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THIS DOCUMENT IS NO LONGER VIEWED AS GUIDANCE FOR CURRENT MEDICAL PRACTICE
Understanding Acute Low Back ProblemsPatient Guide
Consumer Guideline Number 14AHCPR Publication No. 95-0644: December 1994
About the Back and Back Problems
The human spine (or backbone) is made up of small bones called vertebrae. The vertebrae are stacked on top of each other to form a column. Between each vertebra is a cushion known as a disc. The vertebrae are held together by ligaments, and muscles are attached to the vertebrae by bands of tissue called tendons.
Openings in each vertebra line up to form a long hollow canal. The spinal cord runs through this canal from the base of the brain. Nerves from the spinal cord branch out and leave the spine through the spaces between the vertebrae.
The lower part of the back holds most of the bodys weight. Even a minor problem with the bones, muscles, ligaments, or tendons in this area can cause pain when a person stands, bends, or moves around. Less often, a problem with a disc can pinch or irritate a nerve from the spinal cord, causing pain that runs down the leg, below the knee called sciatica.
Purpose
This booklet is about acute low back problems in adults. If you have a low back problem, you may have symptoms that include:
- Pain or discomfort in the lower part of the back.
- Pain or numbness that moves down the leg (sciatica).
Low back symptoms can keep you from doing your normal daily activities or doing things that you enjoy.
A low back problem may come on suddenly or gradually. It is acute if it lasts a short while, usually a few days to several weeks. An episode that lasts longer than 3 months is not acute.
If you have been bothered by your lower back, you are not alone. Eight out of ten adults will have a low back problem at some time in their life. And most will have more than one episode of acute low back problems. In between episodes, most people return to their normal activities with little or no symptoms.
This booklet will tell you more about acute low back problems, what to do, and what to expect when you see a health care provider.
Causes of Low Back Problems
Even with todays technology, the exact reason or cause of low back problems can be found in very few people. Most times, the symptoms are blamed on poor muscle tone in the back, muscle tension or spasm, back sprains, ligament or muscle tears, joint problems. Sometimes nerves from the spinal cord (see Figure 1) can be irritated by slipped discs causing buttock or leg pain. This may also cause numbness, tingling, or weakness in the legs.
People who are in poor physical condition or do work that includes heavy labor or long periods of sitting or standing are at greater risk for low back problems. These people also get better more slowly. Emotional stress or long periods of inactivity may make back symptoms seem worse.
Low back problems are often painful. But the good news is that very few people turn out to have a major problem with the bones or joints of the back or a dangerous medical condition.
Things To Do About Low Back Problems
Seeing a health care provider
Many people who develop mild low back discomfort may not need to see a health care provider right away. Often, within a few days, the symptoms go away without any treatment.
A visit to your health care provider is a good idea if:
- Your symptoms are severe.
- The pain is keeping you from doing things that you do every day.
- The problem does not go away within a few days.
If you also have problems controlling your bowel or bladder, if you feel numb in the groin or rectal area, or if there is extreme leg weakness, call your health care provider right away.
Your health care provider will check to see if you have a medical illness causing your back problem (chances are you will not). Your health care provider can also help you get some relief from your symptoms.
Your health care provider will:
- Ask about your symptoms and what they keep you from doing.
- Ask about your medical history.
- Give you a physical exam.
Talking about your symptoms
Your health care provider will want to know about your back problem. Here are some examples of the kinds of questions he or she may ask you. You can write down the answers in the space below each question:
- When did your back symptoms start?
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- Which of your daily activities are you not able to do because of your back symptoms?
- __________________________________________________________
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- Is there anything you do that makes the symptoms better or worse?
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- Have you noticed any problem with your legs?
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- Around the time your symptoms began, did you have a fever or symptoms of pain or burning when urinating?
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Talking about your medical history
Be sure to tell your health care provider about your general health and about illnesses you have had in the past. Here are some questions your health care provider may ask you about your medical history. You can write your answers in the space below each question:
- Have you had a problem with your back in the past? If so, when?
- __________________________________________________________
- __________________________________________________________
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- What medical illnesses have you had (for example, cancer, arthritis, or diseases of the immune system)?
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- Which medicines do you take regularly?
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- Have you ever used intravenous (IV) drugs?
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- Have you recently lost weight without trying?
