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Low back pain is pain that can occur anywhere below the ribs and above the legs. It is very common. Almost everyone has it at one time or another.
Low back pain can be:
Causes of low back pain may include overuse, injury, illness, or changes that happen with age, such as arthritis. In most cases, it's not clear what causes low back pain.
Low back pain may be dull or sharp. It may be in one small area or over a broad area. You may also have muscle spasms, numbness, tingling, or weakness in one or both legs.
Your doctor will do a physical exam and ask questions about your back and overall health. Most people don't need any tests right away. Imaging is only required if there is clinical suspicion of serious pathology (red flags) or if planning a specific intervention. Otherwise, no imaging should be ordered before 12 weeks.
Most low back pain improves with self-care. This includes ice or heat and light activity such as walking. Use over-the-counter pain medicine as needed.
For severe symptoms or pain that continues after 2 weeks of self-care, see your doctor. You may benefit from other treatment, such as stronger medicine, exercises, or manual therapy.
There are a number of other treatments for back pain. You may need to try more than one to see what works best for you. Common treatments include acupuncture, massage, and yoga.
For chronic back pain, one type of treatment by itself may not help. The best plan is often a mix of treatments.
In most cases, there isn't a clear cause. Some causes of low back pain are:
Less common spinal conditions that can cause low back pain include:
You're more likely to have low back pain if:
Other things that may put you at risk include:
There are some things you can do that may help prevent low back pain. And they can prepare you for a faster recovery if you do have low back pain.
But there is no clear evidence that you can prevent low back pain or keep it from coming back.
Back pain can come on quickly or over time. You may feel:
The course of low back pain depends both on its cause and on how well you treat your back.
Most back pain gets better within 4 to 6 weeks with some basic self-care. But for some people, the pain lasts longer.
Chronic back pain is pain that has lasted longer than 3 months. This kind of back pain not only wears you down, but it also can trigger other problems. If your back pain causes you to use your body in different ways (for example, to limp or to sit differently), pain can develop in other areas of your body. Pain can also cause changes in your body that tend to keep the pain going.
Chronic back pain can be difficult to treat. But by working with a doctor and trying different treatments, most people can find relief.
Call 911 or other emergency services immediately if:
Call your doctor now if:
Most low back pain doesn't require a visit to a doctor.
If the pain doesn't get better after 1 or 2 days and you can't do your normal daily activities, call your doctor.
If you still have mild to moderate pain after at least 2 weeks of home treatment, talk with your doctor. You may need to be checked for problems that may be causing your back pain.
A physical exam is the main way to diagnose low back pain. Your doctor may examine your back, check your nerves by testing your reflexes, and make sure that your muscles are strong. Your doctor also will ask questions about your back and overall health.
Most people don't need any tests right away. Tests often don't show the reason for your pain.
If your pain lasts more than 6 weeks or you have symptoms that your doctor is more concerned about, then your doctor may order tests. These may include an X-ray, a CT scan, or an MRI. Sometimes other tests such as a bone scan or nerve conduction test may be done.
Most acute low back pain gets better on its own within several weeks, no matter what the cause. Time and doing usual activities are all that most people need to feel better.
Using heat or ice and taking over-the-counter pain medicine also can help while your body heals.
If you aren't getting better on your own or your pain is very bad, your doctor may recommend:
If you have chronic low back pain, treatment will help you understand and manage your pain. Treatment may include:
Surgery isn't needed for most people. But it may help some types of low back pain.
Hear from a health care provider
Almost everyone has low back pain at some time. The good news is that most low back pain will go away in a few days or weeks with some basic self-care.
Some people are afraid that doing too much may make their pain worse. In the past, people stayed in bed, thinking this would help their backs. Now doctors think that, in most cases, getting back to your normal activities is good for your back, as long as you avoid doing things that make your pain worse.
Body mechanics are the way you use your body. Posture is the way you sit or stand.
Worrying about the pain can cause you to tense the muscles in your lower back. This in turn causes more pain. Here are a few things you can do to relax your mind and your muscles:
Hear from others
Medicine can help relieve low back pain and reduce muscle spasms in some people. But medicine alone doesn't work well to treat low back pain. It should be used along with other treatments, such as walking and using heat or ice.
Medicines that work for some people don't work for others. Let your doctor know if the medicine you take doesn't work for you. You may be able to take another medicine for your back pain.
Your doctor may recommend several medicines, depending on how long you've had pain, what other symptoms you have, and your past health.
The medicines suggested most often are:
These seem to be the over-the-counter pain relievers that work best for low back pain. But if you can't take NSAIDs, you can try acetaminophen instead. You can buy these kinds of medicines without a prescription. Some of them also come in stronger doses. For those, you'll need a prescription.
These medicines can help with severe muscle spasms that happen when the back pain starts (acute phase). Side effects are common. For example, you may feel drowsy.
Some of these medicines, such as duloxetine, not only treat depression but also may help with chronic pain.
Other medicines are sometimes used for low back pain. They include:
These injections don't seem to help most people with chronic back pain. They may give short-term relief to some people with leg pain from a back problem.
This is a shot into the back muscles. It hasn't been well tested for chronic low back pain.
When you're in a lot of pain, you might wonder if you need surgery to fix what's wrong so that you can feel better.
Every case is different. But most people don't need surgery for low back pain.
Reasons for having surgery for low back pain include:
Back surgery doesn't always work. Depending on the condition, you may still have back pain after surgery.
A rehabilitation program is very important after most back surgery. If you can't or won't commit to physiotherapy after surgery, you may not be a good candidate for surgery.
There are several types of back surgery. Some, like a discectomy, can help people who have severe symptoms. Others have not been proved to work.
If you do need surgery, you and your doctor will decide which type is best for you. Having surgery for a herniated disc or another back problem is a big decision.
Types of surgeries include:
You can choose from a number of alternative treatments for your low back pain. Because some of these treatments are new or aren't yet well researched, they may not be covered by your provincial health plan.
CitationsMu J, et al. (2020). Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews, 12: CD013814. DOI: 10.1002/14651858.CD013814. Accessed March 25, 2021.Hsieh LL, et al. (2006). Treatment of low back pain by acupressure and physical therapy: Randomised controlled trial. BMJ, 333(7543): 696–700.Wieland LS, et al. (2017). Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews, 1: CD010671. DOI: 10.1002/14651858.CD010671.pub2. Accessed April 6, 2021.Gagnier JJ, et al. (2016). Herbal medicine for low back pain: A Cochrane review. Spine, 41(2): 116–133. DOI: 10.1097/BRS.0000000000001310. Accessed June 17, 2016.
Adaptation Date: 12/13/2023
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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