Low Back Pain

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Low Back Pain

Topic Overview

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This topic provides a general overview of low back pain. If you have been diagnosed with a herniated disc or spinal stenosis, see the topic Herniated Disc or Lumbar Spinal Stenosis.

What is low back pain?

Low back pain can happen anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body’s weight. So it's pretty easy to hurt your back when you lift, reach, or twist. In fact, almost everyone has low back pain at one time or another.

What causes low back pain?

Causes of low back pain include:

Often doctors don't really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.

What are the symptoms?

Depending on the cause, low back pain can cause a range of symptoms. The pain may be dull or sharp. It may be in one small area or over a broad area. You may have muscle spasms.

Low back pain can also cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee.

A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs or you lose bladder or bowel control.

Most low back pain is short-term (acute) and will go away in a few weeks. It is more likely to become long-lasting (chronic) if you are depressed or under stress.

How is low back pain diagnosed?

The doctor will ask questions about your past health, symptoms, and activities. He or she will also do a physical examination. Your answers and the examination can help the doctor rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first examination.

X-rays, CT scans, and MRIs don't usually help.

But if you have a back pain problem that has lasted longer than 4 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for one of these tests.

How is it treated?

Most low back pain will improve with basic first aid, which includes resting for a day or two, getting up and active as soon as possible, and taking over-the-counter pain medicine as needed.

Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.

A doctor or physiotherapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. Strengthening the muscles in your trunk can improve your posture, keep your body in better balance, and lower your chance of injury.

Certain other treatments work for some people but not for others. You may need to try different things to see which work best for you, such as:

If your symptoms are severe or you still have them after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from physiotherapy.

Having ongoing (chronic) back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both counselling and medicine. Special counselling can help you learn stress management and pain control skills. Antidepressant medicines may help too.

How can you prevent low back pain from returning?

After you've had low back pain, you're likely to have it again. But there are some things you can do to help prevent it. And they can help you get better faster if you do have low back pain again.

To help keep your back healthy and avoid further pain:

  • Practice good posture when you sit, stand, and walk.
  • Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
  • Wear low-heeled shoes with good support.
  • Sleep on your side. A medium-firm mattress may put the least stress on your back.
  • Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
  • Don't try to lift things that are too heavy for you. When you must lift, learn the right way to lift.

If you sit or stand for long periods at work:

  • Pay attention to your posture. Sit or stand up straight, with your shoulders back.
  • Make sure your chair has good back support.
  • Take regular breaks to walk around.

If your work involves a lot of bending, reaching, or lifting:

  • Talk to your human resources department to see if there are other ways you can do your work.
  • Don't depend on a "back belt" to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting.

Frequently Asked Questions

Learning about low back pain:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Cause

The most common causes of low back pain are:

  • Injury or overuse of muscles, ligaments, and joints.
  • Pressure on nerve roots in the spinal canal. This can be caused by:
    • A herniated disc, sometimes brought on by repeated vibration or motion (as during sport activity or when using a machine or lifting in the wrong way) or by a sudden heavy strain or increased pressure to the lower back.
    • Osteoarthritis, usually caused by getting older. When osteoarthritis affects the small joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.
    • Spondylolisthesis, a defect that allows one vertebra to slide over another.
    • Spinal stenosis, or narrowing of the spinal canal, which is usually caused by getting older.
    • Fractures of the vertebrae caused by a lot of force, such as from a car crash or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.
    • Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.
  • Compression fractures. These are more common among post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less common spinal conditions that can cause low back pain include:

  • Ankylosing spondylitis, which is a form of arthritis that most often affects the spine.
  • Bacterial infection. Bacteria are usually carried to the spine through the bloodstream. You may have back pain from an infection in the bone, in the spinal discs, or in the spinal cord. An infection may enter the spine from:
    • An infection somewhere else in the body.
    • Intravenous (IV) drug use.
    • Surgery or injection treatments.
    • An injury.
  • Spinal tumours, which are growths on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.

Symptoms

Symptoms of low back pain depend on the cause.

