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.

Figure

Figure 1. Muscles of the back and the spine.

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

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.

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.

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.

Figure 2. Safe lifting and carrying positions

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.

Back Cover

AHCPR Publication No. 95-0644.