Low back pain - acute
Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new
Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.
Acute back pain can last for a few days to a few weeks.
You might have heard a friend say that they have slipped a disk. Or, you may have slipped a disk yourself during an overly strenuous workout, or by straining while lifting something heavy. A slipped disk can be painful, so painful, in fact, that you can barely move. But what exactly is a slipped disk? And what can you do about it if you have one? This is your spine. In between the bones, which are called vertebrae, are little cushioning disks. These disks not only allow you to bend and move but also prevent your bones from rubbing against each other. Sometimes an injury can push a disk out of place, producing a bulge. This bulge is called a herniated disk. Or, a disk may break open. When a disk moves, it puts pressure on nearby nerves, and that's when you start to feel pain. Most slipped disks are found in the lower back or lumbar region, although you can also have one in your neck, or cervical region. When you have a slipped disk, you'll hurt, but often just on one side of your body. If the disk is in your lower back, you may feel a sharp pain in one part of your leg, hip, or buttocks. Your leg may also feel weaker than usual. If the disk is in your neck, the pain and numbness can stretch all the way from your neck down to your shoulder and arm. You may notice that it hurts even more when you stand for a long period of time, or if you sneeze, cough, or laugh. So, how do you treat a slipped disk? First your doctor will want to make sure that you actually have a slipped disk. To find out, the doctor will check your muscle strength, feeling, and reflexes, and have you move in different ways, for example, by bending, standing, and walking. You may also have a scan to find the exact location of the slipped disk. While bed rest was once the standard therapy for low back pain, studies show that for most people it does not help and may even make the situation worse. Rapid return to healthy normal activity is usually best, being careful not to put too much stress on the back. While you're doing that, you can take medicines like ibuprofen or aspirin to relieve the pain. Muscle relaxants may also help. Acupuncture, massage, and yoga have also been shown to be affective in some studies. Physical therapy may be helpful after the first two or three weeks. It can help strengthen the muscles of your spine, and teach you how to move properly so you don't injure yourself again. If these measures don't help, your doctor may suggest getting steroid injections into the area where you slipped the disk, to reduce pain and relieve swelling. As a last resort when all other treatments have failed, you may have a surgery called a diskectomy to remove the damaged disk. You may be in pain now, but don't despair, with treatment it should ease. Realize that it may take a few months before you're back to your old self. Don't try to overdo it by bending or doing any heavy lifting. You'll just wind up back on your couch, hurting again.
There are five lumbar vertebrae located in the lower back. These vertebrae receive the most stress and are the weight-bearing portion of the back. The lumbar vertebrae allow movements such as flexion and extension, and some lateral flexion.
Although stress can cause backaches it is wise to watch out for other signs that may indicate a more serious condition. Pain which radiates to the buttocks, arms or legs, and weakness or numbness in the arms and legs should not be ignored.
Sciatica. It's not a new trendy restaurant in New York or LA, or a new SciFi program on your favorite cable channel. Sciatica is something much less sexy. Sciatica might actually be the cause of that the sharp pain you occasionally feel in your backside, or traveling down your hip or leg. What is sciatica? What does this pain mean? Sciatica occurs when there is pressure or damage to the Sciatic nerve. This large nerve starts in your lower spine and runs down the back of each leg. It controls the muscles of the back of your knee and lower leg. It also provides sensation to the back of your thigh, part of your lower leg, and the sole of your foot. Sciatica is usually caused by another problem, such as a slipped disk, spinal stenosis or narrowing of the spinal column, piriformis syndrome, the narrowing of muscle in your buttocks, a pelvic injury or fracture, and perhaps even tumors. Your pain may feel like a mild tingling, a dull ache, or a burning sensation. Sometimes the pain can be so bad you might not be able to move. The pain will usually occur on one side, perhaps as a sharp pain in one part of your hip or leg, or maybe you will notice the numbness. The pain may get worse after you stand or sit, at night, when you sneeze, cough, or laugh, or when you bend backwards or walk forward. For treatment, your doctor will perform a careful physical exam. Your doctor might find you have weakness when you bend your knee or move your foot, trouble bending your foot inward or downward, weak reflexes, or pain when you lift your leg straight up off the examination table while lying down. Your doctor may also do other tests to find what's causing your sciatica, including blood tests, x-rays, and other imaging tests. Treatment will focus on what causes your sciatica. Sometimes you may not need treatment because your pain will go away on its own. Your doctor will likely first recommend that you take steps to calm your symptoms and reduce inflammation, such as applying heat or ice to the painful area. You might try ice for the first 48 to 72 hours after you feel pain, then use heat afterwards. Your doctor might also tell you to take over-the-counter pain relievers. If conservative measures don't help your problem, your doctor may recommend you have injections to reduce inflammation around your sciatic nerve and other medicines to reduce the stabbing pain. Physical therapy may be a viable option, so talk to your healthcare provider about this option. Whatever you do, don't stay in bed all day. You need to reduce your normal activity for the first few days after you start having pain, but getting no activity will only make your pain worse. After a few days, try gradually returning to your normal routine. But, avoid heavy lifting or twisting your back for at least 6 weeks. Make sure you start exercising again though after 2 to 3 weeks. Remember, include exercises to strengthen your abdomen or belly and improve the flexibility of your spine.
The main nerve traveling down the leg is the sciatic nerve. Pain associated with the sciatic nerve usually originates higher along the spinal cord when nerve roots become compressed or damaged from narrowing of the vertebral column or from a slipped disk. Symptoms can include tingling, numbness, or pain, which radiates to the buttocks legs and feet.