Back sprain or strain

Symptoms generally include:

  • Muscle spasms, cramping, and stiffness.
  • Pain in the back and buttocks. It may come on quickly or gradually. It most often occurs in episodes. Certain movements make it worse, and resting makes it feel better. The worst pain usually lasts 48 to 72 hours and may be followed by days or weeks of less severe pain. It's very easy to reinjure your back during this time.

Nerve-root pressure

Symptoms generally include:

  • Leg pain. If pain extends below the knee, it is more likely to be due to pressure on a nerve than to a muscle problem. Most commonly, it's a pain that starts in the buttock and travels down the back of the leg as far as the ankle or foot. This pain pattern is known as sciatica (say "sy-AT-ih-kuh"). For more information, see the topic Sciatica.
  • Nerve-related problems, such as tingling, numbness, or weakness in one leg or in the foot, lower leg, or both legs. Tingling may begin in the buttock and extend to the ankle or foot. Weakness or numbness in both legs, or loss of bladder and/or bowel control, are symptoms of cauda equina syndrome, which requires immediate medical attention.

Arthritis of the spine

Arthritis of the spine usually causes pain that:

  • Is worse in the back and hip region.
  • Starts gradually, gets worse over time, and lasts longer than 3 to 6 months.
  • Is generally worse in the morning or after prolonged periods of inactivity. Arthritis pain gets better when you move around.

Other conditions

Symptoms of diseases that affect the spine depend upon the disease. They may include:

  • Pain that is worse in the affected part of the spine (for instance, if there is a compression fracture, tumour, or infection).
  • Pain that starts gradually, is constant, and may be sharp or a dull ache. Bedrest doesn't help and may make it worse (tumours on the spine often cause night pain). The pain lasts longer than 2 to 3 weeks.
  • Fever.
  • Sensitivity of the spine to touch and pressure.
  • Pain that wakes you up from sleep.

What Happens

The course of low back pain depends both on its cause and on how well you treat your back.

  • Most low back pain lasts less than 3 months.
    • In 60 out 100 people, low back pain goes away within 1 week.
    • In 90 out of 100 people, low back pain goes away within 6 weeks.
    • In 95 out of 100 people, low back pain goes away within 3 months.
    • In more than 98 out of 100 people, low back pain is gone within 1 year.1
  • After you hurt your back, you're more likely to hurt it again. Many people who recover have back pain again within a year. Most people will have it again sometime during their lives.
  • Long-lasting (chronic) pain not only makes you tired, irritable, and less productive and active but 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 the body. Pain can also cause biochemical changes in your body that tend to keep the pain going. Without special treatment, you may get chronic pain syndrome.

What Increases Your Risk

A risk factor is something that increases your chances of having back pain. Having more risk factors means you have a higher chance of having back pain.

Risk factors that you can't change

These include:

  • Being middle-aged or older.
  • Being male.
  • Having a family history of back pain.
  • Having had a back injury before.
  • Being pregnant. A woman's back is significantly stressed by carrying a baby.
  • Having had compression fractures of the spine.
  • Having had back surgery before.
  • Having spine problems since birth.

Risk factors you can change with lifestyle changes

These include:

  • Not getting regular exercise.
  • Doing a job or other activity that requires long periods of sitting, heavy lifting, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment.
  • Smoking. People who smoke are more likely than people who don't smoke to have low back pain.
  • Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proven. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility. These can lead to low back pain.
  • Having poor posture. Slumping or slouching on its own may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse.
  • Being under stress. Stress and other emotional factors are believed to play a major role in low back pain, particularly chronic low back pain. Many people unconsciously tighten their back muscles when they are under stress.

Risk factors you might change with medical treatment

These include:

  • Having long periods of depression.
  • Using medicines long-term that weaken bones, such as corticosteroids.
  • Having an illness or disease that causes chronic coughing.

When to Call a Doctor

Call 911 or other emergency services immediately if:

  • Back pain occurs with chest pain or other symptoms of a heart attack.
  • A person has signs of damage to the spine after an injury (such as a car crash, fall, or direct blow to the spine). Signs may include:
    • Being unable to move part of the body.
    • Severe back or neck pain.
    • Weakness, tingling, or numbness in the arms or legs.
    • Loss of bladder or bowel control.
  • You cannot walk or stand at all because of weakness (and not just because it hurts too much).
  • You suddenly lose bowel or bladder control, even if you were not injured.

