Backache (low-back pain)

14 Min Read

What is it

About 80 percent of all Americans will have at least one backache during their lives. Every year articles and books about back pain appear, espousing new and old theories about its causes and how to treat it. However, there’s room for controversy because the back is such a complicated, sophisticated structure, and while we can name all the bones, joints, nerves, muscles, and ligaments that constitute it, the sum total remains something of a mystery.

Pain and stiffness in the lower back can take several forms:

Strain and sprain

The terms hack strain and hack sprain are often loosely applied to a broad spectrum of back disorders. Strain is generally used when a muscle is overstretched, and sprain when a ligament is partially torn. However, it is seldom clear whether it’s a muscle or ligament that’s been damaged, let alone whether it has been torn or not. Two other terms, muscle spasm and ruptured disk, are more clearly defined.

Muscle spasm

The most common form of spasm is a sudden onset of sustained, painful, involuntary contractions of muscles in the back. This may serve to immobilize irritated back muscles, thereby protecting them and spinal nerves. A spasm usually results from a back injury but may also be caused or aggravated by poor posture, lots of sitting in the same position, tense back muscles, and weak abdominal muscles. Many researchers claim that psychological stress can also trigger muscle spasms.

Disk problems

These are actually relatively uncommon. Only 2 to 4 percent of back ailments are due to what is commonly called a slipped disk. The term slipped is a misnomer, since the disk actually bulges (herniates) from between two vertebrae and may eventually rupture. If a displaced disk presses on a spinal nerve, the nerve can send shooting pains to the legs or arms, or create a tingling or sensation of numbness in them. If, as is common, the affected nerve is the sciatic, the condition is called sciatica.

Underlying diseases and structural problems

A small percentage of all backaches are related to identifiable medical problems such as kidney disease, cancer, arthritis, osteoporosis, or spinal infection. Sideways curvature (scoliosis), sway back (lordosis, or excessive curve in the lower back), or other structural defects may also be at the root of back pain.


  • Persistent tenderness, stiffness, or pain in the lower bock that can range from mild discomfort to excruciating pain that often limits motion.
  • Gradual stiffening, especially after sitting for extended periods.

What causes it

Low-back trouble is so common because the human spine hasn’t evolved to the point where people can walk upright without some risk. Being erect puts extra pressure on the vertebrae of the lower back, or lumbar region, where the back curves most and where pain most often strikes. Backaches become more common between the ages of 30 and 50, as the disks the fibrous pads that cushion the vertebrae start to lose water and elasticity and thus some of their ability to absorb shock. In middle age, too, people tend to become less active, and their muscles grow lax, contributing to back instability.

A small portion of all backaches do have clear causes for instance, a ruptured disk or some underlying disease. But in the great majority of cases the exact diagnosis isn’t known. Is the cause of your backache that sudden movement yesterday when you bent down to pick up the newspaper, or is the problem that you get too little (or too much) exercise? Or could it be poor posture, or just everyday wear and tear? In fact, it’s probably a combination of all these factors.

Normally x-rays show nothing wrong even though the pain yet in certain circumstances there is intense injury to disks but no pain whatever Back injuries are usually made worse by a number of contributing factors that include posture problems, tension and stress, a sedentary lifestyle, obesity, pregnancy, a sagging mattress, or poor body mechanics when lifting heavy objects.

What if you do nothing

Fortunately, most backaches aren’t serious and generally go away in a few weeks, with or without medical attention.

Home remedies

The great majority of backaches (less serious strains, sprains, or spasms) usually don’t require a doctor’s attention. Depending on the severity of the pain, one or more of these measures should provide relief

Avoid physically demanding tasks

For sore ness and minor pain in the back, avoiding physically demanding activity for a few days may be sufficient.

For mild to severe pain, lie down and rest

Reclining may relieve the pain, and it takes mechanical pressure off the stressed back during the first day or two of injury. Some people are helped by putting a pillow under the knees when lying down. You may be able to take pressure off your back and get relief by lying on the floor, with your hips and knees bent, and your heels on the seat of a chair.

Allowing the inflamed tissue to repair itself can prevent a chronic cycle of back injury. Compared to standing, lying down reduces pressure on the lumbar disks by 70 percent, while unsupported sitting increases it by 40 percent.

