Getting the better of back pain

Published On: Nov 08 2012 09:30:46 AM CST   Updated On: Nov 20 2012 10:33:11 AM CST
hip back back

By Cynthia Godsey M.S.N., F.N.P./C. , Pure Matters

Back pain is the second most common nerve problem in the United States, after headaches. It is the most common cause of job-related disability, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Back pain is rare in children and teens. It occurs more frequently in people as they age.

Although pain can occur anywhere in the back, it is the low back, or lumbar region, where most people experience pain. The lumbar region includes five vertebrae, along with muscles and ligaments, and supports most of the weight of the upper body. It also does most of the work of bending, stooping, sitting and lifting. Wear and tear and injury can cause discomfort ranging from a mild ache to sudden, sharp, debilitating pain.

Fortunately, most low back pain goes away on its own in a few days to a few weeks. This short-term, or acute, low back pain is usually caused by an injury to the structures of the low back or by arthritis. Pain that lasts three or more months is called chronic back pain. The cause of chronic pain is often difficult to determine.

Symptom, not disease

Low back pain is a symptom of a problem, rather than a disease itself. Conditions that cause it can be the normal aging process, or sprains, strains or spasms in muscles and ligaments, or a bulging (ruptured) disk.

The spine is a column of 30 round bones called vertebrae stacked on top of each other. Each vertebrae has an opening in the center. The vertebral openings are aligned so that they form a tube that runs the length of the spine. This tube contains the spinal cord, the nerves that carry signals and control movement of many parts of the body. Throughout the length of the spine, more than 50 nerves enter and leave the spinal cord through small openings in the sides of the vertebrae. The spaces between the vertebrae are filled with round spongy pads called intervertebral disks. These cushion the bones and absorb shocks to prevent injury to the vertebrae. Ligaments and tendons hold the vertebrae and disks in place and attach the back muscles to the spinal column.

In the aging process, bones of the spine to become thinner and more easily fractured; muscles, tendons and ligaments that support the back become weaker, less flexible and more easily strained; and the disks between the vertebrae become thinner, stiffer and less able to cushion the vertebrae.

Sprains and strains to muscles and ligaments can be caused by improper body mechanics that overstretches them, such as lifting something too heavy, or a sudden awkward movement. Lifting heavy items can also compress the vertebrae and cause a disk to bulge outward, or rupture.

When a portion of an intervertebral disk is moved out of place, or is ruptured, it can bulge into one of the spaces where a nerve enters or leaves the spinal cord. The bulging disk irritates or puts pressure on the nerve, causing a kind of pain called radiculopathy.


In many cases of back pain, the cause is unknown. These are some of the more common conditions or situations that put a person at risk for back pain:

Uncommon causes of back pain include cancer, infection in the vertebrae or spinal column, aortic aneurysm, kidney stones, fibromyalgia, pregnancy, endometriosis and some inherited conditions.  


Back pain from a sprain or muscle strain usually has these symptoms and usually can be treated with medication and exercise:

Back pain from a sprain or muscle strain does NOT cause pain or weakness in your legs.

Pain from a ruptured disk depends on the where in the spine the disk is located and the size of the rupture. If the ruptured disk does not press on a nerve, there may be no symptoms and you will not know you have it. If it does irritate a nerve, the symptoms are usually pain, burning, tingling, numbness or weakness in the area the nerve serves.

One common cause of low back pain linked to a ruptured disk is sciatica. Sciatica is caused by irritation of one of the nerves that make up the sciatic nerve. The pain from sciatica is usually described as a sharp, shooting pain that runs from the buttock down the back of the leg, sometimes as far as the foot. It is on one side and may be worse when standing, walking or sitting.

If you have symptoms of a ruptured disk, see your health care provider for an evaluation.

