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11/08/2020

Causes of Back Pain

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Back Pain

Back Pain – Causes of Back Pain

Millions of Americans have ongoing back pain. It’s the leading cause of disability in people younger than 45, and many things can cause it.

Spine-Related Problems

Back pain often happens because something is off in the way your spinal joints, muscles, discs, and nerves fit together and move. Your doctor can check to see if you have:

Herniated or slipped discs: If your doctor mentions this, the soft tissue in the discs between your joints has come out. It’s usually caused by wear and tear. Herniated discs can cause pain in your lower back or hip because the nerves there are pressed.

Bulging discs: These protrude, or “bulge,” but not as much as with a herniated disc. You don’t usually have symptoms with this. You’ll feel it if it pushes on a nerve root, though.

Degenerative disc disease: The discs, or “shock absorbers” between your spine’s vertebrae, shrink or tear. That causes the bones to rub together. This may happen as you get older.

Inflammation and wear of the sacroiliac joint: This lies where your spine and pelvis come together. It doesn’t move much, but it’s important because it moves the load of the upper body to the lower body. Swelling and wearing away of the joint cartilage can happen after an injury, because of arthritis, infection, or even pregnancy.

Spinal stenosis : If you have this, your spinal canal has narrowed. That adds pressure on your spine and nerves. As a result, your legs and shoulders probably feel numb. This happens to many people older than 60.

Cervical radiculopathy : This is a pinched nerve. It’s usually caused by a bone spur or a herniated disc.

Spondylolisthesis: A bone in the spine slips forward and out of place, typically in the lower back. The degenerative form of this condition is arthritis, which weakens the joints and ligaments keeping the spine aligned. It can cause a disc to move forward over a vertebra.

Accidents and Injuries

Car accidents, falls, muscle sprains, strains, and fractures are also causes of back pain. Injuries can lead to some of the physical problems, but some can cause pain all on their own.

Continued

Spine or vertebral fractures: A break to your spine can be causes by a hit to the back, a fall, or if you have osteoporosis, a condition that weakens your bones.

Sprains and strains: Injuries to ligaments, muscles, and tendons that support the spine and its joints can lead to back pain. This often happens when you lift something and twist at the same time. It can also happen because of car accidents and sports injuries.

Spasms: You can get these when muscles and tendons are torn in your lower back. They usually happen when you’re weightlifting or playing sports.

Lifestyle Triggers

Back pain can be brought on by things you do — or don’t do — in your day-to-day life, like:

Emotions in Play

Don’t underestimate the power of feelings to bring on pain. Stress can lead to muscle tension in the back, and depression and anxiety may make the pain feel even worse.

Other Causes

Back pain can also be caused by medical conditions like:

Arthritis: This is a joint disease that causes stiffness, swelling, and inflammation.

Osteoarthritis : This type of arthritis happens when your cartilage and bones break down. This most often affects people from middle age onward.

Ankylosing spondylitis : This is a type of arthritis that affects your joints and ligaments along the spine.

Scoliosis, or curvature of the spine: This is usually something you have from birth. If there’s pain, it typically starts in mid-life.

Pregnancy: The weight you gain when you’re expecting can strain your back.

Tumors: In rare cases you can get them in your back. They’re usually spread by a cancer that started somewhere else in your body.

Less-common causes of back pain are:

Depending on the cause of your pain, your treatment could include lifestyle changes, medication, or possibly surgery. Talk with your doctor if your back isn’t feeling right. They can help you discover what’s causing the hurt and can help you feel better.

Sources

SOURCES:

American Academy of Pain Medicine web site: “Commonly-Reported Pain Conditions.”

Chien JJ. Curr Pain Headache Rep. Dec 2008.

Arthritis Foundation: “Degenerative Disc Disease;” “Understanding Arthritis;” and “What is Ankylosing Spondylitis?”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Fast Facts About Back Pain;” “Low Back Pain Fact Sheet;” and “What is Spinal Stenosis?”

UCLA Spine Center: “Sacroiliac Joint Disease” and “What You Should Know About Radiculopathy.”

Spine Universe: “Common and Uncommon Causes of Back Pain.”

American Academy of Orthopaedic Surgeons: “Lumbar Spinal Stenosis;” “Fractures of the Thoracic and Lumbar Spine;” and “Sciatica.”

UpToDate: “Patient information: Low back pain in adults (Beyond the Basics).”

Cedars-Sinai web site: “Back Spasm.”

National Institute of Neurological Disorders and Stroke: “Recommendations for Keeping One’s Back Healthy.”

Mayoclinic.org: “Sacroiliitis.”

Rheumatology.org: “Osteoarthritis.”

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11/08/2020

Sciatica

Diagnosis

During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.

Imaging tests

Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.

