What is low back pain?
Low back pain is pain and stiffness in the lower back. It is one of the most common reasons people miss work.
How does it occur?
Low back pain is usually caused when a ligament or muscle holding a vertebra in its proper position is strained.
Vertebrae are bones that make up the spinal column through which the spinal cord passes. When these muscles or
ligaments become weak, the spine loses its stability, resulting in pain. Because nerves reach all parts of the body
from the spinal cord, back problems can lead to pain or weakness in almost any part of the body.
Low back pain can occur if your job involves lifting and carrying heavy objects, or if you spend a lot of time sitting or
standing in one position or bending over. It can be caused by a fall or by unusually strenuous exercise. It can be
brought on by the tension and stress that cause headaches in some people. It can even be brought on by violent
sneezing or coughing.
People who are overweight may have low back pain because of the added stress on their back.
Back pain may occur when the muscles, joints, bones, and connective tissues of the back become inflamed as a
result of an infection or an immune system problem. Arthritic disorders as well as some congenital and
degenerative conditions may cause back pain.
Back pain accompanied by loss of bladder or bowel control, difficulty in moving your legs, or numbness or tingling
in your arms or legs may indicate an injury to your spine and nerves, which requires immediate medical treatment.
What are the symptoms?
• pain in the back or legs
• stiffness and limited motion.
The pain may be continuous or may occur only in certain positions. It may be aggravated by coughing, sneezing,
bending, twisting, or straining during a bowel movement. The pain may occur in only one spot or may spread to
other areas, most commonly down the buttocks and into the back of the thigh.
A low back strain typically does not produce pain past the knee into the calf or foot. Tingling or numbness in the calf
or foot may indicate a herniated disk or pinched nerve.
Be sure to see your health care provider if:
• You have weakness in your leg, especially if you cannot lift your foot, because this may be a sign of nerve
• You have new bowel or bladder problems as well as back pain, which may be a sign of severe injury to
your spinal cord.
• You have pain that gets worse despite treatment.
How is it diagnosed?
Your health care provider will review your medical history and examine you. He or she may order x-rays. In certain
situations a myelogram, CT scan, or MRI may be ordered.
How is it treated?
The following are ways to treat low back pain:
• Using a heating pad or hot water bottle.
• Taking ibuprofen, aspirin, or other anti-inflammatory medications. Occasionally muscle relaxants or other
pain medications may be
• Having your back massaged by a trained person.
• Wearing a belt or corset to support your back.
• Talking with a counselor, if your back pain is related to tension caused by emotional problems.
• Beginning a program of physical therapy, or exercising on your own. Begin a regular exercise program to
gently stretch and strengthen your muscles as soon as you can. Your health care provider or physical
therapist can recommend exercises that will not only help you feel better but will strengthen your muscles
and help avoid back trouble later.
When the pain subsides, ask your health care provider about starting an exercise program such as the following:
• Exercise moderately every day, using stretching and warm-up exercises suggested by your provider or
• Exercise vigorously for about 30 minutes two or three times a week by walking, swimming, using a
stationary bicycle, or doing low-impact aerobics.
Participating regularly in an exercise program will not only help your back, it will also help keep you healthier
How long will the effects last?
The effects of back pain last as long as the cause exists or until your body recovers from the strain, usually a day or
two but sometimes weeks or even months.
How can I take care of myself?
In addition to the treatment described above, keep in mind these suggestions:
• Use an electric heating pad on a low setting (or a hot water bottle wrapped in a towel to avoid burning
yourself) for 20 to 30 minutes. Don’t let the heating pad get too hot, and don’t fall asleep with it. You could
get a burn.
• Try putting an ice pack wrapped in a towel on your back for 20 minutes, one to four times a day. Set an
alarm to avoid frostbite from using the ice pack too long.
• Put a pillow under your knees when you are lying down.
• Sleep without a pillow under your head.
• Lose weight if you are overweight.
• Practice good posture. Stand with your head up, shoulders straight, chest forward, weight balanced evenly
on both feet, and pelvis tucked in.
Pain is the best way to judge the pace you should set in increasing your activity and exercise. Minor discomfort,
stiffness, soreness, and mild aches need not interfere with activity. However, limit your activities temporarily if:
• Your symptoms return.