Call your doctor if:

  • You have new numbness in the buttocks, genital or rectal area, or legs.
  • You have leg weakness that is not solely due to pain. Many people with low back pain say their legs feel weak. See your doctor if your leg is so weak that you cannot bend your foot upward, get out of a chair, or climb stairs.
  • You have new or increased back pain with fever, painful urination, or other signs of a urinary tract infection.
  • You have long-term back pain that suddenly gets much worse, and you did not cause it by being more active.
  • You have a history of cancer or HIV infection, and you have new or increased back pain.
  • You have severe pain that does not improve after a few days of home treatment.
  • Pain wakes you from sleep.
  • Pain does not improve after 2 weeks of home treatment.

For more information, see the topic Back Problems and Injuries.

Watchful waiting

Most low back pain does not 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. He or she may want to check for problems that may be causing your back pain.

Who to see

Your family doctor or general practitioner can diagnose the cause of back pain, evaluate back injuries, and start treatment. You may be referred to a specialist, such as:

You may also be referred to one of the following specialists:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Your doctor will begin by asking questions about your medical history, your symptoms, and your work and physical activities. He or she will also do a physical examination. The questions and examination can help him or her rule out a serious cause for your pain. Your doctor may also ask questions about stress at home and at work that may make you more susceptible to chronic pain.

If your back pain has lasted for less than 4 weeks, your doctor may hold off on testing. This is because most back pain goes away on its own in a month or so.

But if you have a back pain problem that has lasted longer than 4 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for a test.

Which tests are used?

Tests for low back pain include:

Sometimes other tests can be useful, such as a bone scan or electromyogram and nerve conduction. These are used to look for bone, nerve, and muscle/nerve problems that might be causing low back pain.

If you’re still thinking about testing, here’s some information that may help you make a decision:

Click here to view a Decision Point. Low Back Pain: Should I Have an MRI?

Treatment Overview

Doctors divide low back pain into two categories:

  • Acute: This is pain that has lasted less than 3 months. Most people get better with home treatment.
  • Chronic: This is pain that has lasted longer than 3 months. People with chronic back pain are usually helped with more intensive treatment.

After you have had low back pain once, the pain is likely to come back. To avoid further problems, keep your back and stomach muscles strong, use good posture, learn the safest way to lift heavy objects, and learn to manage stress.

Treatment for acute low back pain

Learn about the first aid steps you can take when you first get back pain, such as using heat or ice, taking medicine, and not resting too much.

Sometimes acute low back pain lasts longer than a few days, even after you try these treatments. Then your doctor may suggest other treatments, such as physiotherapy or stronger pain medicine.

If your pain is very bad, your doctor may recommend short-term use of an opiate painkiller or a muscle relaxant. Some people consider epidural steroid shots.

For more information, see:

Picture of Keller

Answers From an Expert:

"Stay as active as you can. Doctors used to say to rest, but it turns out that this is not the case. The more active you are, the better you will be, and the faster you will heal."—Dr. Robert Keller

Read more advice from this back specialist.

Photo of a woman sweeping the floor

One Woman's Story:

"I thought, 'Okay, it will hurt for a day or two, and that's it.' But it lasted a lot longer. It took about 3 weeks. I guess we're used to fast cures. We take ASA, and the headache goes away. We take the antibiotic, and the infection disappears." —Lorna

Read more about how Lorna learned to be patient with her back.

Treatment for chronic low back pain

If you've got chronic back pain, you know that one type of treatment by itself doesn't always stop your pain.

Think of your treatment plan as a recipe. You and your doctor may need to add or take out ingredients to make it work.

Here are some choices to think about:

  • Acupuncture is a treatment based on traditional Chinese medicine. Very thin needles are inserted into the skin at certain points on the body to produce energy flow.
  • Biofeedback is a way to train your mind to control a body function that is normally not under your control.
  • Cognitive-behavioural therapy can teach you stress management and pain control skills.
  • Chiropractic is a treatment that affects the muscles and bones.
  • Massage involves rubbing the soft tissues of the body, such as the muscles, to help reduce tension and pain, improve blood flow, and help you relax.
  • Comprehensive rehabilitation programs offer a variety of treatments and specialists. They are considered one of the best ways to treat chronic low back pain, and they may be your best bet for finding the right combination of treatments.2

For more information, see Other Treatment.

