| Overview of Low Back Pain
Low back pain is the #2 reason that Americans see
their doctor, with colds and flu being the #1 reason.
spine is surrounded by many muscles and ligaments which give it great
strength and flexibility.
Most often low back pain is
triggered by some nonspecific combination of overuse, muscle strain, or injury to
these muscles and ligaments. Less commonly,
low back pain is caused by a spinal condition (such as spinal stenosis, sciatica, or vertebral compression fracture) or a serious illness such as cancer.(1)
Acute back pain is the most common type of back pain. It comes on quickly and often leaves just as quickly. Pain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example – is acute pain. To be classified as acute, pain should last no longer than 6 weeks.
Chronic pain is much less common than acute pain. Chronic pain last more than 3 months. It may come on either quickly or slowly.(2)
|When should I see the doctor?
In most cases, it is not necessary to see a doctor for back pain because pain usually goes away with or without treatment. However, it's a good idea to consult with your doctor if you have:
- Numbness or tingling
- Severe pain
- Pain that doesn't improve with medications and rest, or
- Pain after a fall or an injury.
The following problems along with back pain could signal a serious problem that requires immediate medical attention:
- Trouble urinating;
- Weakness, pain, or numbness in your legs;
- Fever; or
- Unintentional weight loss.
Acute back pain usually gets better on its own and without treatment, although the following general measures will be helpful to relieve the pain and speed recovery.
- Greatly reduce normal physical
activity for the first few days to help relieve the acute
stage of pain and reduce inflammation. Long-term bed rest is no
longer recommended for most cases of back pain. In fact, after
2 to 3 days of inactivity, the muscles supporting the spine
start to weaken which can actually contribute to recurrent back
problems. In most cases,
you will be expected to progress back to nonstrenuous activity
within 24 to 72 hours. At this time, controlled
exercise, preferably supervised by a physical therapist should
- Apply ice for the first 48-72 hours
for 20 minutes at a time with a towel under an ice packs
or 10 minutes at
a time for ice directly on the injured area, for example, ice in
a pillow case. This is a recommended technique used by physical
therapists. With either method, apply ice approximately 4
times daily. After the first 2-3 days, apply either ice
(as above) or warm, moist
heat for 20 minutes at a time, approximately 4 times daily.
At this point, whether it's best to use ice or heat varies with
the individual. Some people do better with ice and some do
better with heat.
- Over-the counter pain relievers can
be helpful for the pain
(unless you are allergic to them,
have contraindications, or have
been advised to avoid these medications by your doctor. Read more)
- ibuprofen (Advil),
- naproxen sodium (Aleve)
- acetaminophen (Tylenol)
- Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable
- Avoid the following when
recovering from low back pain
- Prolonged sitting or
standing--take frequent breaks, walking around slowly.
- Heavy lifting or
twisting of the back--especially lifting
and twisting at the same time.
- Weight lifting, jogging, football,
- Leg lifts when lying on
your stomach, or sit-ups with straight legs (rather than bent
- Many people find that some simple
changes in their posture and positioning can make a huge
difference in their back pain.
- While sitting
place a lumbar
support pillow, small throw pillow or a rolled up towel behind
your lower back. Place your feet on a small foot rest so that
your knees are at the same level as your hips.
- Remove items from back pockets
while sitting. Men who drive for long distances
with thick wallets in their back pockets can have back
problems as a result.
- Avoid high-heeled shoes
High heels pitch you forward, forcing your back muscles to
- While sleeping, try lying in
on your side in a curled-up position with a pillow
between your legs. If you usually sleep on your back, place a pillow under your knees to relieve pressure. Avoid sleeping
on your stomach.
- Assess your
mattress--An old worn mattress makes and
old worn back. It should be comfortable and supportive but
not hard. Many people find adding 1-2 inches of extra
padding on top of a firm mattress provides comfort without
losing support. This padding is available
at most stores that sell linens or mattresses. When
testing for a mattress, don't push on it or bounce up and
down, as many people do. The only way to tell if the
mattress is comfortable, is to lie on it for 10 minutes or
so -- on your back, on your side, every way.
- Do not bend from the
twist while lifting
your back straight.
- Think ahead--get help if the
object is heavy.
the object as close to your body
- Have a good
base of support with your legs apart.