• The pain increases when you are more active.
• The pain increases within 24 hours after a new or higher level of activity.
What can I do to help prevent low back pain?
You can reduce the strain on your back by doing the following:
• Don’t push with your arms when you move a heavy object. Turn around and push backwards so the strain
is taken by your legs.
• Whenever you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
• Bend your knees and hips and keep your back straight when you lift a heavy object.
• Avoid lifting heavy objects higher than your waist.
• Hold packages you carry close to your body, with your arms bent.
• Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Bend your knees when you bend over.
• Sit close to the pedals when you drive and use your seat belt and a hard backrest or pillow.
• Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your
• Put a pillow under your knees when you sleep on your back.
• Raise the foot of the bed 8 inches to discourage sleeping on your stomach unless you have other problems
that require that you keep your head elevated.
To rest your back, hold each of these positions for 5 minutes or longer:
• Lie on your back, bend your knees, and put pillows under your knees.
• Lie on your back, put a pillow under your neck, bend your knees to a 90-degree angle, and put your lower
legs and feet on a chair.
• Lie on your back, bend your knees, and bring one knee up to your chest and hold it there. Repeat with the
other knee, then bring both knees to your chest. When holding your knee to your chest, grab your thigh
rather than your lower leg to avoid over flexing your knee.
What Is the Role of Exercise and Movement in Low Back Pain?
Regular exercise can stretch and strengthen your back as well as help to relieve your pain. This
article provides extensive tips about correct body movement and outlines specific exercises to
increase low back strength.
Resuming Activity Levels after Acute Back Pain
Overexertion may be as unhelpful as prolonged bed rest during acute back pain. (In one study, recovery from
acute back pain was slower for patients who immediately embarked on flexibility exercises than for those who
gradually resumed normal activity.) Walking, stationary biking, swimming, and even light jogging, however, may
begin within two weeks of symptoms. An incremental aerobic exercise program is less stressful than stretching
or exercises strengthening the trunk muscles. Patients should never force themselves to exercise if, by doing
so, pain increases.
Exercises to Avoid during Recovery
It should be strongly noted that incorrect movements or long-term high-impact exercise is a cause of back pain.
People vulnerable to back pain should avoid activities that put undue stress on the lower back or require sudden
twisting movements, such as football, golf, ballet, and weight lifting. Jogging is usually not recommended, at
least not until the pain is gone and muscles are stronger. Exercises that put the lower back under pressure
should be avoided until the back muscles are well toned. Such exercises include leg lifts done in a prone (facedown)
position, straight leg sit-ups, and leg curls using exercise equipment.
Exercise for Chronic Back Pain
Exercise plays a very beneficial role in chronic back pain. In one study, for example, patients with back pain
lasting for an average of 18 months were assigned eight one-hour exercise sessions over four weeks. They
showed greater improvement in nearly every area, including reduced pain and increased capacity, compared to
patients who did not exercise. Patients who choose a passive route (massage and heat therapy) experience
slower recovery from pain than those who exercise (although after a year their conditions do not appear to differ
much). Some studies suggest that the positive impact of exercise on low back pain does not depend on
improving strength and flexibility but on changing the patients’ attitudes toward their disability and pain. Some
exercise programs used for prevention or for chronic low back pain include the following:
•Low Impact Aerobic Exercises. Low- impact aerobic exercises, such as swimming, bicycling,
and walking, can strengthen muscles in the abdomen and back without over-straining the back.
Programs that use strengthening exercises while swimming may be a particularly beneficial
approach for many patients with back pain.
•Lumbar Extension Strength Training. Exercises called lumbar extension strength training are
proving to be effective. Generally, these exercises attempt to strengthen the abdomen, improve
lower back mobility, strength, and endurance, and enhance flexibility in the hip and hamstring
muscles and tendons at the back of the thigh. [For examples of some good exercises for the
back, see Specific Exercise for Low Back Strength, below.]
•Flexibility Exercises. Whether flexibility exercises alone offer any significant benefit is
uncertain. One study suggested that any benefits derived from flexibility exercises are lost
unless the exercise regimens are sustained.
