Problems and Injuries /
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Back pain is a problem for most
people at some point during their lives. Back pain refers to pain
anywhere from the area of the neck to the tailbone
(coccyx). The back includes:
- The bones of the spine (vertebrae).
- The joints that guide the
direction of the movement of the spine.
- The discs
that separate the vertebrae and absorb shock as a person moves.
- The muscles and ligaments that
hold the spine together.
Back pain may be caused by an
injury to one or more of these structures, or it may have nothing to do
with an injury. Some people are more
likely to develop back pain and injury than others. Home treatment
will often help relieve back pain caused by minor injuries. See an
illustration of the spine
or the discs
of the spine.
injuries are the most common cause of back pain. Common back
- Overuse injuries. You
may not remember a specific injury, especially if your symptoms
began gradually or during everyday activities. These injuries occur
most often from improper movement or posture while lifting,
and walking, sitting,
or even while sleeping.
Symptoms can include pain, muscle spasms, and stiffness. The pain
often goes away within 4 weeks without any treatment. Home treatment
can help speed healing, relieve pain, and prevent reinjury.
- A sudden (acute) injury,
such as a sprain
This may occur from tripping, falling a short distance, or excessive
twisting of the spine. Severe back injuries may occur from car
accidents, falls from significant heights, direct blows to the back
or the top of the head, a high-energy fall onto the buttocks, or a
penetrating injury, such as a stab wound.
- Discs may tear or rupture.
If the tear is large enough, the jellylike material inside the
disc may leak out (herniate) and press against a nerve. See an
illustration of a herniated
on a nerve root.
- A fracture or dislocation
of the spine can cause permanent paralysis. It is important to
immobilize and transport the injured person correctly to reduce
the risk of permanent paralysis.
Injury is not the only cause of
back pain. Back pain may be caused by other health problems.
- Conditions that weaken the
spine, such as osteoarthritis,
stenosis, or Paget's
disease. These conditions are most common in older adults. In
rare cases, tumors or infections can develop in or around the spine.
conditions can cause pain to spread to the back from other parts
of the body (referred pain). Many health problems that can cause
back pain have nothing to do with the bones, joints, muscles, or
ligaments of the back.
- Spinal deformities such as scoliosis,
(Scheuermann's disease), and spondylolisthesis
can cause back pain.
Low back pain may occur in children
and teenagers, but children and teens are less likely to see a
health professional for low back pain.
Treatment for back pain depends
on the cause and severity of symptoms as well as a person's age and
overall health. Treatment may include first aid measures, medication,
physical therapy, manipulative therapy (such as chiropractic), and, in
some cases, surgery.
To determine the seriousness of
your back problem or injury, review the Emergencies and Check Your
you have any of the following symptoms that require emergency
treatment? Call 191 or other
emergency services immediately.
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- Pain in the upper back that
occurs with chest pain that is crushing, squeezing, or feels like a
heavy weight on the chest or that occurs with any other symptoms
of a heart attack
- Back pain that follows a
severe injury, such as a:
- Motor vehicle accident
- Fall from a height of 15
ft (4.57 m) or higher
- Major sports-related
- Direct blow to the spine
with a moving object
- Forceful strike on top of
the head or fall onto the buttocks
- Penetrating injury, such
as a gunshot wound or stab wound
- Immediately following a back
injury, signs of a spinal cord injury, including:
Note: If you suspect a
spinal injury, do not move the person unless there is an immediate
threat to his or her life, such as a fire. If there is immediate danger,
keep the head, neck, and back supported and aligned while you move the
person to safety.
If you answer yes to any of the
following questions, click on the "Yes" in front of the
question for information about how soon to see a health professional.
and diseases to review high-risk health conditions that may increase
the seriousness of your back problem or injury.
Note: If you have any of
the following symptoms, evaluate them first.
Do you have leg weakness?
Do you have numbness
or tingling in the buttocks, genital area, leg, or foot?
Did your back pain start
after a recent back
Do you have back pain but
no known injury?
Did you have a tailbone
Have you had back pain
for longer than 2 weeks?
Do you have any of the following
If a visit to a health
professional is not needed immediately, see the Home Treatment section
for self-care information.
If you do not need to visit your health professional immediately, try
home treatment to relieve your symptoms.
For an injury to the tailbone
- Apply ice
or a cold pack to the tailbone area for 15 to 20 minutes, 3 to 4
times a day, for the first 24 to 48 hours. Cold decreases
inflammation, swelling, and pain.
- A warm sitz
bath for 20 minutes, 3 to 4 times per day after the first 24 to
48 hours, can be soothing to the tailbone area. Sitting in a hot tub
or warm bath may also feel good, as long as you are not sitting
directly on your tailbone.
- Sit up straight; avoid
slumping or slouching.
- Do not sit on hard, unpadded
- Use a doughnut-shaped pillow
to take pressure off the tailbone area.
- Avoid constipation. Straining
to have a bowel movement will increase tailbone pain. See the topic
Constipation in Related Information.
For a back injury:
- Apply ice
or a cold pack to the injured area for the first 24 to 48 hours.
Apply cold packs or ice for 15 to 20 minutes, 3 to 4 times a day or
up to once an hour for at least the first 3 days. Cold decreases
swelling and pain.
- After the first 24 to 48
hours, heat may help relieve pain and muscle spasm. Use a warm pack
or heating pad set on low. Apply the heat to the injured area for 20
to 30 minutes. Inspect your skin frequently during the application.
Repeat every 2 to 3 hours. Never fall asleep with a heating pad in
- Avoid sitting up in bed,
sitting on soft couches, and twisting or sitting in other positions
that make your symptoms worse.
