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Published: May 2020 Last reviewed: December 2021 Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information. This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer. Back pain is a common condition and in the UK, it is the largest cause of work-related absence. Back pain can be very uncomfortable, but it is not usually serious. This article has been updatedThe evidence in this article is no longer current. Click here to see an updated and expanded article OverviewBack pain can affect anyone, regardless of age, but it is more common in people who are between 35 and 55 years of age. In the majority of cases, the cause of back pain can be linked to the way that the bones, muscles and ligaments in the back work together. Top tips
The structure of the backThe back is a complex structure consisting of:
The lower part of your back is known as the lumbar region, which is made up of five vertebrae, known as L1, L2, L3, L4 and L5. The lumbar supports the entire weight of your upper body (plus any extra weight that you are carrying), and it is under constant pressure, particularly when you are bending, twisting and lifting. Lower back painLower back pain, also known as lumbago, affects seven out of 10 people at some time in their lives. Lower back pain is a pain or ache on your back, in between the bottom of your ribs and the top of your legs. Lower back pain can come on suddenly or gradually, and is sometimes the direct result of a fall or injury. The complex structure of your lower back means that even small amounts of damage to any part of the lumbar region can cause a lot of pain and discomfort. Pain in your lower back is usually a symptom of stress or damage to your ligaments, muscles, tendons or discs. In some cases, if a nerve in your back is pinched or irritated, the pain can spread to your buttocks and thighs. This is known as sciatica (go to ‘Useful links’ for more information). In most cases of back pain your back will heal itself, and staying active and continuing with your usual activities will normally promote healing. Back pain will usually last from a few days to a few weeks. Pain that lasts longer usually clears up after about six weeks. However, in severe and persistent cases of back pain, it is important to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given. Treatment for back pain will usually depend on the underlying cause of the condition. For example, pain that is caused by some types of arthritis may be treated using specific medicines. SymptomsSymptoms of back painThe symptom of lower back pain is a pain or ache anywhere on your back, in between the bottom of the ribs and the top of the legs. The majority of cases of back pain usually clear up quite quickly. However, if you experience back pain together with any of the following symptoms, visit your GP as soon as possible:
You should also seek medical advice if you’re experiencing back pain and:
Ask your GP for advice if your back pain has developed gradually and has got increasingly worse over several days or weeks. CausesCauses of back painMost cases of lower back pain are known as ‘non-specific’ because they are not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve. Back pain can also be triggered by everyday activities at home or work, and by poor posture. For example, back pain may be triggered by:
Sometimes, you may wake up with back pain and have no idea what has caused it. Common causes Some common causes of back pain include:
Serious back pain The bulging or rupture of one or more of the intervertebral discs can sometimes cause serious back pain. This results in the inner jelly-like material (nucleus pulposus) pressing on the spinal cord or nerve roots, which run next to the disc. This is commonly known as a ‘slipped disc’, but is more accurately described as a ‘prolapsed’ (bulging) or ‘herniated’ (ruptured) disc. The pain will usually be in your lower back, but you may also experience pain in you buttocks, thigh, calves, feet and toes, due to irritation of the sciatic nerve, which runs down both legs. Occasionally, the pain is also accompanied by pins and needles, numbness and weakness. Intervertebral discs tend to dry out and weaken with age, or following an injury. This results in the discs becoming less flexible, which means they do not cushion the vertebrae as well as they did before. This is a common cause of stiffness and pain, particularly in the elderly. It also tends to be worse early in the morning. Persistent lower back pain can also be caused by a number of rare conditions, such as:
DiagnosisDiagnosing back painYour GP will be able to diagnose back pain by discussing your symptoms with you and conducting a physical examination. Usually, there is no need for tests, such as X-rays or scans, when diagnosing back pain. If you have simple back pain, tests are not always helpful because they often do not show anything unusual. You’ll only usually be sent for tests if your pain lasts for longer than six weeks, if you have had an injury or blow to your back, or if your GP suspects that there may be an underlying cause for your pain. For suspected disc problems, X-rays or a computerised tomography scan (CT scan) may be required. Your GP may suggest having a magnetic resonance imaging (MRI) scan, that uses a strong magnetic field and radio waves to produce detailed images of the inside of your body, in order to provide more accurate information about the soft tissues in your back. In some cases, blood tests or a myelogram (a special kind of X-ray using an injected dye) may be needed. A chiropractor, osteopath or physiotherapist? Chiropractic and osteopathy are similar disciplines. Both osteopaths and chiropractors can diagnose by visual inspection and feeling by hand (palpation). Chiropractic treatment tends to involve a more ‘direct’ approach, with an emphasis on adjustments of the spinal joints. Chiropractors also rely on X-rays, blood and urine tests and MRI scans for diagnosis. The osteopathic approach involves mobilisation (slow, rhythmic stretching), pressure or ‘indirect’ techniques and manipulations on the muscles and joints. Physiotherapists are trained to diagnose problems in the joints and soft tissues of the body. Physiotherapy for back pain provides a wide range of treatments to relieve pain, promote relaxation and restore movement. They include manipulation, mobilisation and massage. Exercise may also be used to increase general fitness or to strengthen muscles that support the spine. TreatmentTreating back painAdvice from Pain Concern
Generally, back pain is categorised as:
