preventing back pain

Eight out of 10 Americans will experience back pain at least once or more in their lifetimes. In fact, a third of people ages 18 to 29 already have back problems, while nearly half of those ages 65 and older do. And women are slightly more likely to experience back pain than men.

Learn more about treating and preventing lower back pain.

Types of Back Pain

Back pain is usually categorized by the area where you feel the pain. The most common type of back pain is in the lower back.

Lower back pain

Lower back pain can happen anywhere below the ribs and above the legs. You can hurt your lower back when you lift, reach, or twist. In fact, almost everyone has low back pain at one time or another.

Depending on the cause, low back pain can have a range of symptoms. The pain may be dull or sharp. It may be in one small area or over a broad area. You may have muscle spasms.

Low back pain also can cause leg pain, numbness, or tingling, often extending below the knee.

Seek emergency treatment if you have weakness or numbness in both legs or if you lose bladder or bowel control.

Upper and middle back pain

Upper and middle back pain are less common because the bones in this area of the back don’t flex or move as much as the bones in your lower back or neck.

Upper and middle back pain can occur anywhere from the base of your neck to the bottom of your rib cage. If a nerve in this area is pinched, irritated, or injured, you also may feel pain in other places where the nerve travels, including your arms, legs, chest, and belly.

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What Causes Back Pain?

“The most common causes of occasional back pain include overuse, strain, or injury to the muscles, ligaments, and discs that support your spine,” says UPMC spine surgeon Sheela Vivekanandan.

“Fast movement, repetitive lifting, an awkward bend, or an attempt to lift something beyond your capabilities can cause pain. If you routinely lift and bend, repetitive stress on your lower back can trigger painful muscle spasms.”

Dr. Vivekanandan says the main cause of back pain usually is years of weight gain and inactivity. “Back pain is the result of years of strain on the body,” she says. “The spine is the last level of support for the rest of the body.”

Additionally, if you’re spending hours at a computer each day — whether at the workplace or at home — poor posture and ergonomics (how your desk is set up) can lead to chronic back pain.

Other common causes include:

In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection. Often, doctors don’t know what causes low back pain. About 90% of the time there is no clear cause.

How Can I Reduce Back Pain at Home?

Most low back pain will improve with conservative treatment you can do at home. Dr. Vivekanandan also recommends that you:

  • Try to keep moving. Continue light activity, like walking. If your back hurts a lot, take a break. But try not to let too much time pass before you get moving again. Instead, return to activities slowly. Walking is perhaps the simplest and best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.
  • Try aqua therapy. If land-based exercise is difficult, try moving in a warm pool. The reduced gravity of the water can help build more range of motion in your spine.
  • Use over-the-counter pain medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen seem to work best for low back pain. Be safe with medicines. Read and follow all instructions on the label.
  • Use a heating pad or ice pack. Heat can reduce pain and stiffness. Ice can help reduce pain and swelling. There is no rule about using heat or ice for back pain. Try each to see which works best for you.
  • Try a gentle yoga/stretch class. Slow, deliberate movement and stretching can build core strength and increase flexibility.
  • Try chiropractic care but avoid any sudden repositioning or snapping of the back or neck. Chiropractic can relieve pain, but request that they not adjust your back or neck abruptly.
  • Try acupuncture. Research shows that many people find relief of muscle spasms and back pain with this Eastern medicine practice which uses strategically placed needles to treat pain. A qualified, well-trained professional can provide safe treatment.
  • Try manual therapy. Manual therapy is a general term for treatment performed mostly with the hands, including massage, mobilization, and manipulation. The goals of manual therapy include relaxation, decreased pain, and increased flexibility.
  • Get regular aerobic exercise. During aerobic exercise, you move your large muscle groups. That gets your blood pumping throughout your body and you begin to take in more oxygen as your breathing rate picks up. Aerobic exercise builds whole body fitness, which helps with back pain and all aspects of life.
  • Do some simple core-strengthening exercises. Good posture depends on strong abdominal muscles – the opposing muscle group to the low back. Strengthening the core can relieve low back pain. Your doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises for core stabilization. Strengthening the muscles in your trunk or torso can improve your posture, keep your body in better balance, and lower your chance of injury.
  • Ask for help if you are depressed or anxious. Having ongoing (chronic) back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both antidepressant medicines and counseling. Counseling can help you learn stress management and pain control skills. More than half of people with chronic pain can have depression. It doesn’t matter which one came first – the depression or the pain.

If your symptoms are severe or you still have symptoms after two weeks of self-care, see your primary care provider. You may need stronger pain medicines.

Your provider will perform a physical exam and possibly tests, such as an x-ray, MRI, or CT scan to help make a diagnosis. After that, you and your provider can work together to find the most effective treatment plan that is tailored to you.

When Should I See a Spine Specialist for Back Pain?

Time is your friend when dealing with low back pain, says Dr. Vivekanandan, but if your pain does not subside within six weeks of treatment, including taking NSAIDs and trying pain relief methods at home, your PCP may refer you to a spine surgeon.

However, spine surgery is rarely a first-line treatment. There are lots of nonsurgical options you can try before spine surgery ever becomes a consideration.

“Roughly 80% to 90% of patients with back pain get better within three to six months using conservative therapy,” Dr. Vivekanandan says. “Nonsurgical medical options coupled with lifestyle changes can alleviate back pain for a majority of patients without surgery.”