Prevention

There is no clear evidence that you can prevent low back pain. But there are some things you can do that may help prevent it. And they can prepare you for faster recovery if you do have low back pain.

  • Exercise to keep your back healthy and strong. Exercise programs that include aerobic conditioning and strengthening exercises can help keep low back pain from coming back. For more information, see:
    Click here to view an Actionset. Fitness: Increasing Core Stability.
    Click here to view an Actionset. Low Back Pain: Exercises to Reduce Pain.
  • Learn how to lift objects safely to protect your back. For more information, see:
    Click here to view an Actionset. Back Problems: Proper Lifting.
  • Protect your back while sitting. Standing posture is also important. For most people, good posture means that when you stand, your ears, shoulders, hips, and knees should be in line with one another.
  • Try different sleeping positions that protect your back. If you sleep on your side, try putting a pillow between your knees. If you sleep on your back, use a pillow under your knees. You can also try rolling up a small towel and using it to support your lower back.
  • Wear low-heeled shoes.
  • Stay at a healthy weight to avoid excess strain on your lower back. For more information, see the topic Weight Management.
  • If you're a smoker, quit. Smoking increases your risk of bone loss (osteoporosis) and increases your sensitivity to pain. Smoking also interferes with blood circulation by tightening the arteries, which makes it harder for blood to flow, and by decreasing the amount of oxygen the red blood cells can carry. Spinal discs don't have their own blood supply, but they receive nutrition in part from the blood supply to the vertebral bones above and below them. Decreased circulation may increase the speed of degeneration and/or slow the healing of the discs. For more information on how to quit, see the topic Quitting Smoking.
  • Eat a healthy diet. Getting plenty of calcium and vitamin D may help prevent osteoporosis, which can lead to compression fractures and low back pain.
  • Manage the stress in your life, both at home and at work.

Living With Low Back Pain

Photo of a man

One Man's Story:

"Some people get better fast, but others take a lot of time. That was my case. If you have back pain, do what you can for it, but don’t be in a hurry. It usually gets better."—Jack

Read more about how Jack learned that he didn't need surgery.

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 things that make your pain worse.

Ease back into your daily activities

Avoid or change activities that cause pain

Pay attention to your body mechanics and posture

Body mechanics are the way you use your body. Posture is the way you sit or stand.

  • To prevent a return of low back pain, you will need to take extra care when you lift. When you must lift, bend your knees and flex from your hips. Don't let your spine slump.
  • Stand or sit tall without slumping or arching your back too much. Slouching and slumping increase stress on your back.

Stretch and strengthen your back

When you no longer have acute pain, you may be ready for gentle strengthening exercises for your stomach, back, and legs, and perhaps for some stretching exercises. Exercise may not only help decrease low back pain but also may help you recover faster, prevent reinjury to your back, and reduce the risk of disability from back pain.

Walking is the simplest and perhaps the best exercise for the low back. Your doctor or a physiotherapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and decrease your chance of injury. For more information, see:

Click here to view an Actionset. Fitness: Increasing Core Stability.
Click here to view an Actionset. Low Back Pain: Exercises to Reduce Pain.
Photo of a man with his dog

One Man's Story:

"I discovered that what you have to do is this: You do as much as you can."—Robert

Read more about how Robert controls his back pain by staying active.

Take care of stress

Stress and low back pain can create a vicious circle. You have back pain, and you begin to worry about it. This causes stress, and your back muscles begin to tense. Tense muscles make your back pain worse, and you worry more... which makes your back worse... and so on.

There are lots of ways to teach yourself to relax. Try one of these:

Click here to view an Actionset. Stress Management: Practicing Yoga to Relax
Click here to view an Actionset. Stress Management: Doing Guided Imagery to Relax
Click here to view an Actionset. Stress Management: Breathing Exercises for Relaxation
Click here to view an Actionset. Stress Management: Doing Progressive Muscle Relaxation
Click here to view an Actionset. Stress Management: Relaxing Your Mind and Body
Click here to view an Actionset. Stress Management: Managing Your Time
Click here to view an Actionset. Stress Management: Doing Meditation
Photo of a woman holding her head in her hands

One Woman's Story:

"I had too much to do and too little time. That means stress. And when I start stressing, my back starts aching. Before I knew it, my back was screaming at me."—Cathy

Read more about how Cathy made time to deal with her stress.