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You should also tell your health care provider about anything you may be doing for your symptoms: medicines you are taking, creamsor ointments you are using, and other home remedies.
Having a physical exam
Your health care provider will examine your back. Even after a careful physical examination, it may not be possible for your health care provider to tell you the exact cause of your low back problem. But you most likely will find out that your symptoms are not being caused by a dangerous medical condition. Very few people (about 1 in 200) have low back symptoms caused by such conditions. You probably wont need special tests (page 11) if you have had low back symptoms for only a few weeks.
Getting Relief
Your health care provider will help you get relief from your pain, discomfort, or other symptoms. A number of medicines and other treatments help with low back symptoms. The good news is that most people start feeling better soon.
Proven treatments
Medicine often helps relieve low back symptoms. The type of medicine that your health care provider recommends depends on your symptoms and how uncomfortable you are.
- If your symptoms are mild to moderate, you may get the relief you need from an over-the-counter (nonprescription) medicine such as acetaminophen, aspirin, or ibuprofen. These medicines usually have fewer side effects than prescription medicines and are less expensive.
- If your symptoms are severe, your health care provider may recommend a prescription medicine.
For most people, medicine works well to control pain and discomfort. But any medicine can have side effects. For example, some people cannot take aspirin or ibuprofen because it can cause stomach irritation and even ulcers. Many medicines prescribed for low back pain can make people feel drowsy. These medicines should not be taken if you need to drive or use heavy equipment. Talk to your health care provider about the benefits and risks of any medicine recommended. If you develop side effects (such as nausea, vomiting, rash, dizziness), stop taking the medicine, and tell your health care provider right away.
Your health care provider may recommend one or more of the following to be used alone or along with medicine to help relieve your symptoms
- Heat or cold applied to the back. Within the first 48 hours after your back symptoms start, you may want to apply a cold pack (or a bag of ice) to the painful area for 5 to 10 minutes at a time. If your symptoms last longer than 48 hours, you may find that a heating pad or hot shower or bath helps relieve your symptoms.
- Spinal manipulation. This treatment (using the hands to apply force to the back to adjust the spine) can be helpful for some people in the first month of low back symptoms. It should only be done by a professional with experience in manipulation. You should go back to your health care provider if your symptoms have not responded to spinal manipulation within 4 weeks.
Keep in mind that everyone is different. You will have to find what works best to relieve your own back symptoms.
Other treatments
A number of other treatments are sometimes used for low back symptoms. While these treatments may give relief for a short time, none have been found to speed recovery or keep acute back problems from returning. They may also be expensive. Such treatments include:
- Traction.
- TENS (transcutaneous electrical nerve stimulation).
- Massage.
- Biofeedback.
- Acupuncture.
- Injections into the back.
- Back corsets.
- Ultrasound.
Physical Activity
Your health care provider will want to know about the physical demands of your life (your job or daily activities). Until you feel better, your health care provider may need to recommend some changes in your activities. You will want to talk to your health care provider about your own personal situation. In general, when pain is severe, you should avoid:
- Heavy lifting.
- Lifting when twisting, bending forward, and reaching.
- Sitting for long periods of time.
The most important goal is for you to return to your normal activities as soon as it is safe. Your health care provider and (if you work) your employer can help you decide how much you are able to do safely at work. Your schedule can be gradually increased as your back improves.
Bed Rest
If your symptoms are severe, your health care provider may recommend a short period of bed rest. However, bed rest should be limited to 2 or 3 days. Lying down for longer periods may weaken muscles and bones and actually slow your recovery. If you feel that you must lie down, be sure to get up every few hours and walk around--even if it hurts. Feeling a little discomfort as you return to normal activity is common and does not mean that you are hurting yourself.
About Work and Family
Back problems take time to get better. If your job or your normal daily activities make your back pain worse, it is important to communicate this to your family, supervisor, and coworkers. Put your energy into doing those things at work and at home that you are able to do comfortably. Be productive, but be clear about those tasks that you are not able to do.
Things You Can Do Now
While waiting for your back to improve, you may be able to make yourself more comfortable if you:
- Wear comfortable, low-heeled shoes.
- Make sure your work surface is at a comfortable height for you.
- Use a chair with a good lower back support that may recline slightly.
