Lower Back Pain
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Get a thorough self-assessment before your visit to the doctor.
What it is
Most people will experience severe low back pain during their life and almost all will get better with non-surgical treatment. Exercise and stretching, over-the-counter medications, and a healthy lifestyle are really the best things to speed recovery. —Dr. Brian Walcott
Pain that is felt anywhere between the lower part of your ribs to the lower part of your backside is considered lower back pain.
There are two types: Sciatica (called lumbosacral radiculopathy) and non-sciatica. The sciatica nerve runs from your lower back through your buttocks and down your legs.
Sciatica pain is often described as a sudden, hot pain that shoots down the buttocks and leg. Sciatica can be caused by a number of conditions that put pressure on the sciatica nerve.
Non-sciatica pain is mostly in your back and not felt in the legs.
Lower back pain can also be caused by arthritis, over-exertion, and trauma.
Back pain usually improves on its own in about 4 weeks. If you are experiencing significant pain, or your pain isn’t getting better, contact your doctor.
Understanding types of lower back pain
Sciatica and non-sciatica pain have somewhat different symptoms.
Sciatica pain typically feels like a sharp, electric-like pain that starts in your lower back and travels through the buttocks and down one leg.
Non-sciatica pain is felt within the lower back area. The pain can be dull, achy, sharp, or burning.
- Sharp pain in your back that moves down one leg.
- The pain is usually felt behind the legs.
- Sometimes there is numbness or weakness in legs.
- Dull, achy, or sharp pain mostly in your back. It’s usually worse with movement.
- Usually not felt in legs.
- Can feel like your back is “tight.”
- May be painful around your hips.
If symptoms don’t get better on their own—it takes time—talk to your doctor about the next steps. Different types of doctors evaluate and treat back pain, including primary care, physical medicine and rehabilitation, sports medicine, pain medicine (anesthesia), orthopedic surgery, and neurosurgery. —Dr. Walcott
Causes of low back pain
The longest nerve in the body is the sciatica. it starts in your lower spinal cord and extends through the butt, down into your legs.
Sciatica pain is caused by something irritating the sciatic nerve at its root in the spinal cord. If a disk (the cushion between bones in the spine) moves out of position (known as a disk herniation), or if the bones, disks, or ligaments wear down with age, this can pinch or irritate the sciatica nerve nearby and cause pain.
Several other conditions can mimic sciatica, including diabetic polyneuropathy, hip arthritis, and piriformis syndrome. A doctor will do an exam and may order tests to make an accurate diagnosis.
For non-sciatica lower back pain, the cause is often unknown. It may be caused by damage to the spinal disks, bones, and joints, or strains to soft tissue like muscle or ligaments.
You’re more likely to develop lower back pain if you:
- Smoke cigarettes (smoking lowers bone density and may affect your spine)
- Drink alcohol regularly
- Are overweight or obese
- Participate in sports like football or gymnastics, which put pressure on your spine
- Sit for most of the day
- Over-exercise (doing too much shoveling or pushing too hard)
- Have certain health issues like osteoporosis or pain in other parts of your body, such as hip, knees, or wrist
- Take medications like steroid pills
- Have had surgery on your spine
- Are older
What can I do to relieve my lower back pain?
Ask your doctor what you can do to speed your own recovery. Oftentimes, the most effective measures to cure back pain include exercise, stretching, and weight loss—all of which depend on you! —Dr. Walcott
Your doctor will probably tell you to continue your normal activities. You can use ice packs or heat for pain relief and to reduce muscle tension. And take over-the-counter pain relievers.
Your doctor may prescribe medications to relieve pain and relax back muscles. They may recommend physical therapy, exercise, and over the long-term, weight loss.
Over-the-counter (OTC) and prescribed medications can relieve symptoms. Discuss any possible side effects with your doctor before taking.
- OTC drugs like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen, and lidocaine patches can help reduce pain and inflammation.
- There are several types of prescription drugs your doctor may recommend. They include opioids (pain-killers, though these come with a risk of addiction), muscle relaxants, prescription-strength NSAIDs, and neuropathic pain modulators (gabapentin).
Discuss the risks of any of these drugs with your doctor. For example, NSAIDs may cause stomach irritation and other digestive tract issues Opioids come with a high risk of addiction.
If the pain does not go away, your doctor may want to look at your spine with X-rays or other types of imaging. There are many treatment options you can try.
They might suggest getting a steroid injection close to the nerves causing the pain. If the pain is from tight muscles (a knot) in your lower back, your doctor may suggest a trigger point injection (injecting small amounts of anesthetic and steroid into the muscle).
Some of the more common options include:
- Physical therapy (includes electric stimulation, manual therapy, stretching and strengthening exercise, heat/ice).
- An epidural injection of a steroid and pain reliever (i.e. lidocaine) close to the nerves causing the pain.
- Trigger point injections.
- Surgery. There are various surgical procedures that you may need to consider, depending on your diagnosis.
How do I know if my back pain is serious?
Lower back pain usually gets better on its own. If you are experiencing significant pain or if the pain lasts longer than a month, see your doctor.
If you have a history of cancer, feel weakness in your legs, have urinary incontinence or loss of bowel control, fever, or other bodywide symptoms, then you may have a more serious issue such as a herniated disk or cancer. Go to the emergency room.
If you had a trauma (like a fall or motor vehicle accident), go to the emergency room.
Most lower back pain gets better after about 4 weeks of medications and/or physical therapy. If the pain continues, discuss with your doctor what to do next.
How to prevent back pain
You can help prevent back pain by leading a healthy lifestyle and following these tips:
- Do aerobic exercise like swimming or walking.
- Stretch and strengthen the muscles supporting your lower back. The American Academy of Orthopaedic Surgeons recommends these exercises.
- If you smoke, stop.
- Lose weight if you are overweight.
- Avoiding extreme sports and activities that put too much stress on your back.
- Avoid sitting for long periods of time. Try to take breaks where you stand up and walk around.
Avoid heavy lifting, and lift properly, bending at the knees, not the waist
Dr. Krystal Hill is an Internal Medicine Physician Resident at Baylor College of Medicine. She received her undergraduate degree in History from Princeton University and graduated from the Perelman School of Medicine at the University of Pennsylvania. Prior to medicine, she was a middle and high school teacher. She enjoys empowering her patients with education and she joined Buoy health to continue her passion for equipping people with health information.