See your health care provider if you have back pain with these symptoms:


Most acute low back pain can be treated with a pain reliever, gentle exercises, cold and hot compresses, and one to two days of bed rest (for severe pain).  Most patients with back pain recover without a loss of function. In some cases, surgery may be needed. If you try self-care of your back pain and it is not better after 72 hours, call your health care provider.

Several prescription drugs and over-the-counter (OTC) drugs are available for pain relief. Be sure to check with your health care provider before taking OTC drugs for pain relief because some are unsafe during pregnancy, may interact with other medications you take, and may cause side effects, including drowsiness, or may lead to liver damage. These are common OTC pain relievers:

Prescription drugs that offer pain relief include anti-seizure drugs; certain antidepressants, such as amitriptyline and desipramine, which relieve pain and help with sleep; and opioids, such as codeine, oxycodone, hydrocodone and morphine, which are for short-term use to treat severe acute and chronic back pain.

Exercises prescribed by your health care provider or a physical therapist may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.

You should resume your activities as soon as possible. Only people with severe back pain should rest in bed -- and then only for one or two days. Studies have shown that people who continue their activities without bed rest after an episode of low back pain recover more quickly and suffer fewer complications, such as depression, decreased muscle tone and blood clots in the legs.

Alternating ice and heat treatments may help reduce pain and inflammation. The NINDS says that you should apply a cold pack or cold compress as soon as possible after an injury. A cold compress can be a bag of ice or a bag of frozen vegetables wrapped in a towel. Apply the cold to the tender spot several times a day for up to 20 minutes at a time. After two to three days of cold treatment, apply a heating lamp or hot pad for brief periods to relax muscles and increase blood flow. A warm bath may also help relax muscles. Don't sleep on a heating pad, which can cause burns and lead to additional tissue damage.

Sleep on your side with a pillow between your knees.

If these measures don’t relieve pain, your health care provider may suggest other treatments. Medications that block the transmission of pain impulses from nerves to the brain can be injected into the painful area. Ultrasound therapy can help muscles relax. Transcutaneous electrical nerve stimulation (TENS) blocks pain signals to the brain by sending a mild electric pulse sent along nerve fibers.


If your back pain is caused by poor physical conditioning or improper body mechanics, you can help prevent injuries by regularly doing a combination of exercises that don't jolt or strain the back, maintaining correct posture, and learning how to lift objects properly. Activities that include stretching exercises, swimming, walking and movement therapy can improve coordination and develop proper posture and muscle balance, the NINDS says. Yoga helps stretch and strengthen muscles and improve posture. Always talk to your health care provider before beginning an exercise program to make sure it is the right thing to do.

Although some people use a wide elastic belt to support back and abdominal muscles when lifting heavy objects, studies have not proved that such belts are beneficial. Don’t use these belts as a substitute for physical conditioning and proper lifting techniques.

Here are some general tips on how to maintain a healthy back and avoid causes of low back pain:

Get regular exercise

You should do some type of exercise on most days of the week. Low-impact aerobic exercises, such as speed walking, swimming or stationary bike riding for 30 to 60 minutes a day can increase muscle strength and flexibility and help maintain a healthy weight. A weightlifting program designed by a physical therapist or professional trainer can build strength and improve posture. Stretching and flexibility exercises maintain posture and prevent injury and falls.

Maintain good posture

Eat a nutritious diet

A nutritious diet can help you lose extra pounds, especially weight around the waist. Your body mass index should be between 18.5 and 24.9. Make sure you get enough calcium, phosphorus and vitamin D each day to promote new bone growth. For more information on a healthy diet, go to

Learn how to lift

Learn and practice proper lifting techniques. Do not lift things that are too heavy for you. Don’t lift by bending over; instead, bend your knees and squat to pick up the object. Before you lift, tighten your stomach muscles by pulling them in; keep your back straight so the weight is pushed onto your knees, keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. To move heavy objects, push rather than pull.

Sleep on a firm mattress

Sleep on your side with a pillow between your knees, if needed to relieve back aches.