It’s a familiar tale for many people. After spending hours shoveling snow or playing softball for the first time in years, they pay the price the next day with debilitating back pain.
Each year, 20 percent of the U.S. population has an episode of back pain, says David Borenstein, MD, a rheumatologist in Washington, D.C.
“Second to the cold, it’s the most common affliction of mankind,” he says.
Most of the time, the cause is strained muscles.
“I am amazed at the number of people who are offended when I tell them it’s muscular,” notes Alabama family care physician John Meigs, MD, “They think muscles can’t hurt that bad, and I say ‘Oh, yes they can.’”
Some people don’t notice back pain right away.
That is because as muscles become sore, they get inflamed and irritated, and that leads to swelling and spasms. “It’s the spasm that causes the pain, and sometimes it just takes two or three days to get to the point where the spasm gets so bad that you have the pain,” says Meigs, the president of the American Academy of Family Physicians.
The good news is that although the causes of low back pain can be serious, most of the pain is muscular and will heal in a few days to a few weeks, experts say. Ice for a few days, then heat, painkillers such as ibuprofen or naproxen, light stretching exercises, and physical therapy all may provide relief, Meigs says.
Test your knowledge of low back pain by taking the following quiz.
1. Which of the following may lead to low back pain?
B. Engaging in strenuous physical activities
C. Twisting while lifting
D. A herniated disc
E. All of the above
2. Back surgery is an effective treatment for back pain and is used frequently.
True or false
3. Exercise will not help prevent back pain.
True or false
4. Which symptoms signal that your back pain could be serious? (Check all that apply.)
A. Back pain that radiates down the leg
B. Pain that responds to ice and heat
C. Pain associated with loss of ability to control one’s bladder or bowels
D. Pain that follows a strenuous activity a person has not done in a while
E. A and C
5. Chronic back pain is harder to treat than acute back pain.
True or false
(Scroll down for the answers.)
1. E. “Sitting is the new smoking,” Borenstein says. When a person sits for too long, his or her muscles work the whole time, fatiguing and not getting the same amount of oxygen they otherwise would if they were able to contract and relax, he explains. Muscles need oxygen to function well. Without a sufficient amount of it, they will still work, but they’ll build up byproducts that are irritating and make muscles ache.
Taxing physical activities may also cause out-of-condition muscles to spasm and tighten, leading to back pain, Meigs says. “You may not think the activity you were doing was strenuous,” he says, “but it may be something you’re not in the habit of doing,” like moving boxes or turning a mattress.
Sometimes older people try to do the same activities that they did when they were younger and realize that is not always possible, he said.
Another cause of back pain is twisting while lifting.
“I call that the twist and shout,” quips Borenstein, author of Heal Your Back: Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain (M. Evans and Co., 2011).
“We’re made to really go forward and back. When you actually put it into a twist, unless you have everything aligned appropriately, that can strain something — usually is a muscle. Every once in a while, you can irritate joints, but that’s kind of the next step,” he says.
Although most low back pain is due to strained muscles or ligaments, Meigs says, many other conditions may lead to back pain.
• A herniated disc occurs when one of the jelly-like cushions between the vertebrae squeezes through a crack in the tough, outer layer and impacts a spinal nerve, causing pain. “Disc herniations, when they occur in the back, usually cause nerve compression which will cause pain down the leg — sciatica,” Borenstein says.
• A bulging disc occurs when the jelly-like center of the disc stays inside the tough, outer layer but may extend into the spinal canal. The condition may or may not cause back pain, Borenstein says, and almost everyone has one. “You have to think of them as sort of a cushion, as a big marshmallow between two bones, and in the beginning they’re pretty much straight up and down, but as the day goes on, they bulge out in the middle a little bit.”
• Osteoarthritis occurs when the cartilage at the edge of bones wears away. This is more common as we get older.
• Spinal stenosis happens when the spinal cord in the neck or lower spine becomes compressed, leading to weakness, numbness, and pain.
Other rarer causes of low back pain include compression fractures, abdominal aortic aneurism, the inflammatory condition known as ankylosing spondylitis, cancer, abscesses, and infection, Meigs says.
If you have low back pain that does not resolve in two weeks, see a doctor, Borenstein says.
2. False. Back surgery is an option of last resort, experts say. Surgery should only occur in less than one in 20 people with back trouble and only if medical therapy has not been successful at reversing the pain.
A discectomy is an operation for a herniated or slipped disc in which a surgeon removes part of the disc that has herniated and is pressing on a nerve. Laminectomy is a surgery for spinal stenosis in which a surgeon removes part of the bone of the vertebral body, Borenstein explains.
