Overview

Most people will have a minor back problem at one time or another. Our body movements usually don't cause problems. But sometimes symptoms can develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreation activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

Back injuries are the most common cause of back pain. Injuries often occur when you use your back muscles in activities that you don't do very often. This can be things like lifting a heavy object or doing yard work. Minor injuries also may occur if you trip, fall a short distance, or twist your spine too much. A severe back injury may be caused by a car crash, a fall from a high place, a direct blow 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.

Back pain is often caused by an injury to one or more of the structures of the back. But it may have another cause. Some people are more likely to have back pain than others. Things that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting too long, lifting or pulling heavy objects, and having a degenerative disease such as osteoporosis.

Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means that your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.

Low back pain may occur in children and teens. It's often caused by overuse or repeated activities like carrying a backpack. But children and teens are less likely to see a doctor for low back pain. Most back problems occur in adults ages 20 to 50. But back problems in children younger than 20 and adults older than 50 are more likely to have a serious cause.

Sudden (acute) injuries

Pain from an injury may be sudden and severe. Bruising and swelling may occur soon after the injury. Pain from an acute injury usually doesn't last longer than 6 weeks. Acute injuries include:

• An injury to the ligaments or muscles in the back. Examples of this are a sprain or a strain.
• A fracture or dislocation of the spine. It can cause a spinal cord injury that may lead to lifelong paralysis. It's important to immobilize the injured person and then move him or her the right way to reduce the risk of lifelong paralysis.
• A torn or ruptured disc. If the tear is large enough, the jelly-like material inside the disc may leak out (herniate) and press against a nerve.
• An injury that causes the compression of nerves in the lower back (cauda equina syndrome).

Overuse injuries

You may not remember a specific injury, especially if your symptoms began slowly or during everyday activities. These injuries occur most often from a wrong movement or posture when you lift, stand, walk, sit, or even sleep. Symptoms can include pain, muscle spasms, and stiffness. The pain often goes away within 4 weeks without any treatment.

Conditions that may cause back problems

Back pain or problems may not be related to an injury. Some other causes include:

• Conditions that weaken the spine. These include ankylosing spondylitis, osteoarthritis, osteoporosis, spinal stenosis, and Paget's disease. They are most common in older adults. In rare cases, tumours or infections can form in or around the spine.
• Some medical conditions that 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. These include scoliosis, kyphosis (Scheuermann's disease), and spondylolisthesis.
• Chronic pain syndrome caused by a past injury or degenerative disease with aging.

Treatment

Most back pain will get better and go away by itself in 1 to 4 weeks. Home treatment will often help relieve back pain that's caused by minor injuries. It's usually a good idea to keep doing your regular activities while your back is healing. Avoid heavy lifting and activities that seem to make your back problems worse.

Other treatments for a back problem or injury may include first aid, physiotherapy, manipulative therapy (such as chiropractic), and medicine. In some cases, surgery is needed. Treatment depends on:

• The location and type of injury, and how bad it is.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Self-Care

First aid for possible spinal injury

The possibility of a spinal injury must be considered anytime an injury involves the head, face, neck, or back. Permanent paralysis may be avoided if the injured person is kept from moving (immobilized) and is transported correctly.

Do not move the person.

If you think the person may have a spinal injury, do not move him or her unless there is an immediate threat to his or her life, such as a fire. If there is immediate danger, keep the person's head and neck supported and in a straight line while you move him or her to a safe place.

Do not remove the person from the water if he or she has a diving injury. Float the person face up in the water until help arrives.

Call emergency services.

Call 9-1-1 or other emergency services to transport the injured person if you think he or she may have a spinal injury. This will reduce the risk of more injury to the spinal cord.

Try the following tips to help relieve back pain, swelling, and stiffness.

• Return to normal activities.

  Return to your normal daily activities and work as soon as you can. You may need to make changes to or limit some work tasks.

• Stay out of bed.

  Avoid bedrest. Bedrest doesn't work well for back pain. And it may cause you to heal more slowly.

• Try using heat or ice.
  • Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours. Try a warm shower in place of one session. You can also buy single-use heat wraps that last up to 8 hours.
  • You can also use an ice pack for 10 to 15 minutes every 2 to 3 hours.
• Change positions every 30 minutes.
• Rub the area.

  Gently massage or rub the area to help relieve pain and to encourage blood flow. Don't massage the affected area if it causes pain.

• Watch your posture.

  Avoid sitting up in bed, sitting on soft couches, and twisting or sitting in other positions that make your symptoms worse.

• Change sleep positions.

  Try one of the these sleep positions if you have trouble 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 doesn't make your pain worse.
• Start to exercise.

  Back pain often gets better when you slowly increase your physical activity.

  Begin moderate aerobic exercise. Take short walks (3 to 5 minutes every 3 hours) on level surfaces as soon as you can. This can help keep your muscles strong. Avoid hills and stairs. Walk only distances that you can manage without pain, especially pain in your legs.

  After 2 to 3 days:

  • Keep doing daily walks. But increase 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 right after a back injury. But lap swimming or kicking with swim fins often helps prevent back pain from coming back.
  • Take a yoga class.

  Add to your exercise program every week to make more progress.

• Do pelvic tilt exercises.

  These gently move the spine and stretch 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 6 seconds. Don't hold your breath. Slowly relax.

• Don't smoke or use other tobacco products.

  Smoking slows healing because it decreases blood supply and delays tissue repair.

Tailbone injury

Things you can do at home to treat a back injury—such as being active and getting exercise—can also help you care for a tailbone (coccyx) injury. Here are some more things you can try for a tailbone injury.

• Take a warm sitz bath.

  Do this for 20 minutes, 3 to 4 times a day after the first 48 to 72 hours. This can be soothing to the tailbone area. Sitting in a hot tub or warm bath may also feel good, as long as you don't sit directly on your tailbone.

• Watch where you sit.

  Don't sit on hard, unpadded surfaces.

• Use a special pillow.

  Sit on a C-shaped pillow with the open space under your tailbone. This can take pressure off the tailbone area.

• Avoid constipation.

  Straining to have a bowel movement will increase tailbone pain.

• Don't smoke or use other tobacco products.

  Smoking slows healing because it decreases blood supply and delays tissue repair.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• One or both legs become weak or numb.
• Loss of bowel or bladder control.
• Back pain does not improve, or it gets worse.
• A fever.
• Symptoms occur more often or are more severe.

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