- To lift, bend
from the knees and let your legs do
instead of your
- Keep your back
Physical therapy treatments
are optimal for pain relief measures as well as education and
exercise to improve the strength
flexibility of the muscles. Physical therapists may employ
massage, ultrasound, aquatic therapy, and controlled application of
heat or ice to relieve the pain and inflammation. A specifically
tailored exercise program is taught and supervised by the therapist
to help patients regain
full use of their back. These exercises will strengthen both the
abdominal and back muscles in order to stabilize the spine which
will greatly help to prevent future back injury.
for Low Back Pain Stretching and strengthening
exercises are important in the long run. However, starting these
exercises too soon after an injury can make your pain worse. Furthermore, some exercises can aggravate certain causes of back
pain. The best way to recover quickly from back pain and
prevent further injury is to see your health care provider and a licensed
physical therapist to get started on a home exercise program that
is right for you. In general, the
following are some of the exercises that might be recommended by
your physical therapist or physician.
an exercise program with a warm up of 5 to 10
minutes Easy walking is a good warm up.
|1) Pelvic Tilts: This is an excellent exercise. It is easy-to-do and can be very relaxing,
relieving the mild stress and tightness that has built up over time,
but also improves endurance of the abdominal muscles.
not do this exercise if it causes pain.
|Pelvic tilts lying: Lie flat on the floor with
legs bent Flatten back against the
floor by tightening stomach muscles and buttocks. Hold this position for
several seconds to start, gradually increasing to hold
this position for 2-3 min. Don't hold your breath
during this exercise--continue to breathe normally.
(Holding this position for longer lengths of time will train
your muscles and improve endurance that is necessary for
sustained strength in the abdominal muscles.) Repeat this at least 10
times per session, once daily as a routine.
||Pelvic tilts standing: Pelvic tilts
can also be done while standing in
place, such as standing in line or standing at a counter working.
With knees slightly bent, tighten
stomach and flatten back by rolling pelvis down.
|2) Stretching: The following exercises should be done as
follows: Stretch slowly to the point where you
feel a mild tension, relax and hold the stretch for a total of 30 seconds--repeat
3-5 times. The feeling of tension should diminish as you hold the position.
If it does not, ease off slightly until you find a degree of tension
that is comfortable. Do not bounce or stretch to the point of pain.
This stretches the lower back & hips. With both hands behind knee, pull knee
into chest until a comfortable stretch is felt in lower back and
buttocks. Keep opposite leg straight and on the floor. Keep
Note: Do not do this
exercise if this causes pain, or if you have pain radiating down the
leg, or have a diagnosis of bulging disc or herniated disc.
Tension on the hamstring can increase tension on the nerve and
further aggravate your symptoms if you have any of these conditions. To do this exercise, with
one leg straight, tuck the other foot near the groin.
Reach down leg that is straightened until a stretch is felt in
the back of the thigh. Keep back straight and bend at the
hips. Hold this stretch for 30 seconds then relax.
Repeat 3 times on each side.
Stand facing a wall, about a foot away.
Place both hands on the wall for balance. Put one foot behind
you. Slightly bend the front knee. Keep the front heel
down. Keep the back leg straight and the back heel down. Press
your hips toward the wall.
|3) Eventually an exercise program
to strengthen the back should include either light walking, riding a stationary
bicycle, or swimming. Your physical therapist or
health care provider should tell you when it's safe to begin this program. Start very slowly (5 minutes at a time)
and work up to 30 minutes a day, five days per week. Such aerobic activities
improve blood flow to the back and promote healing. They also
strengthen the muscular support in the stomach and back.
|Educational Video Tutorial:
Low Back Pain
@ Medline Plus
This link takes you to the Medline Plus Home Page. Locate the
button in the upper R hand column. This will take you to
an extensive list of available videos that are excellent patient education
Scroll down to back pain and follow the directions. You
will view a comprehensive tutorial about back pain, complete
with exercises for low back pain.
This site is a service of the Nat'l Library of Medicine and
Nat'l Institute of Health.
1) American College of Physicians and the American Pain Society Guidelines For Low Back Pain Annals of Internal Medicine, October 2007
2) Back Pain from the National Institute of Arthritis and Musculoskeletal Skin Diseases
Low Back Pain and
American Association of Neurological Surgeons
|Assistance with this page provided by Foundation Physical Therapy--with offices in Largo (727)-518-8115 and Clearwater (727)-784-6088 |
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