Back Pain

Back pain affects eight out of ten people at some point in their lives and is one of the most common reasons people seek medical care, yet most cases improve with simple home treatments and lifestyle changes.

Table of contents

• Overview and Types
• What Causes Back Pain
• Symptoms and When to See a Doctor
• How Back Pain is Diagnosed
• Treatment Options
• Prevention and Lifestyle Changes

Overview and Types

Back pain describes discomfort you feel anywhere along the back of your body, from the base of your neck to the top of your buttocks^[1][2]. It is one of the most common medical problems affecting people worldwide. In 2020, back pain affected 619 million people globally, and estimates suggest this number will increase to 843 million cases by 2050^[7].

Back pain is a leading cause of disability worldwide and one of the top reasons people visit healthcare providers^[1][2]. The lifetime prevalence of low back pain is reported as over 70% in industrialized countries, with a worldwide lifetime prevalence of 84%^[3]. Approximately half of adults experience low back pain during any given year^[3].

Healthcare providers describe back pain according to where it occurs in the body. Upper and middle back pain affects the area between the base of your neck and the bottom of your rib cage, where your thoracic spine (the middle section of the spine) runs through. Lower back pain occurs below your ribcage, where your lumbar spine (the lower section of the spine) is located^[2]. Lower back pain is more common than upper and middle back pain because the lumbar spine bears most of your body weight and most of the stress when you lift or carry things^[2].

Back pain is also classified by how long it lasts. Acute back pain lasts less than four weeks and comes on suddenly. Subacute back pain can last anywhere from four to 12 weeks. Chronic back pain lasts more than 12 weeks or three months^[2][4]. Most back pain is acute and improves over time with home treatment, often within a few weeks^[1].

What Causes Back Pain

Back strains and sprains are the most common causes of back pain^[2]. These injuries can occur suddenly or develop over time. Strains are injuries to your muscles or tendons (the tissue connecting muscles to bones). They can occur from a single event like lifting a heavy object or from prolonged, repetitive movements like constantly bending down at work. Sprains are injuries to your ligaments (the tissue connecting bones to each other). They typically occur after a sudden fall, twist, or blunt force injury that stretches a ligament beyond its normal range of motion^[2].

Back pain arises from a broad range of causes, though most are mechanical in nature or have a nonspecific origin. Mechanical back pain comprises 90% of cases^[3]. Nonspecific low back pain accounts for over 85% of all low back pain and is defined as pain not due to a recognizable specific condition such as infection, tumor, fracture, or nerve damage^[3].

Beyond strains and sprains, there are many other possible causes of back pain. These include mechanical or structural problems in your back, such as:

• Issues with the bones that make up your spine (vertebrae)
• Problems with the flat, round cushions between your vertebrae (intervertebral disks), including herniated disks (when a disk bulges outward) or disk degeneration from aging
• Problems with soft tissues surrounding your vertebrae and disks, including muscles, tendons, and ligaments
• Radiculopathy, including sciatica, where a spinal nerve is compressed, inflamed, or injured, causing pain that radiates to other areas of the body
• Spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves
• Spondylosis, general wear and tear in the joints, disks, and bones of the spine
• Skeletal irregularities such as scoliosis (a curvature of the spine) or lordosis (an abnormally accentuated arch in the lower back)

^[2][11]

Other conditions that can cause back pain include arthritis (including osteoarthritis, rheumatoid arthritis, and spondylitis), osteoporosis (which causes bones to become brittle and can lead to fractures), infections, and tumors^[2][11]. Back pain can also result from conditions affecting organs in your pelvis or belly, such as kidney stones, menstrual cramps, or endometriosis^[2][6].

Several factors increase your risk of experiencing back pain. Poor posture and body mechanics, such as sitting or standing for extended periods with improper alignment, can strain muscles and lead to chronic pain^[20]. Being overweight puts additional stress on the spine^[1][20]. Other risk factors include being pregnant, having poor posture, not being physically active, falling or having an accident, and smoking^[4][14].