Don’t overstay your time in bed

The current trend in treating common backaches is to get people out of bed as soon as they can get up comfortably. While doctors traditionally recommended a week or two of bed rest, research has found that two days in bed are usually sufficient for run-of-the-mill backaches, while longer bed rest should be reserved only for disk problems. Moreover, shorter periods of bed rest tend to reduce the likelihood of the adverse effects associated with prolonged bed rest, such as weakening of muscles from inactivity, that can lead to further back injury. (As patients bedridden for other reasons often discover, a couple weeks of bed rest can actually produce a painful back.) It’s also a good idea to begin walking as soon as possible.

Try over-the-counter anti-inflammatory pain relievers

Nonprescription NSAIDs aspirin, ibuprofen, and naproxen will help reduce the intensity of pain and inhibit inflammation.

Apply ice and heat

If you feel soreness in one specific area of the lower back put an ice pack on the area to temporarily block the transmission of pain messages to the brain. Wrap the ice in a towel to avoid damaging the skin. Keep the ice on for no longer than 20 minutes at a time to avoid chilling the back muscles, which can lead to a muscle spasm.

You may find that heat provides better pain relief than ice. Hot compresses applied with a hot water bottle, a heating pad (on a low or medium setting), or a towel heated in water can help relieve spasm symptoms after the first 24 hours. Keep the heat on the lower back for no longer than 30 minutes. Reapply it up to four times a day. A hot bath or shower or sitting in a hot tub will also increase blood flow to the lower back and contribute to pain relief.

Take it easy

Remember, any resumption of activity must be gradual, since your back needs time to heal completely. Once the pain is gone, avoid heavy chores and sports for at least two weeks. If you wish, continue taking aspirin or other anti-inflammatories to reduce pain. However, do not use a corset or back brace unless your doctor prescribes it.


Because most backaches are due at least in part to excessive strain or to weak or tense muscles, there is much you can do to prevent them. In more than half of all cases, back pain eventually recurs, so it’s a good idea to consider the following preventive measures, especially if you have a history of back problems.

Maintain a good weight for your height

A paunch can strain back muscles, distort posture, and overly compress the disks in the lower back. Not surprisingly, then, most obese people have chronic back problems. Excess weight, particularly if it has been recently gained, puts increased; strain on back muscles and ligaments. Being; pregnant can have a similar adverse effect because it alters an expectant mother’s center ‘ of gravity.

Improve your posture

Sitting and standing; put considerable pressure on the lower back. Correct posture keeps the head and chest high, neck straight, pelvis forward, and stomach and buttocks tucked in.

Change your sleeping position

Don’t He on your stomach, since that makes the stomach muscles sag and increases sway back. Instead, lie on your side with your knees bent to relive pressure on the disks. For the same reason, if you lie, on your back, keep your knees slightly bent by putting a pillow under them. For most people the ideal mattress has firm inner support but adequate surface cushioning. If your mattress is too soft, insert a board under it.


Regular exercise is vital to the health of your back. Calisthenics and stretching routines can help strengthen the back. In addition, low-impact activities like walking, swimming (but not the butterfly or breast stroke, which can put excessive strain on the lower back), and cycling (with an upright posture or recumbent position) are good for the back. You should concentrate not only on exercises that stretch and strengthen back muscles, but also on those that strengthen the abdominal muscles (such as situps), which help support the back.

However, sports that involve lifting, twisting, excessive arching of the spine, jumping, sudden starts and stops, and/or collisions with other players (including racket sports, golf, bowling, football, and basketball) are usually not recommended for people with chronic back problems.

Think before lifting and carrying

Bending to pick up an object puts maximum strain on your back and is probably the primary cause of backaches. When you lift, bend at the knees, not at the waist, making your leg muscles do most of the work. To pick up something heavy, squat with your legs apart, tighten your stomach muscles, keep your back straight, and hold the object close to your body. Better yet, push a heavy object instead of lifting it. Pulling is more likely to injure your back.

When carrying a heavy load, don’t arch your back or twist your body try to let your arms and abdominal muscles bear the weight. Because a heavy purse or briefcase can pull your back out of alignment, alternate the load from side to side.

Dress for ease of movement

Prolonged use of tight pants and girdles may induce weak abdominal muscles and result in back trouble. Avoid high heels since they tend to increase the curvature of the back and increase the risk of a fall.

Sit in a straight-backed chair

Whenever you sit, hold your spine against the back of the chair. Try to keep your knees a little higher than your hips.

Check your shoes

Wear flat shoes or shoes with low heels (one inch or lower).

Stop any activity that hurts

Any twisting, bending, turning, and stretching that contributes to pain can create back problems that could take weeks to cure.

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