Manage your weight

Extra body weight, especially around the waist, may put strain on your back.

If you want to get to a healthy weight and stay there, lifestyle changes will work better than dieting.

Here are the three steps to reaching a healthy weight:

  • Improve your eating habits. Do it slowly. You may be tempted to do a diet overhaul and change everything about the way you eat. But you will be more successful at staying with the changes you make if you pick just one eating habit at a time to work on.
    Click here to view an Actionset. Weight Management: Starting a Plan for Change
  • Get moving. Try to make physical activity a regular part of your day, just like brushing your teeth. Start small, and build up over time. Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before you start an exercise program.
  • Change your thinking. Our thoughts have a lot to do with how we feel and what we do. If you can stop your brain from telling you discouraging things and have it start encouraging you instead, you may be surprised at how much healthier you'll be—in mind and body.
    Click here to view an Actionset. Weight Management: Using Positive Thinking

Quit smoking

People who smoke take longer to heal—from any injury, not just back pain. If you stop smoking, you may feel better sooner.

People who smoke are also much more likely to have back pain than people who don’t smoke. This is because the nicotine and other toxins from smoking can keep spinal discs from getting all the nutrients they need from the blood, making disc injury more likely. These discs cushion the bones in your spine. An injured disc can cause low back pain.

Interactive Tool: Are You Ready to Quit Smoking?
Click here to view an Actionset. Quitting Smoking: Getting Support

Medications

Medicine can decrease low back pain and reduce muscle spasms in some people. But medicine alone is not an effective treatment for low back pain. It should be used along with other treatments, such as exercise and physiotherapy.

Medication choices

There are several medicines your doctor may recommend, depending on how long you have had pain, what other symptoms you have, and your medical history.

The medicines recommended most often are:

  • Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs like ASA and ibuprofen (Advil). You can buy these medicines without a prescription. Some of them also come in stronger doses. For those, you'll need a prescription.
  • Muscle relaxants. Also called sedatives, these medicines can help when you get bad muscle spasms along with low back pain. Side effects, such as drowsiness, are common.
  • Narcotic pain medicines. These are very strong medicines that you may use to ease sudden, severe back pain. They are usually taken for only 1 to 2 weeks. People with chronic low back pain may take them for longer periods. You can take these drugs without becoming addicted.
  • Antidepressants. These medicines not only treat depression but also may help with chronic pain.

Other medicines sometimes used for low back pain are:

  • Anesthetic or steroid injections. These have been prescribed for chronic low back pain, but they have not been researched enough to know if they work well for back pain.
  • Anticonvulsants. These are sometimes used to treat low back pain, even though there isn't strong evidence that they help.
  • Botox injection. This is a shot into the back muscles. It has not been well tested for chronic low back pain.

Medicines that work for some people don't work for others. Let your doctor know if the medicine you are taking doesn't work for you. You may be able to take another medicine for your back pain.

Surgery

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.

Most back surgeries are done to treat nerve pain from herniated discs.

  • Most herniated discs heal—and pain eases—after a few weeks or months of treatment.
  • About half of people with herniated discs get better within a month without surgery.
  • After 6 months, most people with herniated discs have recovered. Only about 10 out of 100 end up having surgery.3

When surgery may help

Surgery might be an option when a disc problem causes pain in your leg that prevents you from doing everyday tasks. You may have pain, numbness, or tingling through your buttock and down the back of your leg (sciatica) or in the front of your thigh. Other problems that may require surgery include:

  • A spinal fracture caused by an injury.
  • An infection in your spine.
  • A problem that causes your spine to be unstable.
  • A tumour in your spine.
  • Spinal stenosis.
  • Loss of feeling or weakness in your back or legs that gets worse over time.
  • Loss of control of your bowel or bladder.