However, most people with lower back pain experience mild pain and have occasional bouts of pain that are more severe. This can make it difficult to determine whether their back pain is acute or chronic. Treating acute back pain Most cases of acute back pain can be treated using self-help techniques. These are discussed below. Over-the-counter (OTC) painkillers: Stronger painkillers: Muscle relaxants: Diazepam can make you feel very sleepy, so do not drive if you have been prescribed this medication. After your course of diazepam has ended, you should wait at least 24 hours before driving. Diazepam will also make the effects of alcohol worse, so you should avoid alcohol while you are taking the medication. Diazepam has the potential to be habit-forming, and can cause a number of unpleasant withdrawal symptoms when coming of the medication. To minimise these effects, your GP will not usually prescribe more than seven days worth of the medicine. Exercise: Recommended exercises for back pain include walking and gentle stretching. Your back pain may be so severe that you need to have some time off work. However, if this is the case, you should aim to return to work as soon as possible. While you may not feel any immediate benefit, research has shown the people who continue to work during an episode of back pain recover quicker than people who stay at home. Compression packs: Treating chronic back pain This will usually require a combination of self-help techniques and medical treatment. Treatment options are discussed below. Painkillers: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, should only be used for long periods under the advice of your GP. If long-term treatment using NSAIDs is required, your GP may prescribe gastro-protective medicines, such as proton pump inhibitors (PPIs). Amitriptyline: If you are prescribed a course of amitriptyline, you may experience some side effects including:
You should not drive if you are taking amitriptyline and it is making you drowsy. Amitriptyline should not be taken by people with a history of heart disease. Exercise: Regular exercise will help to strengthen the muscles that support your back. Exercise also promotes the production of endorphins, which are natural painkilling chemicals. Ask your GP for advice about a suitable exercise plan for you. Bending, twisting, or placing strain on your back can be painful. However, excessively protecting your back can delay return to normal activities. The trick is to be careful when making potentially painful movements, but to pace your return to full normal activity. Physiotherapy: A physiotherapist will be able to teach you exercises that strengthen the muscles that support your back, as well as improving the flexibility of your spine. They can also teach you how to improve your posture and reduce any future strain on your back. Cognitive behavioural therapy (CBT): CBT is based on the principle that the way you feel is partly dependent on the way that you think about things. Studies have shown that people who train themselves to react differently to pain, by using relaxation techniques and maintaining a positive attitude, report that their levels of pain went down. They were also more likely to remain active and take exercise, further reducing the severity of their symptoms. Surgery:
The type of surgery that will be recommended will depend on the cause of your back pain. Some surgical options are listed below.
As with all surgical procedures, spinal surgery carries some risks. For example, following surgery, there is a 10% chance of infection. If this occurs, further surgery may be required to clean out the infection, although some cases can be treated with antibiotics. In the case of fusion surgery, there is a 1-2% chance of the vertebrae failing to fuse into place. If this occurs, further surgery will be required. There is a very low risk that your spinal cord will be damaged during surgery. The chances of this happening are estimated to be six in 1,000 (0.6%). In the rare situation that the spinal cord is damaged during surgery, it could result in problems ranging from some muscle weakness to total paralysis. Your bladder and bowel control may also be affected. Before having back surgery, your surgeon will be able to fully discuss the risks and benefits of the procedure with you. Complementary therapies: Complementary therapies such as chiropractic, osteopathy, shiatsu and acupuncture may help to ease your back pain, and encourage you to feel relaxed. An osteopath is a health professional who specialises in treating the skeleton and muscles, and chiropractor treats joint, muscle and bone problems, focusing on the spine. Shiatsu is a traditional Japanese technique that is often described as ‘finger pressure’ therapy. It is a form of massage that works by applying pressure to energy lines in your body. A shiatsu therapist will use their fingers, thumbs and elbows to carry out the treatment. Acupuncture is a form of traditional Chinese medicine which involves the insertion of very fine needles at key points in the body. This can help encourage the body to release its natural form of painkillers, known as endorphins. It can also help to stimulate nerve and muscle tissue. For many complementary therapies, clinical studies have not produced conclusive evidence as to their safety and effectiveness. Therefore, if you are considering using a complementary therapy, you should carefully weigh up any benefits and potential risks and discuss it with your GP if you are uncertain. Transcutaneous electrical nerve stimulation (TENS): It is thought that these pulses work in two ways. A low electric pulse can encourage your body to produce more endorphins - the body’s own painkilling chemical. A high electric pulse can also block pain signals going from your back to your brain. Many medical studies have been carried out on the use of TENS but the results have been conflicting. Some studies suggest that the machines are of little use, while other studies suggest that they may be able to help certain people. You should only use a TENS machine under the direction of your GP or other healthcare professional. The following people should avoid using a TENS machine:
Managing your painPain management programmes can help you to learn how to manage your pain, increase your activities and have a better quality of life. This is done with a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain. People with persistent pain may be able to attend a specialist pain clinic for assessment and possible pain management. You need to be referred to a pain clinic by your GP or consultant. For more information on pain clinics in your area, contact the British Pain Society. PreventionPreventing back painTo avoid back pain, you must reduce excess stresses and strains on your back and ensure that your back is strong and supple. If you have persistent, recurring bouts of back pain, the following advice may be useful:
Posture How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture:
Exercise Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (back pain that has lasted more than three months), you should consult your GP before starting any exercise programme. Exercises like walking or swimming strengthen the muscles that support your back without putting any strain on it, or subjecting it to a sudden jolt. Activities like yoga or pilates can help improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor. There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain:
At first you should do these exercises once or twice a day, and then gradually increase to doing them six times a day, as your back allows. These exercises are also useful for ‘warming up’ your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. ‘Warming up’ your back before you start these chores can help prevent injury. Lifting and handling One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain.
