The lower back is made up of five lumbar bones (vertebrae), all of which are separated by spinal discs composed of a gel-like substance and covered with cartilage. These discs act as shock absorbers and help your entire spinal column to move. The vertebrae themselves can be felt when you touch your back, and all the muscles that stabilize the spine attach to these bony points. The spinal canal, which holds the spinal cord and the nerves that branch off, runs the length of the spinal column. Because your lower back supports the majority of your body’s weight, it is very common to experience pain that comes from the muscles, the nerves, or the spine itself.

In fact, low back pain is the second most common reason people visit their doctor (cold and flu are number one).* There are many causes of back pain, and there is no single explanation for each person, although most people experience pain because of injury or trauma. The most common causes of back pain include:

• Injury to a muscle (strain) or ligament (sprain)
• Disc herniation
• Degenerative disc disease
• A pinched nerve (sciatica)
• Hip joint inflammation (sacroiliitis)

Strains and sprains can occur for many reasons, and may not be caused by any single event. Using improper lifting techniques, being overweight, and having poor posture can cause enough strain on the structures of the lower back to cause injury. You are particularly at risk if you have a job that requires heavy lifting, don’t exercise, or have a history of osteoporosis or arthritis.

Most people find that low back pain improves with simple, at-home measures that include rest (limited to two days) and nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen to relieve pain. Sometimes, stronger muscle relaxants and narcotics are used for a short period. Prolonged bedrest (longer than two or three days) is not recommended and may actually worsen the problem.

It is important to gradually resume activity after the first couple of days. Other methods of care include applying heat or cold packs, massage therapy, ultrasound, electrical stimulation, and traction and reduction (physically maneuvering the bones). Injection with local anesthetics or corticosteroids is also an option for short-term pain relief. With all causes of low back pain, one of the most important ways to improve your condition is with back strengthening and conditioning. This is done with specific exercises, as well as general aerobic conditioning.

Surgery for low back pain is an option when nonsurgical options have been unsuccessful. The most commonly performed back operation is spinal fusion, which limits movement of the most painful part of your back. Surgery is considered successful when pain is reduced; however, recovery can take longer than a year. Furthermore, it is rare for people to have complete recovery from pain. Surgery is not the right answer for everyone, and your doctor can best discuss the benefits and limitations of surgery for your particular condition.

How to prevent low back pain:

• Use correct lifting techniques.
• Exercise regularly to strengthen back muscles.
• Maintain good posture.
• Maintain a healthy body weight.

Home care for low back pain:

• Stop normal activity and apply ice for first few days.
• Apply heat to lower back.
• Gradually increase activity to normal.
• Take over-the-counter pain relief (ibuprofen or acetaminophen).

Back pain with a loss of bowel or bladder control, leg weakness, weight loss, or fever may suggest a more serious condition. If you experience these symptoms, please seek emergency care for further evaluation.

Brief Evidence – Update: Primary Care Interventions to Prevent Low Back Pain – U.S. Preventive Services Task Force (USPSTF)

Disc Degeneration

Disc degeneration and loss of elasticity due to aging are one of the most common causes of herniation, although improper lifting, excessive back strain, and repetitive injury to the back area make the discs weaker and more vulnerable to injury. Because the nerves of the spine exit at every level of the spinal column, symptoms may be felt along the length of the nerve that is affected (e.g., down the length of the leg). The pain that radiates from the herniation can range from mild to severe and can be associated with numbness, tingling, or weakness. Pain may be worsened by movement, straining, coughing, or with leg raises.

Herniated Disc

Disc herniation, often referred to as a “slipped” or “ruptured” disc, is a common cause of low back, neck, and even arm or leg pain. The most frequently affected area of the spinal column is the lower back (the lumbar section of the spine), but any disc in the vertebral column can rupture.

Vertebral discs are the shock-absorbing, protective discs found between the bones of the spinal column (vertebrae). These discs are made up of a strong outer shell of cartilage encasing an inner gel-like substance. Although they do not actually “slip,” they may rupture or split, allowing the inner gel-like material to escape into the surrounding tissues. This puts pressure on nearby spinal nerves, which are very sensitive to even the slightest of pressure. Nerve irritation then results in pain, numbness, or weakness in the back and can radiate to one or both legs or arms.