•Retraining Deep Muscles. Of interest are studies that are finding a link between low back pain
and impaired motor control of deep muscles of the back and trunk. According to these studies,
contraction exercises specifically designed to retrain these muscles may be effective for
patients with both acute and chronic pain.
It is important for any person who has low back pain to have an exercise program guided by professionals who
understand the limitations and special needs of back pain and who can address individual health conditions.
One study indicated that patients who planned their own exercise did worse than those in physical therapy or
Specific Exercises for Low Back Strength
Perform the following exercises at least three times a week:
Partial Sit-ups. Partial sit-ups or crunches strengthen the abdominal muscles.
•Keep the knees bent and the lower back flat on the floor while raising the shoulders up three to
•Exhale on the way up and inhale on the way down.
Perform this exercise slowly eight to tens times with the arms across the chest.
Pelvic Tilt. The pelvic tilt alleviates tight or fatigued lower back muscles.
•Lie on the back with the knees bent and feet flat on the floor.
•Tighten the buttocks and abdomen so that they tip up slightly.
•Press the lower back to the floor, hold for one second and then relax.
•Be sure to breathe evenly.
Over time increase this exercise until it is held for five seconds. Then, extend the legs a little more so that the
feet are further away from the body and try it again.
Stretching Lower-Back Muscles. The following are three exercises for stretching the lower back:
•Lie on the back with knees bent and legs together. Keeping arms at the sides, slowly roll the
knees over to one side until totally relaxed. Hold this position for about 20 seconds (while
breathing evenly) and then repeat on the other side.
•Lying on the back, hold one knee and push it gently toward the chest. Hold for 20 seconds.
Repeat with other knee.
•While supported on hands and knees, lift and straighten right hand and left leg at the same time.
Hold for three seconds while tightening the abdominal muscles. The back should be straight.
Alternate with the other arm and leg and repeat on each side eight to 20 times.
Note: No one with low back pain should perform exercises that require bending over right after getting up in the
morning. At that time, the discs are more fluid-filled and more vulnerable to pressure from this movement.
Tips for Daily Movement and Inactivity
The way a person moves, stands, or sleeps during the day plays a major role in back pain:
•Maintaining good posture is very important. This means keeping the ears, shoulders, and hips
in a straight line with the head up and stomach pulled in.
•It is best not to stand for long periods of time. If it is necessary, walk as much as possible and
wear shoes without heels, preferably with cushioned soles. Using a low stool, alternate resting
each foot on it.
•Sitting puts the most pressure on the back. Chairs should either have straight backs or low-back
support. If possible, chairs should swivel to avoid twisting at the waist, have arm rests, and
adjustable backs. While sitting, the knees should be a little higher than the hip, so a low stool or
hassock is useful to put the feet on. A small pillow or rolled towel behind the lower back helps
relieve pressure while either sitting or driving.
•Riding and particularly driving for long periods in a vehicle increases stress. Move the seat as
far forward as possible to avoid bending forward. The back of the seat should be reclined not
more than 30° and, if possible, the seat bottom should be tilted slightly up in front. For long
rides, one should stop and walk around about every hour and avoid lifting or carrying objects
immediately after the ride.
•Be sure to have a firm mattress. If the mattress is too soft, a 1/4-inch plywood board can be put
between the mattress and box spring. On the other hand, some people have experienced
morning backache from a mattress that is too hard. The back is the best guide.
Tips for Lifting and Bending
Anyone who engages in heavy lifting should take precautions when lifting and bending:
•If an object is too heavy or awkward, get help.
•Spread your feet apart to give a wide base of support.
•Stand as close as possible to the object being lifted.
•Bend at the knees; tighten stomach muscles and tuck buttocks in so that the pelvis is rolled
under and the small of the back is flexed slightly. Do not arch the back. (Even when not lifting
an object, always try to use this posture when stooping down). Hold objects close to the body to
reduce the load on the back.
•Lift using the leg muscles, not those in the back.
•Stand up without bending forward from the waist.
•Never twist from the waist while bending or lifting any heavy object. If you need to move an
object to one side, point your toes in that direction and pivot toward it.
•If an object can be moved without lifting, pull it, don’t push.