Having surgery for a herniated disc or another back problem is a big decision. Talk to your doctor about it.

Rehabilitation after surgery

A comprehensive rehabilitation program is very important after most back surgery. As you regain flexibility, recondition your back and stomach muscles, and increase your endurance for activity, you increase your chances of treatment success.

If you are unable or unwilling to commit to physiotherapy after surgery, you may not be a good candidate for surgery.

Surgery choices

There are several types of back surgery. Some, like a discectomy, can help people with severe long-term symptoms. Others have not been proven to work.

If you do need surgery, you and your doctor will decide which type is best for you. For more information about these surgeries, see:

What to think about

Back surgery is not always successful. Depending on the condition, you may still have back pain after surgery.

If you and your doctor are considering surgery, get as much information as you can about possible results, and consider whether you will be willing to do physiotherapy after surgery. It is also a good idea to get a second opinion before you decide to have surgery.

Interactive Tool: Should I Consider Surgery for My Low Back Problem?
Click here to view a Decision Point. Herniated Disc: Should I Have Surgery?

Other Treatment

You can choose from a number of alternative treatments for your low back pain. Because many of these treatments are new or not yet well researched, they may not be covered by your provincial health plan, private health insurance, or your Workers' Compensation Board.

The following complementary treatments are often used for low back pain.

  • Massage may reduce low back pain, especially when combined with exercises and back care education.4
  • Spinal manipulation is likely to help both acute and chronic low back pain in the short-term, but probably no more than other treatments such as physiotherapy, exercise, or pain medicine.5 While they differ in their training, osteopaths, chiropractors, physiatrists, and specially trained physiotherapists can all perform spinal manipulation. Spinal manipulation usually has its greatest impact after one treatment, so multiple treatments are seldom needed.6 Learn more about chiropractic and spinal manipulation. One comparison has shown that people who get osteopathic manipulative treatment may need less medicine to control their pain than those who get standard treatment such as pain medicine and physiotherapy.7 For more information, see:
    Click here to view a Decision Point. Low Back Pain: Should I Have Spinal Manipulation?
  • Biofeedback has not been well studied as a treatment for low back pain. But recent research has not shown that biofeedback is effective for controlling low back pain.
  • Acupuncture may help decrease pain and increase activity. Some studies showed that acupuncture reduced pain and disability related to back problems more than usual treatment.8 Another summary of several studies showed that acupuncture reduced pain and increased the ability to be active for a short time after treatment but not any more than other treatments.9
  • Acupressure uses pressure on certain points in the body to decrease symptoms. Small studies suggest that acupressure reduces pain and allows a person to be more active.10
  • Relaxation techniques can help reduce muscle tension, stress, and depression.
  • Yoga is another way of staying active while also helping with relaxation and stress management. It is not clear whether yoga is more helpful than other activity or treatment for low back pain.11 There are different types of yoga. Talk to your doctor or physiotherapist before you start a yoga program.

Here are some other treatment choices to think about:

  • Learning about your back:
    • Back school teaches you all about back care, how to stand and sit, and how to move your body in a safer way. It also teaches you how to prevent long-term back problems.
    • A pain management clinic is a place where you can learn how to cope with chronic pain. You also can get treatment there.
  • Electric currents:
    • Transcutaneous electrical nerve stimulation (TENS) gives brief pulses of electricity to nerve endings in the skin to relieve pain. Although TENS may help some people, there is no evidence that it works.
    • Spinal cord stimulation uses an electrical current to treat chronic pain. A doctor puts an electrical generator under the skin. This device sends pulses through electrodes placed in the spinal canal. There is not strong evidence that it works.12
  • Other procedures:

Experimental treatments

New and experimental treatments are constantly being developed and offered to people with low back pain. If you are considering such a treatment, be sure to ask your doctor for two things:

  1. The scientific evidence that shows that the treatment works and is safe.
  2. The results that your doctor has seen in his or her own practice.