Whether to have back surgery is an individual choice. Some people can’t handle the pain, and others would much rather endure pain and not have an operation, Borenstein says.
But as a general rule, people who live with back pain should not consider surgery unless they have acute loss of function, cannot walk, have severe pain going down the leg, or can’t control their bowels or bladder, Meigs says.
Another important consideration is that the body can resorb most herniated discs over time without surgery, Borenstein adds. When comparing surgical patients to non-surgical patients two years out, most are doing equally well.
“Making patients comfortable with nonsteroidals and having them stay out of bed to stop deconditioning are important,” he says. “Surgery is reserved for individuals with significant muscle weakness or severe pain that is not tolerable.”
Meigs notes that severe acute pain needs to be addressed by surgery, and some people get relief from surgery. “But for somebody who’s got a mild disc bulge, or arthritis in their back, more times than not they’re going to be disappointed in the results of surgery,” he explains.
Unless a person’s back pain has not responded to conservative measures, Meigs also suggests that people stay away from imaging such as CT scans and MRIs. The risk of imaging is that it may show a finding that has nothing to do with one’s pain. For example, an X-ray may show that a patient has a bulging disc at disc 14, but her pain is at disc 11.
For people whose pain is not serious enough to warrant surgery, bed rest has been shown to be helpful, but only for 48 hours, Meigs says. After that, it starts to make things worse.
“You actually need to move your muscles, stretch your muscles, so just lying in bed all the time is not the answer.”
Light exercises may be best at first. “Just kind of gradually ease back into your day-to-day routine,” Meigs says.
Whether to focus on flexion or extension exercises depends on the nature of the back pain, Borenstein says. “Sometimes if you have stenosis, then you want flexion exercises. If you have a herniated disc, you want extension exercises.”
Core exercises like crunches are also a good idea. If you can strengthen your abdominal muscles front and back, that will help support the spine, Borenstein says. The problem is if you’re in pain, it’s hard to do core exercises.
For acute back pain, ice will help too, Meigs suggests. He recommends adding heat into the mix a couple of days later. Painkillers such as ibuprofen, naproxen, and acetaminophen will likely help relieve the pain, but try to stay away from narcotic analgesics like opioids, Meigs says.
Physical therapists, who often work in tandem with physicians, can be helpful too, Borenstein notes, but he is on the fence about chiropractors. There are good chiropractors and bad ones. Some know how to do the basics of physical therapy and understand the musculoskeletal system reasonably well. “Then there are others who really don’t know what they’re doing, don’t know the illnesses that actually occur in the spine, and can miss problems altogether,” he says.
Meigs, however, says chiropractors are safe and helpful with acute back pain, but not as helpful with chronic back pain.
3. False. In fact, exercise can prevent low back pain, Borenstein says.
A lot of times it is a sedentary lifestyle that leads to muscles getting out of shape, Meigs notes. “With regular exercise, you help keep your muscles in tone, and they’re able to handle some of the routine things,” he says. “And then, when you get something a little more than routine, if your muscles are in shape and used to that sort of stuff, you’re not as likely to have back pain or it won’t happen as easily.”
4. E. It is time to visit a doctor if you have back pain that radiates down your leg, if you lose feeling in a leg, or if you lose bladder or bowel control. They are all signs that something serious is going on, Meigs says.
5. True. Chronic back pain is harder to treat than acute back pain, Meigs says, because there is both a physical and psychological component to it.
“When you’re dealing with pain day in and day out, week after week, month after month, it does become a psychological issue as well,” Meigs explains. “Folks tend to get depressed and can’t do the things they want to do, and it leads to disability of various forms.”
It is important to recognize that if you have chronic back pain, you have more going on that just muscle aches, Borenstein emphasizes. He advises people with long-term back pain to visit a doctor to investigate further.
After the source of your back pain is determined, an exercise program can be developed that will help you minimize your pain.
Four Back Pain Prevention Tips
• Take breaks from sitting. Make sure to get up off your chair at least once an hour, Borenstein suggests. “The muscular skeletal system is made to be moving,” he says, “and it does much better as it gently moves. That’s the way it learns how to heal.”
• Use proper lifting technique. Do not bend to lift, advises the American Academy of Family Physicians. Bend at the knees to lift an object or squat. Try not to twist while lifting.
• Maintain a healthy weight and eat right. Studies show that obesity is associated with a greater risk of having low back pain, Borenstein says.
• Don’t smoke. Smoking robs your body of oxygen, which muscles need to function.
Want to learn more about back pain? Read “How Spinal Cord Stimulation Can Alleviate Chronic Pain,” “Recovering From a Herniated Disk,” and “Self-Advocacy for Back Pain Relief.”