Symptoms and When to See a Doctor

Back pain can feel different depending on its cause. You might describe your pain as burning, aching, dull, sharp, shooting, stabbing, or throbbing^[2]. Back pain can range from a muscle ache to a sudden, sharp pain^[1]. The pain can radiate down a leg, and bending, twisting, lifting, standing, or walking can make it worse^[1].

You may also experience muscle tightness or stiffness, tingling, numbness or weakness, or sudden muscle twitches or contractions ranging from mild to extremely painful (back spasms)^[2]. Pain or other sensations may spread from your back to other areas like your buttocks, hips, or legs^[2]. Certain positions, such as standing up, bending over, or lying down, may worsen or improve your symptoms. Pain may come and go and may be worse at certain times of the day^[2].

Most back pain improves over time with home treatment and self-care, often within a few weeks^[1]. However, you should contact your healthcare professional for back pain that:

• Lasts longer than a few weeks
• Is severe and doesn’t improve with rest
• Spreads down one or both legs, especially if it goes below the knee
• Causes weakness, numbness, or tingling in one or both legs
• Is paired with unexplained weight loss

^[1]

In rare cases, back pain can signal a serious medical problem. Seek immediate care for back pain that:

• Causes new bowel or bladder problems
• Is accompanied by a fever
• Follows a fall, blow to the back, or other injury

^[1]

How Back Pain is Diagnosed

Your healthcare professional examines your back and assesses your ability to sit, stand, walk, and lift your legs. The health professional might also ask you to rate your pain on a scale of zero to 10 and talk about how your pain affects your daily activities^[9]. These assessments help determine where the pain comes from and how much you can move before pain or muscle spasms force you to stop^[9].

Before a doctor can begin treating back pain, they may do tests to diagnose what is causing your problem. The diagnosis often starts with a thorough medical history and physical examination. The doctor may ask questions about when the pain started, any triggering factors, and the specific location and nature of the pain^[3].

Further diagnostic tests may be necessary to identify the cause of back pain. One or more of these tests might help pinpoint the cause:

• X-ray: These images show arthritis or broken bones, but they alone won’t find conditions affecting the spinal cord, muscles, nerves, or disks
• MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans: These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels
• Blood tests: These can help determine whether an infection or other condition might be causing pain
• Nerve studies: Electromyography (EMG) measures the electrical impulses produced by the nerves and how the muscles respond to them. This test can confirm pressure on the nerves caused by herniated disks or spinal stenosis

^[9]

Treatment Options

Most back pain gets better within a month using home treatment, especially for people younger than age 60^[9]. Fortunately, measures can help prevent or relieve most back pain episodes^[1]. If prevention fails, simple home treatment and using the body correctly often can heal the back within a few weeks. Surgery is rarely needed to treat back pain^[1].

Treatment for back pain depends on what kind of pain you have and what is causing it. Pain relievers and the use of heat might be all that’s needed^[9]. Continue your activities as much as you can with back pain. Try light activity, such as walking. Stop activity that increases pain, but don’t avoid activity out of fear of pain^[9]. Bed rest isn’t recommended, and staying in bed for more than one or two days can make it worse^[4].

An estimated $200 billion is spent annually on managing back pain in the United States^[3]. There are many alternative treatments for back pain, many of which are easy to do at home and affordable, with no doctor’s prescription necessary^[12].

Non-drug therapies and treatments include:

• Physical therapy that includes supervised exercise is often a first-line approach. The goals are to help strengthen the muscles that support the spine, improve flexibility, and promote better posture^[17]
• Heat and cold therapy: Heat may be dry (heat lamps, heating pads) or moist (warm baths, washcloths soaked in warm water). Cold therapy can reduce pain and swelling. Use cold for pain in the first 24 to 48 hours after pain starts^[19]
• Mind-body practices like yoga, tai chi, and mindfulness-based stress reduction may ease pain and improve your ability to function, especially when combined with other therapies^[17]
• Massage therapy: Studies show that many people who get massages for back pain report less pain and anxiety and improved sleep^[19]
• Acupuncture: This technique, in which tiny needles are inserted into the body to stimulate specific points, is thought by some patients and doctors to relieve back pain^[12]

Medications used to treat back pain include pain relievers targeting peripheral and central neurologic pathways and muscle relaxants^[3]. If your back pain is severe or doesn’t improve after three days, you should call your health care provider^[4].

