Back Pain Overview
*If you are experiencing back pain, see a doctor who can determine the cause. If the pain spreads down your leg or is accompanied by tingling, numbness or weakness, see a doctor immediately.
This site covers the more common causes of back pain, back pain prevention, and back pain treatment. Please do not attempt to diagnose yourself.
Most lower back pain is caused by muscle strain.
The main focus of this site is how to prevent and/or relieve chronic or recurring back pain by learning and practicing good posture habits, increasing strength and endurance in the muscles that support the spine with back exercises, increasing flexibility in the muscles that affect spinal alignment, using proper bending and lifting techniques, and understanding the physical limitations of the back. There is also information on a wide range of treatments for the relief of both acute and chronic back pain.
Though muscle strain is the most common cause back pain there are numerous other causes such as damage or injury to spinal nerves, spinal joints, or discs. Sciatica, which is not a disease in itself but radiating pain and other symptoms caused by inflammation or compression of the sciatic nerve, can be caused by many conditions. Osteoarthritis of the spine is a common cause of back pain in people over 65 years of age (osteoarthritis also affects younger people but risk increases with age). The risk of a herniated disc also increases with age as the discs become less flexible. Back pain is sometimes caused by a problem with the kidneys.
Stress, anxiety, and depression are also linked to back pain. Stress causes muscles to contract, which reduces blood flow to the tissues. Stress hormones also heighten the perception of pain. There are many ways to relieve stress, from exercising to learning relaxation techniques.
Too Much Activity and Poor Body Mechanics Increase Risk of Back Pain
Too much lifting, bending or twisting often leads to back pain. The lower back supports most of the weight of the body and is subject to the most mechanical stress (bending and lifting place the most stress on the lower back). As a result, the lower back is commonly injured. The risk of injury can be reduced with proper bending and lifting techniques. There is a limit to how much weight one can safely lift; even with proper lifting techniques, lifting more weight than one is capable of places one both at risk of herniated discs and strained back muscles. Twisting too far may injure discs and spinal joints as well as injure muscles, tendons, and ligaments.
A Lack of Activity also contributes to the development of back pain.
A sedentary lifestyle leads to a decrease in muscle strength and flexibility and perhaps most importantly, endurance. When muscles that support the spine lack strength and endurance, the back is susceptible to both acute injury and chronic back problems. An unconditioned back is more likely to be strained from overload (e.g. picking up something too heavy) or overuse (e.g. doing one activity for too long or simply holding one position for too long) or may lack the endurance necessary to maintain proper posture.
Back pain can occur suddenly, but more often develops gradually.
For example, when the muscles supporting the back are held in one position (contracted) too long, the back muscles get fatigued and strained; even when demand on the muscles is low. Over time, this can lead to chronic overuse injury. Chronic overuse injuries (also called repetitive stress injuries) may take weeks to months to develop.
Poor posture increases stress on the muscles, spinal joints and discs. Poor posture can be both a cause and result of weakness in the muscles that support the spine and/or inflexibility in the muscles that affect spinal alignment. Proper posture, also called neutral alignment, reduces the risks of lower back pain, as well as neck, shoulder and upper back pain.
Sitting for long periods of time (especially in a fixed position) is particularly detrimental to your back health as well as your general health. Prolonged sitting fatigues and strains the lower back. Poor sitting posture makes matters worse.
While sitting, there is a common tendency to allow the pelvis to tilt backward, causing the lower back to lose its natural inward curve. This creates a pull on the muscles and ligaments and uneven compression of the spinal discs in the lower back and can lead to lower back pain. Rounding the upper back (slouching) and/or the holding the head forward is also common while sitting and is a common cause of neck and shoulder pain.
While some muscles may suffer from overuse from prolonged sitting, others are not being used at all. The abdominal muscles are often disengaged while sitting (abs are usually naturally engaged while standing), letting the stomach hang out onto the lap.
Even with good sitting posture, sitting in one position for too long can cause back strain. It is important to take frequent breaks from sitting. For those whose occupation involves sitting all day, regular exercise to regain and/or preserve strength, endurance and flexibility muscles (as well as regular aerobic exercise) is essential for your back health.
Exercise helps improve posture and core stability. Both poor posture and poor core stability are linked to chronic or recurring back pain. Keeping the back strong also reduces the chances of sudden back injury.
Improve Core Stability with Exercise
Core stability is the ability to keep the spine firm in neutral alignment both while holding one position or during movement (of arms or legs or tilting torso forward from hip joints). The core muscles (the lower back, abs, hips, buttocks) are arranged in layers and work together to stabilize the spine. A weakness in any of the core muscles can affect spinal stability and leave the lower back vulnerable to injury.
Improve Posture with Strengthening & Stretching Exercises
Exercises to increase strength and endurance of the core improve the ability to maintain proper posture and reduce the risk of lower back pain.
Exercises to strengthen the upper back help counteract slouching and reduce the risk of neck pain.
Sufficient flexibility in muscles that affect spinal alignment is also necessary for good posture. For example tight hip flexors (muscles in front of hips) can pull the top of the pelvis forward, which causes an excessive arch in the lower back. This can be corrected over time with stretching exercises.
Weight-bearing aerobics (weight of the body supported by the legs - such as walking) strengthen and increase endurance of muscles in the lower back, hips, and legs as well as prevent bone loss in the lower spine, hips, and legs. Low-impact aerobics (one foot always on the ground) have a low risk of injury and do not place excessive stress on the spine or knees. Moderate intensity aerobics also reduce stress and depression, which can increase back pain.
If back pain persists for over 3 months, it is considered chronic back pain. That doesn't mean wait 3 months to see a doctor - an aching back can be a symptom of something that requires immediate attention such as a kidney infection. Back pain that lasts several days should be diagnosed and treated by a physician. It the pain is severe or is accompanied by numbness or pain down the leg, a doctor should be seen immediately.
The severity of back pain does not always correlate with the severity of the injury or damage.
In many cases the cause of back pain is hard to pin down. A simple muscle strain often causes more pain that a herniated disc. Herniated discs can produce intense back pain but often do not produce any symptoms at all. Even in those with damaged discs and spinal joints, the source of the pain may be strained back muscles.
If a doctor recommends surgery to relieve back pain, a second opinion should be sought. If one has a herniated disc, for example, but the herniated disc is not actually the source of the pain, surgery will not help relieve it. (Most herniated discs improve without surgery)
Recurring back pain is frequently the result of inadequate core muscle strength, shortened muscles; poor posture, being overweight, poor bending and lifting techniques. These are all factors that can be controlled.