- Continue with your usual daily
activities unless you have severe leg pain with back pain. Bed rest
can help relieve back pain, but it may not speed the healing. Modify
or avoid any activity makes your pain worse.
- Try one of the following sleep
if you have difficulty sleeping at night:
- Lie on your back with your
knees bent and supported by large pillows, or lie on the floor
with your legs on the seat of a sofa or chair.
- Lie on your side with your
knees and hips bent and a pillow between your legs.
- Lie on your stomach if it
does not increase your pain.
- Try the following exercises:
- Take short walks (3 to 5
minutes every 3 hours) on level surfaces as soon as you can to
help keep your muscles strong. Avoid hills and stairs. Walk only
distances that you can manage without pain, especially leg pain.
- Do pelvic tilt exercises,
gently moving the spine and stretching the lower back. Lie on
your back with your knees bent and feet flat on the floor.
Slowly tighten your stomach muscles and press your lower back
against the floor. Hold the position for 10 seconds. Do not hold
your breath. Slowly relax.
- Relax your muscles.
- See the topic Stress
Management in Related Information for progressive muscle
- Have someone gently
massage the muscles of your back to relax and soothe painful
- Stop smoking. Smoking may
delay healing because it interferes with blood supply and collagen
metabolism. See the topic Quitting Tobacco Use in Related
nonprescription medication to help relieve your back pain.
sure to follow these nonprescription medication precautions.
- Use, but do not
exceed, the maximum recommended doses.
- Carefully read and
follow all labels on the medication bottle and box.
- If you have been told
to avoid nonsteroidal anti-inflammatory medications, call
your health professional before taking them.
not give aspirin to anyone under age 20 unless directed
to do so by your health professional.
- If you are or could be
pregnant, call your health professional before using any
After 2 to 3 days of home
- Continue with daily walks,
increasing the walks to 5 to 10 minutes 3 to 4 times a day.
- Try swimming, which is good
for your back. It may be painful immediately after a back injury,
but lap swimming or kicking with swim fins often help prevent back
pain from recurring.
- Begin easy exercises that do
not increase your pain as soon as your pain has improved. One or two
of the exercises in the Prevention section may be helpful. Start
with 5 repetitions twice a day and increase to 10 repetitions as you
- Take a yoga
class or get a massage.
- Avoid acupuncture,
which has not been proven to effectively treat back pain.
Back pain responds positively to
a gradual increase in physical activity. Try to get back to your normal
routines and activities as soon as possible. Rest without activity may
actually increase or prolong back pain.
Symptoms to Watch for During
Use the Check Your Symptoms
section to evaluate your symptoms if any of the following occur during
- Weakness or numbness in the
- You lose bowel or bladder
- Your back pain is getting
worse or not improving after 1 to 2 weeks.
- Your symptoms are becoming
more severe or frequent.
The frequency of back pain has
increased dramatically in all developed countries. The more time we
spend sitting at desks, in cars, or in front of television, the more we
must do to prevent back pain.
- Maintain an ideal
body weight. This reduces the load on your lower back.
- Practice good posture and body
mechanics. To reduce stress on your back, see:
- Adjust your car seat so that
you are not reaching for the steering wheel while driving. Your arms
should be in a slightly flexed, comfortable position.
- Always wear your seat belt
while you are in a motor vehicle.
Exercises to prevent back pain
The exercises in this topic and
general aerobic exercise, such as walking, swimming, and cycling, will
help prevent back injury and pain. They will also speed your recovery
from injuries and decrease your chances of having chronic pain.
Do not do these exercises if you
have just injured your back. Instead, see the Home Treatment section of
- You do not need to do every
exercise. Do the ones that help you the most.
- If any exercise increases your
back pain, stop the exercise and try something else. Stop any
exercise that causes the pain to radiate away from your spine into
your buttocks, legs, or feet, either during or after the exercise.
- Start with 5 repetitions, 3 to
4 times a day, and gradually increase to 10 repetitions. Do all
Extension exercises strengthen
your lower back muscles and stretch the stomach muscles and ligaments.
Additional strengthening and
Stretching and strengthening
exercises help keep your back healthy.
Exercises to avoid
Many common exercises actually
increase the risk of low back pain. Avoid:
- Straight leg sit-ups.
- Bent leg sit-ups during acute
back pain (may be safe if back is kept in neutral position).
- Leg lifts (lifting both legs
while lying on your back).
- Lifting heavy weights above
the waist (military press or bicep curls while standing).
- Any stretching done while
sitting with the legs in a V position.
- Toe touches while standing.
for Your Appointment
the most of your doctor visit
You can help your health
professional diagnose and treat your condition by being ready to answer
the following questions:
- Is this the first time you
have had a back problem? If you have had back pain in the past, how
is the pain you have now different? If you have chronic back pain,
has the pain changed significantly?
- Is your back pain related to
an injury or activity? What were you doing at the time the back pain
- Does your back problem get
worse with activity?
- Do you have leg weakness,
numbness in the buttocks, genitals, or legs, or loss of bladder or
- Do you have any other
symptoms, such as abdominal pain, urinary symptoms, or fever?
- Have you recently been treated
for a kidney or bladder infection or other problem?
- Have you had any recent,
unexplained weight loss?
- What home treatment measures
have you tried? Have you taken any nonprescription medications?
- Are you using alcohol or other
drugs, such as marijuana or heroin, to control your pain?
- Have you been in a fight or
been punched or kicked in the back?
- Do you have any of the risk
factors listed in conditions
and diseases that may increase your risk for a back problem or