Am Fam Physician. 2000;61(6):1789-1790
See related article on acute low back pain.
What causes low back pain?
Most often, low back pain is caused by a stretched or strained muscle. This muscle hurts when you move while it is healing.
Back pain can also come from a bulging “herniated” or “ruptured” disc. Sometimes one of the discs that is like a cushion between your back bones pushes out into the space around your spine. There is a nerve in this space. If the disc pushes on this nerve, it hurts. The pain can shoot down your lower back into your buttocks, or down your leg. You might have weak muscles or tingling in your leg or foot on the affected side.
A few other causes of low back pain are arthritis in the bones of your spine and narrowing of your spinal canal. Very rarely, infection or cancer can cause back pain.
Is low back pain a sign of a serious illness?
Only one of 200 people with low back pain has a serious illness. After talking with you and examining you, your doctor can usually tell if you might have a serious illness.
If you have back pain and a fever that won't go away or if you're losing weight without dieting, be sure to tell your doctor. Other signs of a serious cause are pain that is worst when you're lying still, and trouble controlling your bladder or bowels.
How is low back pain treated?
Your doctor may suggest that you take pain pills, possibly with muscle relaxants, for a short time (two to four weeks) while your back heals. Your doctor may also have you make some changes in your daily routine. You might try putting heat or ice on the area that hurts.
Most likely, your back will stop hurting within a month. If your back doesn't get better in a month, see your doctor again.
Is resting my back important?
When a body part hurts, most people try not to use it. However, for most types of back pain, staying in bed for a long time can make your muscles weaker, tighter and more painful. Staying in bed for too long can also slow the healing process.
Your doctor will most likely want you to try “relative rest.” This means that you only avoid activities that make your pain worse, but you still keep moving around. Try not to sit or stand for long periods, or bend from the waist, or lift heavy things. At the same time, start doing exercises to make your back stronger and more flexible.
What exercises should I do?
Here are two stretching exercises that can help the pain in your back:
Stand up and put your hands at the hollow of your back. Then slowly and carefully bend back just a little bit, toward your hands. Hold the stretch for a few seconds and then release.
Lie flat on your back with your knees bent up. Put your hands around your left knee and pull it down toward your chest. Hold the stretch for a few seconds and then release. Now repeat the stretch with your right knee. Then pull both knees to your chest at the same time and hold the stretch for a few seconds.
Do these stretches twice every day, for 5 to 10 minutes in the morning and 5 to 10 minutes in the evening. Ask your doctor about other exercises that might help to make your back feel better.
What can I do to keep from having low back pain in the future?
Being in shape and losing excess weight will help you avoid low back pain. Keep fit with regular exercise like walking, swimming or biking. These activities actually stress your back less than sitting and standing do. Exercises like “tummy crunches” or modified sit-ups reduce the curve in your lower back. This makes it less likely that your back will hurt.
Good posture is important for a healthy back:
When standing, keep your knees relaxed and your shoulders back. Shift your weight often from one foot to the other and move around as much as you can.
Sit on a chair that supports your back and keep your feet flat on the floor, or use a foot rest. Support the curve at your lower back by putting a small pillow there.
Sleep on a comfortable mattress and change positions often. When you get out of bed, roll to your side first and then use your arms to help you get up.
Lifting, carrying and reaching for things carefully can also help you keep from straining your back:
When lifting heavy things, be sure to squat down, not bend at the waist. In this way, you use your legs to lift the item.
Try to keep things close to your body when you are lifting or carrying them.
If you have to reach high for something, use a step stool instead of straining to reach up.