- If you must sit for long periods of time, try resting your feet on the floor or on a low stool, whichever is more comfortable.
- If you must stand for long periods of time, try resting one foot on a low stool.
- If you must drive long distances, try using a pillow or rolled-up towel behind the small of your back. Also, be sure to stop often and walk around for a few minutes.
- If you have trouble sleeping, try sleeping on your back with a pillow under your knees, or sleep on your side with your knees bent and a pillow between your knees.
Exercise
A gradual return to normal activities, including exercise, is recommended. Exercise is important to your overall health and can help you to lose body fat (if needed). Even if you have mild to moderate low back symptoms, the following things can be done without putting much stress on your back:
- Walking short distances.
- Using a stationary bicycle.
- Swimming.
It is important to start any exercise program slowly and to gradually build up the speed and length of time that you do the exercise. At first, you may find that your symptoms get a little worse when you exercise or become more active. Usually, this is nothing to worry about. However, if your pain becomes severe, contact your health care provider. Once you are able to return to normal activities comfortably, your health care provider may recommend further aerobic and back exercises.
If You Are Not Getting Better
Most low back problems get better quickly, and usually within 4 weeks. If your symptoms are not getting better within this time period, you should contact your health care provider.
Special tests
Your health care provider will examine your back again and may talk to you about getting some special tests. These may include x-rays, blood tests, or other special studies such as an MRI (magnetic resonance imaging) or CT (computerized tomography) scan of your back. These tests may help your health care provider understand why you are not getting better. Your health care provider may also want to refer you to a specialist.
Certain things, such as stress (extra pressure at home or work), personal or emotional problems, depression, or a problem with drug or alcohol use can slow recovery or make back symptoms seem worse. If you have any of these problems, tell your health care provider.
About Surgery
Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.
People with certain nerve problems or conditions such as fractures or dislocations have the best chance of being helped by surgery. In most cases, however, decisions about surgery do not have to be made right away. Most back surgery can wait for several weeks without making the condition worse.
If your health care provider recommends surgery, be sure to ask about the reason for the surgery and about the risks and benefits you might expect. You may also want to get a second opinion.
Prevention of Low Back Problems
The best way to prevent low back problems is to stay fit. If you must lift something, even after your back seems better, be sure to:
- Keep all lifted objects close to your body.
- Avoid lifting while twisting, bending forward, and reaching.
You should continue to exercise even after your back symptoms have gone away. There are many exercises that can be done to condition muscles of your body and back. You should talk to your health care provider about the exercises that would be best for you.
When Low Back Symptoms Return
More than half of the people who recover from a first episode of acute low back symptoms will have another episode within a few years. Unless your back symptoms are very different from the first episode, or you have a new medical condition, you can expect to recover quickly and fully from each episode.
While Your Back is Getting Better
It is important to remember that even though you are having a problem with your back now, most likely it will begin to feel better soon. It is important to keep in mind that you are the most important person in taking care of your back and in helping to get back to your regular activities. It may also help you to remember that:
- Most low back problems last for a short amount of time and the symptoms usually get better with little or no medical treatment.
- Low back problems can be painful. But pain rarely means that there is serious damage to your back.
- Exercise can help you to feel better faster and prevent more back problems. A regular exercise program adds to your general health and may help you get back to the things you enjoy doing.
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For Further Information
The information in this booklet was based on the Clinical Practice Guideline, Acute Low Back Problems in Adults. The Guideline was developed by a non-Federal panel of experts sponsored by the Agency for Health Care Policy and Research. Other guidelines on common health problems are available, and more are being developed.
For more information about guidelines or to receive a free copy of Understanding Acute Low Back Problems, call toll-free 800-358-9295, or write to:
- Agency for Health Care Policy and Research
- Publications Clearinghouse
- P.O. Box 8547
- Silver Spring, MD 20907
Note: The picture of the muscles of the back in Figure 1 was taken from another AHCPR-sponsored publication, Back in Action.
- U.S. Department of Health and Human Services
- Public Health Service
- Agency for Health Care Policy and Research
- Executive Office Center, Suite 501
- 2101 East Jefferson Street Rockville, MD 20852
- AHCPR Publication No. 95-0644
- December 1994
[Figures]
Figure 1. Muscles of the back and the spine
Figure 2. Safe lifting and carrying positions