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Back pain is a common problem that affects most people at some point in their life.
It may be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. It’s not generally caused by a serious condition. Find out more about the causes of back pain.
In most cases, back pain will improve in a few weeks or months, although some people experience long-term pain or pain that keeps coming back.
Types of back pain
Backache is most common in the lower back (‘lumbago’), although it can be felt anywhere along your spine, from your neck down to your hips. Read information on neck pain and shoulder pain, which are covered separately.
Sometimes, back pain can be caused by an injury or disease, such as:
- a slipped disc – when one of the discs in the spine is damaged and presses on the nerves
- sciatica – irritation or compression of the sciatic nerve, which causes pain, numbness and tingling that travels down one leg
- whiplash – neck injury caused by a sudden impact
- frozen shoulder – inflammation around the shoulder that causes pain and stiffness
- ankylosing spondylitis – a long-term condition that causes pain and stiffness where the spine meets the pelvis
The rest of this information will focus on back pain that doesn’t have an obvious cause. Doctors call this “non-specific back pain”.
Causes of Back Pain
As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation.
The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body. This is especially important when we are standing or sitting. The lower back is also critically involved in our body’s movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting.
Symptoms of Back Pain
Lower Back
Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disk. See your doctor if back pain results from a fall or a blow to your back. The most common symptom of a herniated disk is sciatica a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve. Other symptoms include:
- Weakness in one leg
- Tingling (a “pins-and-needles” sensation) or numbness in one leg or buttock
- Loss of bladder or bowel control (If you also have significant weakness in both legs, you could have a serious problem and should seek immediate attention.)
- A burning pain centered in the neck
Neck
As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:
- Weakness in one arm
- Tingling (a “pins-and-needles” sensation) or numbness in one arm
- Loss of bladder or bowel control (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
- Burning pain in the shoulders, neck, or arm
Tests and Diagnosis for Back Pain
During the physical exam, your doctor will check your back for tenderness. He or she may ask you to lie flat and move your legs into various positions to help determine the cause of your pain. Your doctor may also perform a neurological exam, to check your:
- Reflexes
- Muscle strength
- Walking ability
- Ability to feel light touches, pinpricks or vibration
In most cases of herniated disk, a physical exam and a medical history are all that’s needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
Imaging tests
- X-rays. Plain X-rays don’t detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
- Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
- Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body’s internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
- Myelogram. A dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Nerve tests
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
Treatment for Back Pain
Nonsurgical Treatment
Nonsurgical treatment is effective in treating the symptoms of herniated disks in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures.
- Rest and over-the-counter pain relievers may be all that is needed.
- Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
- Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
- After any spasms settle, gentle heat applications may be used.
Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift.
If these nonsurgical treatment measures fail, epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks.
Surgical Treatment
Surgery may be required if a disk fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiskectomy or laminectomy, depending on the size and position of the disk herniation.
In the neck, an anterior cervical diskectomy and fusion are usually recommended. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. Bone is placed in the disk space and a metal plate may be used to stabilize the spine.
For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together.
Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.
