Definition
Pain in the spine or muscles of the lower back.

Alternative Names
Backache; Low back pain; Lumbar pain; Pain - back

Considerations
Low back pain usually involves spasm of the large, supportive muscles alongside the spine. Any injury to the back may produce muscle spasms and stiffness.

Pain caused by muscular strain is usually confined to the back. Occasionally, it may radiate into the buttocks or upper leg(s).

The onset of pain may be immediate or may occur a few hours after the exertion or injury. Often the cause is not obvious.

Most back problems will resolve naturally.

Common Causes
 

• muscle strain, pulled muscle in the back, or similar injury (the most common cause)  
• muscle aches related to a viral infection  
• menstruation or premenstrual syndrome (PMS)  
• prolonged sitting in a person who is susceptible to back problems  
• arthritis  
• poor posture  
• in children: scoliosis, Scheuermann’s kyphosis, or spondylolysis  
• nonspecific back pain

Less common, but serious causes:

 
• bladder infection  
• endometriosis  
• ovarian cancer  
• ovarian cysts  
• pressure on a nerve root (for example, spinal stenosis or herniated nucleus pulposus)  
• ruptured vertebral disk

Home Care
A low back pain problem can create a cycle in which a muscle spasm causes pain, and the pain brings additional muscle spasm. Rest and pain killers can help interrupt this cycle. Anti-inflammatory medications should be continued as long as there is significant pain. To avoid an upset stomach, take the medication with food unless otherwise instructed. No medication will speed up the healing. Drugs can only help eliminate the symptoms. Sometimes heat or ice applied to the affected area may provide some relief.

An injury must heal by itself. Try to avoid reinjury during the healing process. Rest flat on the back for the first 24 hours and be very careful when moving around.

Severe muscle-spasm pain usually lasts for 2 to 3 days and may be followed by weeks of less severe pain.

Strenuous activity during the 6 weeks following an injury can bring the problem back and postpone complete recovery. After healing, a conservative exercise program will help prevent reinjury.

It is helpful to sleep on a very firm mattress (with a bed board under the mattress), on a waterbed, or even on the floor.

A folded towel beneath the low back and a pillow under the knees may increase comfort while sleeping.

Call your health care provider if

 
• there is significant pain that persists beyond a week.  
• there is an associated, unexplained fever.  
• there is redness or swelling on the back or spine.  
• the pain travels down the legs below the knee (which suggests pressure on the nerves as they leave the spinal cord).  
• the back pain is the result of a severe blow or fall.  
• the back pain is caused by an injury received at work-examination by a doctor is required by the workers’ compensation laws.  
• there is weakness or numbness in a leg.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting low back pain in detail may include:

 
• location
  • Is the pain on one side only (unilateral)?

   

• quality
       

  • Is it severe?      
  • Is the pain located behind the thigh and down the inside of the leg (sciatic pain)?      
  • Is the pain NOT located behind the thigh and down the inside of the leg (nonsciatic pain)?

   

• time pattern
       

  • Does the pain occur only at night (nocturnal)?      
  • Did the pain begin suddenly?      
  • Is the pain persistent?      
  • Did the pain begin recently?      
  • When did the pain begin (at what age did you first experience back pain)?      
  • Has the pain been long standing (chronic)?      
  • How long does each episode last?      
  • Does the pain occur repeatedly (recurrent)?      
  • How often does back pain occur?

   

• radiation
       

  • Does the pain go into the hip, leg, or feet (lower extremity)?      
  • Is the pain radiating down only one side of the body?

   

• aggravating factors
       

  • Is the pain worse when coughing?      
  • Does the pain get worse with straining, lifting, or similar activities (Valsalva)

   

• relieving factors
       

  • Does exercise relieve the pain?

   

• other
       

  • What other symptoms are also present?

Physical examination will focus on the back, the abdomen, and the extremities, with special attention to testing the nerve function of the legs.

If the history and physical examination indicate damage to the nerves leaving the spinal cord, a myelogram (X-ray or CT of the spine after dye has be injected into the spinal column) may be necessary. Alternatives include a CT of lumbosacral spine or MRI of lumbosacral spine.

Hospitalization, traction, or surgery should only be considered if nerve damage is present or the condition fails to heal for a prolonged period.

After seeing your health care provider:
You may want to add a diagnosis related to low back pain to your personal medical record.