Understanding Low Back Pain

Causes, when to see a doctor, and how you can prevent this common condition.

At some point in our lives, up to 90% of us will have low back pain, or pain in the lumbar (lower) spine. However, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM)1 assures us that in about 50% of these cases, the pain will resolve within 2 weeks, and in 80% of these cases, within 6 weeks. However, one in five individuals will develop chronic back pain, which the National Institute for Neurological Disorders and Stroke (NINDS)2 defines as pain that lasts more than 12 weeks. It is difficult to determine which cases will become chronic, as chronic back pain isn’t necessarily related to the location, onset, or even the initial severity of the pain. (More statistics on low back and neck pain.)

Most low back pain is caused by strains or sprains—people starting a new exercise routine, shoveling snow, or doing yard work. In general, overactivity back strains usually heal on their own, although you might need to use ice/heat packs and/or take over-the-counter anti-inflammatory medications. Other important causes of back pain include osteoarthritis of the spine (or spondylosis), sciatica, and/or a herniated or bulging lumbar disc. Less frequently, notes the North American Spine Society (NASS),3 low back pain may be caused by something more serious, such as an infection, fracture, or cancer. Low back pain can also result from non-spinal causes, such as a kidney infection or stomach ulcer. In women, endometriosis, pregnancy, and fibromyalgia may cause low back pain.

Improving posture and other back-strengthening exercises may alleviate this common painImproving posture and other back-strengthening exercises may alleviate this common pain. (Source: 123RF)

How Do You Know If You Need To See A Doctor?

According to the American Association of Orthopedic Surgeons (AAOS),4 you will likely need medical attention if your back pain is accompanied by fever, chills, or if the pain doesn’t go away or worsens over a few weeks. Other indications of severe low back pain include weakness, numbness, or tingling in your arms, hands or in your groin or going down your leg, as well as swelling, or losing bowel or bladder control. You should also seek medical attention for low back pain that is severe enough to interfere with your ability to do your daily activities and/or preventing you from work.

NINDS, AANEM, and AAOS all mention things you can do to reduce your risk of low back pain, such as losing weight to put less stress and pressure on your back; learning correct exercise or weightlifting form (including shoveling and gardening); and doing exercises to help strengthen the surrounding low back muscles. While we can’t control the natural effects of aging that causes wear and tear on our spine, discs and ligaments, nor can we prevent accidents, injuries, or falls from happening, we can learn how to better deal with the stress on our backs and improving posture, both of which can help reduce the risk of low back pain. In addition, quitting smoking and removing inflammatory foods from your diet might also be beneficial. Making a few simple lifestyle changes can help reduce your risk for and help you deal with low back pain.

NINDS suggests that many cases of low back pain can be diagnosed by a physical examination and a review of your medical history. To help in the diagnostic process, you might think about what triggers your low back pain:

  • Does it get better or worse by rest or inactivity?
  • By prolonged sitting or standing?
  • By moving around?
  • By any specific movements?
  • Were you recently involved in an accident of some type?


Experts at Johns Hopkins Medicine5 suggest that once the cause of your back pain has been identified, your doctor might recommend rest, specific muscle strengthening exercises, diet and lifestyle changes, physical therapy, and OTC anti-inflammatory agents that may provide relief. The potential benefits of prescription drugs—muscle relaxants, anti-inflammatory drugs, and analgesics— need to be weighed against their side effects and risks. Opioid medications are never considered first-line therapy for low back pain.

Injection-based treatments, including epidural steroid injections, nerve blocks or nerve ablations, may be effective in lessening the pain in the short term, but do not address the underlying cause of the pain. The American Association of Neurological Surgeons (AANS)6 notes that surgery is often a last resort or used for people with serious complications such as loss of bladder or bowel functions, difficulty walking or standing, or progressive limitations due to the low back pain. A rehabilitation psychologist might recommend mindfulness, meditation, yoga or other relaxation strategies. Alternative treatments—acupuncture, biofeedback, transcutaneous electrical nerve stimulation (TENS), spinal manipulation/mobilization, and some laser therapies, may also be helpful with low back pain.

*Any treatment decision should be made after speaking with your spine or pain physician.

Updated on: 07/29/19
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