Causes
Most people have at least one backache in their life. Although this pain or discomfort can happen anywhere in your back, the most common area affected is your lower back. This is because the lower back supports most of your body's weight.
Low back pain is the number two reason that Americans see their health care provider. It is second only to colds and flu.
You will 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.
Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.
Causes of sudden low back pain include:
- Compression fractures of the spine (often due to osteoporosis)
- Cancer involving the spine
- Fracture of a spine bone
- Muscle spasm (very tense muscles)
- Ruptured or herniated disk
- Sciatica
- Spinal stenosis (narrowing of the spinal canal)
- Spine curvatures (like scoliosis or kyphosis), which may be inherited and seen in children or teens
- Strain or tears to the muscles or ligaments supporting the back
Low back pain may also be due to:
- An abdominal aortic aneurysm that is leaking
- Arthritis conditions, such as osteoarthritis, psoriatic arthritis, and rheumatoid arthritis
- Infection of the spine (osteomyelitis, diskitis, abscess)
- Kidney infection or kidney stones
- Problems related to pregnancy
- Problems with your gall bladder or pancreas
- Medical conditions that affect the female reproductive organs, including endometriosis, ovarian cysts, ovarian cancer, or uterine fibroids
- Pain around the back of your pelvis, or sacroiliac (SI) joint
Symptoms
You may feel a variety of symptoms if you have hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. 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 the bottom of your foot. You may also have weakness in your legs and feet.
Exams and Tests
When you first see your provider, you will be asked about your back pain, including its location, how often it happens and how severe it is.
Your provider 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 methods.
During the physical exam, your provider will try to pinpoint the location of the pain and figure out how it affects your movement.
Most people with back pain improve or recover within 4 to 6 weeks and often much sooner than that. Your provider may not order any tests of your spine during the first visit or for 4 to 6 weeks unless you have certain symptoms.
Tests that might be ordered include:
- Blood tests such as a complete blood count (CBC) or erythrocyte sedimentation rate (ESR)
- X-ray
- CT scan of the lower spine
- MRI of the lower spine
Treatment
To get better quickly, take the right measures when you first feel pain.
Here are some tips for how to handle pain:
- Stop or reduce normal physical activity for the first few days. This will help relieve your symptoms and reduce any swelling in the area of the pain.
- Apply heat or ice to the painful area. One good method is to use ice for the first 48 to 72 hours and then use heat.
- Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Follow package instructions on how much to take. Do not take more than the recommended amount.
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. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), then you should stay as active as possible. It is important to prevent your back and abdominal muscles from becoming too weak.
You should 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 to 3 weeks, you should gradually start exercising again.
- Begin with light aerobic activity. Walking, riding a stationary bicycle, and swimming are great examples. These activities can improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.
- You may benefit from physical therapy. Your provider will determine whether you need to see a physical therapist and can refer you to one. The physical therapist will first use methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again.
- Stretching and strengthening exercises are important. But, starting these exercises too soon after an injury can make your pain worse. A physical therapist can tell you when to begin stretching and strengthening exercises and how to do them.
If your pain lasts longer than 1 month, your primary provider may send you to see a physiatrist (specialist in rehabilitation), or an orthopedist (bone specialist).
If your pain has not improved after use of medicines, physical therapy, and other treatments, your provider may recommend an epidural injection.
You may also see:
- A massage therapist
- Someone who performs acupuncture
- Someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist)
Sometimes, a few visits to these specialists will help back pain.
Outlook (Prognosis)
Many people feel better within 1 week. After another 4 to 6 weeks, the back pain should be completely gone.
When to Contact a Medical Professional
Contact your provider right away if you have:
- Back pain after a severe blow or fall
- Burning with urination or blood in your urine
- A 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 pain 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
- Difficulty walking or maintaining your balance
Also contact your provider 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
There are many things you can do to lower your chances of getting back pain. Exercise is important for preventing back pain. Through exercise you can:
- Improve your posture
- Strengthen your back and improve flexibility
- Lose weight
- Avoid falls
It is also very important to learn to lift and bend properly. Follow these tips:
- If an object is too heavy or awkward, get help.
- Spread your feet apart to give your body a wide base of support when lifting.
- Stand as close as possible to the object you are lifting.
- Bend at your knees, not at your waist.
- Tighten your stomach muscles as you lift the object or lower it down.
- Hold the object as close to your body as you can.
- Lift using your leg muscles.
- As you stand up with the object, do not bend forward.
- Do not twist while you are bending down for the object, lifting it up, or carrying it.
Other measures to prevent back pain include:
- Avoid standing for long periods. If you must stand for your work, alternate resting each foot on a stool.
- Do not wear high heels. Use cushioned soles when walking.
- When sitting for work, especially if you are using a computer, make sure your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
- Use a stool under your feet while sitting so that your knees are higher than your hips.
- Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods.
- If you drive a long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Do not lift heavy objects just after a ride.
- Quit smoking.
- Lose weight.
- Do exercises on a regular basis to strengthen your abdominal and core muscles. This will strengthen your core to decrease the risk for further injuries.
- Learn to relax. Try methods such as yoga, tai chi, or massage.
References
Corwell BN, Davis NL. Back pain. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 31.
El Abd OH, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 48.
Grabowski G, Gilbert TM, Larson EP, Cornett CA. Degenerative conditions of the cervical and thoracolumbar spine. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 130.
Malik K, Nelson A. Overview of low back pain disorders. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 24.
Murray EL, Misulis KE. Lower back and lower limb pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 33.
Version Info
Last reviewed on: 6/17/2024
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