Prevention and Lifestyle Changes

One of the best ways to prevent back pain is to keep your back muscles strong^[5][16]. Managing chronic back pain often involves lifestyle modifications and self-care strategies that can help alleviate symptoms and improve overall well-being^[15].

The key to recovering from acute low back pain is to maintain the normal curve of the spine. Supporting the hollow of your back will help decrease your recovery time^[15].

Physical activity and exercise

Regular physical activity can make your back stronger and lower your risk of back pain:

• Do muscle-strengthening and stretching exercises at least two days a week^[5][16]
• Try a yoga class. Yoga can help stretch and strengthen muscles and improve your posture^[16]
• Stay active. Regular physical activity can help keep your back muscles strong. Aim for at least 150 minutes a week of moderate-intensity aerobic activity^[16]
• Try water exercise. Warm water is a good place to stretch and strengthen your back muscles. Water allows your muscles to relax and acts as resistance to help build muscle strength^[19]
• Take walks. Walking is a very safe and good exercise. Brisk walking will help you maintain a healthy weight and keep pressure off your back^[14]

Maintain proper posture

Good posture can help prevent back pain^[16]. Posture refers to how a person holds themselves when sitting or standing. Over time, some postures can lead to pain. Examples include forward head posture, slouching, and hyperlordosis^[6].

Tips for good posture include:

• Try not to slouch when standing and sitting
• Sit up straight with your back against the back of your chair and your feet flat on the floor
• Stand tall with your head up and shoulders back
• If you can, switch between standing and sitting so you’re not in the same position for too long
• Use magnification, such as loupes, and adequate lighting to bring your field of vision closer and decrease the extent to which your neck is held forward and flexed down

^[5][16]

Lift correctly

When you lift something heavy, it’s very easy to twist the wrong way. Lift things with your legs, not your back. Keep your back straight and bend at your knees. Get help if the load is too heavy for you to lift alone^[14][16]. Before you lift a heavy object, make sure you have firm footing. Stand with a wide stance close to the object and keep your feet firmly on the ground^[15].

Aim for a healthy weight

Being overweight can strain your back^[1]. Extra weight puts a strain on your back and can cause the spine to become tilted and stressed unevenly^[14]. Getting to and staying at a healthy weight lowers your risk of back pain. If you’re overweight, losing weight in a healthy way can lower the strain on your back^[16].

Eat an anti-inflammatory diet

The foods we eat can prevent and reverse some types of back pain. Inflammation is your body’s natural response to protect itself from harm and is a known cause of back pain. Studies have suggested that an anti-inflammatory diet can be just as effective at treating back pain as nonsteroidal anti-inflammatory drugs (NSAIDs)^[12].

Foods that fight inflammation include brightly-colored fruits and vegetables, fatty fish such as salmon, green leafy vegetables, healthy monounsaturated fats like avocado and olive oil, nuts, and seeds. Avoid foods that can promote inflammation, including fast food, processed foods, and foods that are high in saturated fat and refined carbohydrates^[12].

Get enough calcium and vitamin D

Calcium is key for strong teeth and bones, and getting enough (along with vitamin D) can relieve back pain caused by conditions that affect bone mass and strength, such as osteoporosis. Depending on age, most adults should get between 1,000 and 1,200 mg per day of calcium and between 600 and 800 international units of vitamin D per day^[12][16].

Quit smoking

Smoking restricts blood flow to the disks that cushion your vertebrae. This could lead to quicker disk degeneration. Smoking also reduces calcium absorption and new bone growth, which increases the risk of fractures due to osteoporosis^[14].

Reduce pressure on your back when you sleep

Sleeping flat on your back puts pressure on your spine. Elevate your knees slightly by placing a pillow under them. If you’re a side sleeper, put a pillow between your knees to reduce pressure on your back^[14].