Experimental treatments include:

  • Surgery to replace a ruptured or herniated disc with an artificial disc. This treatment has been approved by Health Canada. Long-term studies have not been done.
  • Botulinum toxin (Botox) injection. This may relax painful muscle spasms in the low back.
  • Radiofrequency ablation of nerves. This may reduce chronic low back pain in some people by preventing pain signals from reaching the brain. It is sometimes used for pain from problems with the small joints in the spine called facet joints.
  • An intrathecal pain pump. This is a small tube inserted under the skin and deeper tissues along the midline of the back and into the spinal canal. The tube connects to a small reservoir of medicine inserted under the skin of your belly. The medicine is regularly delivered to the area of pain through the tube.13

Coping With Chronic Back Pain

Photo of a man smiling

One Man's Story:

"I started feeling sad and angry a lot. I didn’t want to do anything. My back was hurting more. I was having trouble focusing on my work. My life just started feeling smaller and smaller."—Ravi

Read more about how Ravi learned he had depression and how he fought back.

Low back pain can take a toll on your mental health. You may feel fear, frustration, and anger or have depression and anxiety because of ongoing pain. Those common reactions can make your pain last even longer. If pain is starting to get you down:

  • Let people know when you need a helping hand. Ask family members or friends to help out with physical tasks you can't do right now.
  • Be honest with your doctor about how pain is affecting you. Ask for a referral to a counsellor or pain management specialist. Your doctor may also see a need to prescribe antidepressant or antianxiety medicine.
  • Work with your health professionals and your work supervisor to make a return-to-work plan, if necessary. Ask for an ergonomic consultation if you need to learn how to do some of your job duties differently to avoid hurting your back again.

Emotional support is important

Depending on others for emotional support is a normal part of life. You may have to lean on friends and family when facing difficult situations caused by chronic pain or other problems. Your loved ones can play an important role in supporting your recovery. Your doctor and community also may give you extra support.

Asking for support from others is not always easy. It can be hard to tell someone about your problems. But you should not be afraid to ask for help.

Where you can get support

  • Family. Family members can help you cope by giving you comfort and encouragement.
  • Friends. Building strong relationships with others is important for your emotional well-being. Don't be afraid to ask your friends for support. Helping is a big part of friendship. At times you may be the one who encourages a friend.
  • Counselling. Professional counselling can help you cope with situations that interfere with your life and cause stress. Counselling can help you understand and deal with your pain. You can learn ways to think positively and stop negative thoughts. See the topic Positive Thinking With Cognitive-Behavioural Therapy.
    Click here to view an Actionset. Depression: Using Positive Thinking
    Click here to view an Actionset. Anxiety: Using Positive Thinking
    Click here to view an Actionset. Positive Thinking: Stopping Unwanted Thoughts
  • Your doctor. Find a doctor you trust and feel comfortable with. Be open and honest about your fears and concerns. Your doctor can help you get the right treatments, including treatment for depression or other problems.
  • Religious groups. Religious or spiritual groups may help you meet people and get involved in the community. Some religious organizations can help you get counselling or other social support services.
  • Social groups. Social groups can help you meet new people and get involved in activities you enjoy.
  • Community support groups. In a support group, you can talk to others who have dealt with the same problems or illness as you. You can encourage one another and learn ways of coping with tough emotions.
Photo of a woman smiling

One Woman's Story:

"I really work at finding the good things in my day. It helps me get through the day, and I think it makes my pain not bother me as much."—Patty

Read more about how Patty used positive thinking to help her back pain.

Supportive relationships

Your loved ones can offer support by:

  • Giving encouragement. This can keep you from feeling hopeless or alone.
  • Offering to help. Getting a helping hand can keep you from feeling overwhelmed. This may include helping with small daily tasks or bigger problems.
  • Going to doctor visits. Your loved ones can offer support by being involved in your medical care.
  • Being honest and realistic. Make sure your loved ones understand how serious the problem is. They can help by not setting unreachable goals or acting like the problem will just go away.
  • Respecting your wishes. You are responsible for your decisions. Your loved ones can offer support and encouragement without interfering with your major decisions.

Having trouble getting support from friends and family? There are steps you can take to make your social support stronger.

Keep moving

Having chronic back pain can make exercising, even walking, difficult. Being active is often the last thing you want to think about.