Nonsurgical Options for Back Pain

The first treatment options Dr. Vivekanandan considers for new patients with low back pain are different pain management techniques.

Targeted injections include epidural steroid injections that the surgeon uses to target the level of the pain. The injection consists of cortisone and lidocaine. “Patients often see improvement right away or within a week or so, and the relief may last up to several months,” she adds. The injections may need to be repeated.

Radiofrequency ablation (RFA) is a minimally invasive procedure through which the surgeon makes a tiny incision to access the joint. Radiowaves are used to burn the nerve that is overlying the bone to decrease pain stemming form that joint, mostly in the lumbar region.

Prescription muscle relaxers are another option to control muscle spasms that cause back pain. The muscle relaxant cyclobenzaprine or Flexeril is a commonly used medication to reduce muscle spasms in addition to NSAIDs. “There are a lot of muscles around the spine,” Dr. Vivekanandan says. “These medications can help with muscle spasms and improve sleep.”

EMG test is a nerve conduction study to localize where pain is coming from. An EMG may be needed to determine next steps.

Often, nonsurgical treatments have an immediate effect in reducing pain and discomfort.

Dr. Vivekanandan also recommends the following lifestyle changes, if they apply to you:

Improve your diet.

People who have healthy eating habits live longer and are at lower risk of developing serious illnesses, such as type 2 diabetes and obesity. Healthy eating can help manage chronic conditions and prevent complications.

Get to an ideal weight and maintain it.

Losing weight is particularly critical if you have a BMI of 30+. Staying at a healthy weight goes a long way in spine health.

Stop any form of nicotine.

Dr. Vivekanandan cautions that nicotine in any form is linked with quicker spinal degeneration. Although less than 10% of patients need surgery, quitting nicotine will help you be healthier if you are one of them.

Use proper body mechanics.

Don’t just grab that big box and heave it. Pay attention to your form. “Remember, there’s more stress on the body during BLT: bending, lifting, and twisting,” she says.

That means lifting with the legs, not the back. Here are more proper lifting tips:

  • Keep your feet shoulder-width apart and your back straight; squat down behind the object.
  • Place hands on either side of the object.
  • Using your core muscles for assistance, begin to straighten your knees and stand up.
  • Remember to lift with your legs, not your back.

Surgical Options for Back Pain

If conservative efforts have failed or your pain is severe and persistent, your surgeon may recommend surgery. Surgery might be indicated if pinched nerves are causing serious numbness, weakness, loss of bowel or bladder control, or difficulty walking. As with any surgery, a patient’s age, overall health, and other factors are considered.

Spinal surgery involves various procedures that can relieve pressure on the nerves in the back. The type of surgery depends on the underlying condition and outcome goals. Many of these procedures are minimally invasive and can be accomplished with only small incisions.

Some common procedures include:

  • Laminectomy. In this procedure, a section of bone called the lamina is removed from one or more vertebrae through a small incision, decreasing pressure on the spinal cord.
  • Discectomy. This is a procedure to remove disc fragments that can cause back pain and nerve pressure.
  • Foraminotomy or foraminectomy. These procedures expand the openings for the nerve roots to exit the spinal canal. A foraminectomy generally removes more tissue than a foraminotomy.
  • Osteophyte removal. This procedure removes bone spurs that are causing pinched nerves.
  • Kyphoplasty. In this minimally invasive procedure, the surgeon injects bone cement into the cavity to harden and stabilize a fractured vertebra.
  • Artificial disc surgery. This procedure replaces the damaged discs, allowing the spine to move with materials that mimic the motion of your natural disc.
  • Fusion surgery. This surgery permanently joins together two or more vertebrae in the spine so there is no movement between them. It is sometimes combined with one or more other procedures to stabilize the spine.

How Can I Prevent Low Back Pain from Returning?

After you’ve had low back pain, you’re likely to have it again. But there are some things you can do to help prevent it. And they can help you get better faster if you do have low back pain again.

To help keep your back healthy and avoid further pain:

  • Practice good posture when you sit, stand, and walk. “Good posture” generally means your ears, shoulders, and hips are in a straight line.
  • Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
  • Sleep on your side and put a pillow between your knees. If you need to sleep on your back, put a towel roll in the curve of your back. Or put a pillow under your knees.
  • Watch what you lift. Don’t try to lift things that are too heavy for you. When you must lift, do it the right way.
  • If you sit or stand for long periods at work, sit or stand up straight, with your shoulders back. Make sure your chair fits you and has good back support. Make sure to keep both feet flat on the floor. It also may help to put a small pillow or a rolled-up towel in the curve of your back. Take regular breaks to walk around. If you have to stand in one position for a long time, put one foot on a low stool, and change feet every now and then.
  • If your work involves a lot of bending, reaching, or lifting, use the right techniques. And don’t depend on a “back belt” to protect your back.

Spine Care for Back Pain

If you experience severe symptoms, or your symptoms linger over a long period of time, you and your provider have many treatment options available — both nonsurgical and surgical.

Help is available, so reach out to your primary care provider or an orthopaedic provider to learn about possible treatments for your pain.

For more information about UPMC Spine Care, visit our website.

Editor's Note: This article was originally published on , and was last reviewed on .

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.