts when lying on your stomach
• Sit-ups with straight legs (rather than bent knees)
• Weight lifting

Expectations (prognosis)

Many people will feel better within 1 week after the start of back pain. After another 4 - 6 weeks, the back pain will likely be completely gone.

Calling your health care provider

Call your doctor right away if you have:

• Back pain after a severe blow or fall
• Burning with urination or blood in your urine
• History of cancer
• Loss of control over urine or stool (incontinence)
• Pain traveling down your legs below the knee
• Pain that is worse when you lie down or that wakes you up at night
• Redness or swelling on the back or spine
• Severe pain that does not allow you to get comfortable
• Unexplained fever with back pain
• Weakness or numbness in your buttocks, thigh, leg, or pelvis

Also call if:

• You have been losing weight unintentionally
• You use steroids or intravenous drugs.
• You have had back pain before, but this episode is different and feels worse.
• This episode of back pain has lasted longer than 4 weeks.

Prevention

References

US Preventative Services Task Force. Primary Care Interventions to Prevent Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.

Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007;32:291-298.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463-472.

Chou R, Loeser JD, Owens DK, Rosenquist RW, et al; american Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34:10660-1077.

Jüni P, Battaglia M, Nüesch E, Hämmerle G, Eser P, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2009;68:1420-1427.