But the truth is that daily activity and physiotherapy exercises can help relieve back pain and can lead to long-term improvement for low back pain.14

So be as active as you can. Take short walks as often as you can. Talk to a physiotherapist about exercises you can do. Also see:

Click here to view an Actionset. Fitness: Increasing Core Stability.
Click here to view an Actionset. Low Back Pain: Exercises to Reduce Pain.

Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone: 1-800-346-AAOS (1-800-346-2267)
(847) 823-7186
Fax: (847) 823-8125
Email: orthoinfo@aaos.org
Web Address: www.orthoinfo.aaos.org
 

The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS website contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.


Canadian Orthopaedic Foundation
PO Box 7029
Innisfil, ON L9S 1A8

Canadian Physiotherapy Association
2345 Yonge Street
Suite 410
Toronto, ON  M4P 2E5
Phone: (416) 932-1888
1-800-387-8679
Fax: (416) 932-9708
Email: information@physiotherapy.ca
Web Address: http://www.physiotherapy.ca

U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) toll-free
(301) 495-4484
Fax: (301) 718-6366
TDD: (301) 565-2966
Email: niamsinfo@mail.nih.gov
Web Address: www.niams.nih.gov
 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.

The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.


References

Citations

  1. Carragee EJ, Hannibal M (2004). Diagnostic evaluation of low back pain. Orthopedic Clinics of North America, 35(2004): 7–16.
  2. Chou R, et al. (2009). Interventional therapies, surgery and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10): 1066–1077.
  3. Hu SS, et al. (2006). Lumbar disc herniation section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 246–249. New York: McGraw-Hill.
  4. Furlan AD, et al. (2008). Massage for low-back pain. Cochrane Database of Systematic Reviews (4).
  5. Chou R, Huffman LH (2007). Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147(7): 492–504.
  6. Hadler NM (2005). Low back pain. In WJ Koopman, ed., Arthritis and Allied Conditions, 15th ed., vol. 2, pp. 2073–2086. Philadelphia: Lippincott Williams and Wilkins.
  7. Andersson GB, et al. (1999). A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. New England Journal of Medicine, 341(19): 1426–1431.
  8. Abramowicz M (2006). Acupuncture. Medical Letter on Drugs and Therapeutics, 48(1234): 38–39.
  9. Furlan AD, et al. (2005). Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews (1).
  10. Hsieh LL, et al. (2006). Treatment of low back pain by acupressure and physical therapy: Randomised controlled trial. BMJ, 333(7543): 696–700.
  11. Graves N, et al., (2004). Does yoga speed healing for patients with low back pain? Journal of Family Practice, 53(8): 661–662.
  12. Mailis-Gagnon A, et al. (2004). Spinal cord stimulation for chronic pain. Cochrane Database of Systematic Reviews (3).
  13. Deer T, et al. (2004). Intrathecal drug delivery for treatment of chronic low back pain: Report from the National Outcomes Registry for Low Back Pain. Pain Medicine, 5(1): 6–13.
  14. McIntosh G, Hall H (2008). Low back pain (chronic), search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Other Works Consulted

  • American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons (2009). Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57(8): 1331–1346.
  • Assendelft WJJ, et al. (2003). Spinal manipulative therapy for low back pain: A meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine, 138(11): 871–881.
  • Cailliet R (2003). Low Back Disorders: A Medical Enigma. Philadelphia: Lippincott Williams and Wilkins.
  • Carragee EJ (2005). Persistent low back pain. New England Journal of Medicine, 352(18): 1891–1898.
  • Chaiamnuay S, et al. (2006). Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs. American Journal of Health-System Pharmacy, 63(19): 1837–1851.
  • Chou R, et al. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7): 478–491.
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  • Deshpande A, et al. (2007). Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews (3).
  • Hu SS, et al. (2006). Spondylolisthesis and spondylolysis section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 271–277. New York: McGraw-Hill.
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  • Kovacs FM, et al. (2003). Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial. Lancet, 362(9396): 1599–1604.
  • Mercier LR (2008). The back. In Practical Orthopedics, 6th ed., pp. 143–184. Philadelphia: Mosby Elsevier.
  • Modic MT, et al. (2005). Acute low back pain and radiculopathy: MR Imaging findings and their prognostic role and effect on outcome. Radiology, 237(2): 599–604.
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Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
Last Revised August 15, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.