Preventing back pain in childrenBack pain in secondary-school-age children has been linked to heavy schoolbags and ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from poor posture, carrying overloaded bags, and an unhealthy lifestyle. The best schoolbag for your child is a well designed backpack. This should be worn over both shoulders to balance out the weight. A heavy satchel or shoulder bag can put stress on your child’s spine. Encourage your child to exercise regularly, or plan joint activities, such as a walk in the countryside or a trip to a swimming pool. ReferencesCKS Guidelines (2008). Lower back pain and /or sciatica Waddell, G. (2004) The back pain revolution. 2nd edn. London: Churchill Expert ViewBack pain expert Philip Sell on the questions to askWe asked Philip Sell, consultant orthopaedic and spinal surgeon, what he would want to know if he was suffering from back pain. What is the cause of my back pain? When should I visit my GP with back pain? Should I be resting? Are there any drugs to help me cope with the pain? Should I be worried that my back pain will get worse as I get older? My friends and family have been giving me advice about how to handle my back pain. I’m confused. What should I do? Real StoriesAnne’s story‘I’ve picked up my life again’Back pain was agony for Anne Parker, 68, from Berkshire, but thanks to the right diagnosis she’s now walking tall “My bad back started 12 years ago, with pains in my right buttock. When I saw my GP, he said the problem was actually my back and gave me painkillers. I do orienteering so I tried to move and stretch more, but the pain just got worse. Then I saw an osteopath, who said I should rest. “One morning, when I was getting up, I rubbed the bad spot on my spine. It triggered a sciatic spasm that left me immobile and screaming in pain. My GP gave me stronger painkillers and anti-inflammatories, which improved things when I was lying down or standing up, but sitting was agony. I still went walking, though. Now it’s recognised that exercise is one of the best things for certain kinds of back pain. “A year later, I had an X-ray and an MRI scan and discovered I had a lateral stenosis, a build-up of tissue that blocks the spinal canal. The treatment was an injection of steroids into my spine. It took away the constant, gnawing pain. Three months later I was able to go orienteering again.” Kiran’s story‘I can continue going about my daily life’Kiran Mohan, a 42-year old teacher, has suffered from lower back pain for the past seven years “My back problems started in 1999 when I developed a severe pain in the heel of one of my feet, which gradually progressed to the other foot. It was incredibly painful and badly affected my walking. It was eventually diagnosed as plantar fasciitis, a condition where the heels and surrounding joints become inflamed. This condition means that I walk with a limp, which in turn kicked off my lower back pain. “Because I’m a teacher, I’m unable to remain seated for most of the day to take the weight off my feet, which can make the problem much worse. My doctor recommended a lower back exercise class, which was a six-week course of relevant exercises. It did help and I found that the exercises gave me some relief. But over the years, I’ve also privately seen an osteopath, had acupuncture and tried Pilates. In addition, because of limping, I’ve had a couple of falls, which have caused whiplash and made my lower back pain much worse. “In 2002, after trying just about everything, I started to see a chiropractor and since doing so I have seen a significant improvement. Unfortunately, due to my day-to-day life I’m not able to rest as much as I would like and no doubt this affects the rate of my recovery. Chiropractic treatment has certainly improved my quality of life and, with a few treatments along the way, I can continue going about my daily life. Useful linksNHS Choices links
External links
This article was originally published by NHS choices How do you relieve back pain during pregnancy?keep your back straight and well supported when sitting – look for maternity support pillows. get enough rest, particularly later in pregnancy. have a massage or a warm bath. use a mattress that supports you properly – you can put a piece of hardboard under a soft mattress to make it firmer, if necessary.
Which of the following exercises should be taught to a pregnant woman who complains of backaches?Gentle Pilates exercise is a safe and effective way to lessen low back pain during pregnancy. Lower back pain is a common complaint for women during pregnancy.
What kind of back pain is associated with pregnancy?Symptoms. Lumbar pain during pregnancy is generally located at and above the waist in the center of the back, and it may be concurrent with pain that radiates into the woman's leg or foot. Posterior pelvic pain (in the back of the pelvis) is four times more prevalent than lumbar pain in pregnancy.
Which of the following is the best exercise for a pregnant woman during her second trimester?Choose low-impact exercises like walking, swimming, and yoga. Start with a low level of exertion and work up to 30 minutes a day, three to five times a week.
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