When you experience back pain, it usually means your body’s muscles and support have fallen below a threshold of carrying out your daily activities or just resisting gravity. As a result, your back can hurt.
This is reversible with treatments and exercise to strengthen your back and core muscles. That can help you get on the other side of the threshold and become pain-free.
Types of Back Pain
Back pain is usually divided 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. It is possible to 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 can also 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 may also feel pain in other places where the nerve travels, including your arms, legs, chest, and belly.
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. 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, such repetitive stress on your lower back can trigger painful muscle spasms.
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:
- Arthritis.
- Compression fractures.
- Pressure on the spinal nerves from certain problems, such as a herniated disc.
- Osteoarthritis caused by the breakdown of cartilage that cushions the small facet joints in the spine.
- Myofascial pain that affects the connective tissue of a muscle or group of muscles.
In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection. Sometimes, doctors don’t know what causes low back pain.
How Can I Reduce Back Pain?
Most low back pain will improve with non-surgical treatment. You can continue light activity, like walking, and take over-the-counter pain medicines as needed
- Try to keep moving. 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 your activities slowly. Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.
- Use over-the-counter pain medicines. Acetaminophen (i.e. Tylenol) and 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. You can try each to see which works best for you.
- 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. Here are some low back pain exercises that may help reduce your pain.
- 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.
If your symptoms are severe or you still have symptoms after two weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from manual therapy. This 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.
Your doctor 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 doctor can work together to find the most effective treatment plan that is tailored to you.
Surgical Options for Back Pain
Often, non-surgical treatments have an immediate effect in reducing pain and discomfort. However, a doctor may suggest surgery if symptoms are severe and persistent and if no other treatment has helped.
A person might need surgery if pinched nerves result in 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 its effect on the patient. Some common procedures include the following:
- Laminectomy. This is a procedure in which 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 is a procedure to remove bone spurs that are causing pinched nerves.
- Kyphoplasty. This is a minimally invasive procedure in which 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 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, you can put a pillow under your knees.
- Watch your weight. Don’t try to lift things that are too heavy for you. When you must lift, learn the right way to lift.
- 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.
Healthy lifestyle habits also can help to keep back pain away. So, if you smoke, stop. Managing your stress, following a healthy diet, and exercising regularly also can help.
UPMC Orthopaedic Care: We’ve Got Your Back
If you experience severe symptoms, or symptoms over a long period of time, you and your doctor have many treatment options — non-surgical and surgical.
Help is available, so reach out to your family doctor or an orthopaedic provider to learn about possible treatments for your pain.
UPMC Orthopaedic Care has experts trained to care for a wide range of musculoskelatal conditions, including back pain. To learn more or to schedule an appointment with a doctor near you, call 1-866-987-6784 or visit our website.