  • X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
  • MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
  • CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
  • Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment

If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.

Medications

The types of drugs that might be prescribed for sciatica pain include:

  • Anti-inflammatories
  • Muscle relaxants
  • Narcotics
  • Tricyclic antidepressants
  • Anti-seizure medications

Physical therapy

Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.

Steroid injections

In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.

Surgery

This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.

Lifestyle and home remedies

For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.

Other self-care treatments that might help include:

  • Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
  • Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
  • Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
  • Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.

Alternative medicine

Alternative therapies commonly used for low back pain include:

  • Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
  • Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.

Preparing for your appointment

Not everyone who has sciatica needs medical care. If your symptoms are severe or persist for more than a month, though, make an appointment with your primary care doctor.

What you can do

  • Write down your symptoms and when they began.
  • List key medical information, including other conditions you have and the names of medications, vitamins or supplements you take.
  • Note recent accidents or injuries that might have damaged your back.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your doctor tells you.
  • Write down questions to ask your doctor to make the most of your appointment time.

For radiating low back pain, some basic questions to ask your doctor include:

  • What’s the most likely cause of my back pain?
  • Are there other possible causes?
  • Do I need diagnostic tests?
  • What treatment do you recommend?
  • If you’re recommending medications, what are the possible side effects?
  • For how long will I need to take medication?
  • Am I a candidate for surgery? Why or why not?
  • Are there restrictions I need to follow?
  • What self-care measures should I take?
  • What can I do to prevent my symptoms from recurring?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • Do you have numbness or weakness in your legs?
  • Do certain body positions or activities make your pain better or worse?
  • How limiting is your pain?
  • Do you do heavy physical work?
  • Do you exercise regularly? If yes, with what types of activities?
  • What treatments or self-care measures have you tried? Has anything helped?

Aug. 01, 2020

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11/08/2020

Herniated Disc – Symptoms, Causes, Prevention and Treatments

Harvey William Cushing American Association of Neurological Surgeons

Herniated Disc | American Association of Neurological Surgeons

The bones (vertebrae) that form the spine in the back are cushioned by discs. These discs are round, like small pillows, with a tough, outer layer (annulus) that surrounds the nucleus. Located between each of the vertebra in the spinal column, discs act as shock absorbers for the spinal bones.

A herniated disc (also called bulged, slipped or ruptured) is a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus. Discs that become herniated usually are in an early stage of degeneration. The spinal canal has limited space, which is inadequate for the spinal nerve and the displaced herniated disc fragment. Due to this displacement, the disc presses on spinal nerves, often producing pain, which may be severe.

Herniated discs can occur in any part of the spine. Herniated discs are more common in the lower back (lumbar spine), but also occur in the neck (cervical spine). The area in which pain is experienced depends on what part of the spine is affected.

Causes

A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families with several members affected.

Symptoms

Symptoms vary greatly, depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, the patient may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.

Lumbar spine (lower back): Sciatica/Radiculopathy frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Straightening the leg on the affected side can often make the pain worse. Along with leg pain, one may experience low back pain; however, for acute sciatica the pain in the leg is often worse than the pain in the low back.

Cervical spine (neck): Cervical radiculopathy is the symptoms of nerve compression in the neck, which may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.

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When & How to Seek Medical Care

Fortunately, the majority of herniated discs do not require surgery. With time, the symptoms of sciatica/radiculopathy improve in approximately 9 out of 10 people. The time to improve varies, ranging from a few days to a few weeks.

General Guidelines

  • Limit activities for 2 to 3 days. Walking as tolerated is encouraged, along with an anti-inflammatory, such as ibuprofen, if not contraindicated for the patient. Bedrest is not recommended.
  • Primary care evaluation during this time may lead to considering other non-surgical treatments noted below, such as physical therapy.
  • Radiographic imaging, such as an MRI, is not recommended by the American College of Radiology, unless symptoms have been present for six weeks.
  • Referral to a spine specialist, such as a neurosurgeon, is also recommended if symptoms persist for greater than four weeks. A specialist will often want advanced imaging, such as the MRI, completed prior to the appointment.
  • Urgent evaluation and imaging is recommended if there are symptoms of significant leg/arm weakness, loss of feeling in the genital/rectal region, no control of urine or stool, a history of metastatic cancer, significant recent infection or fever AND radiculopathy or a fall/injury that caused the pain. Imaging should also be considered earlier for findings of progressive neurologic deficit (such as progressive weakness) on exam.

Testing & Diagnosis

Testing modalities are listed below. The most common imaging for this condition is MRI. Plain x-rays of the affected region are often added to complete the evaluation of the vertebra. Please note, a disc herniation cannot be seen on plain x-rays. CT scan and myelogram were more commonly used before MRI, but now are infrequently ordered as the initial diagnostic imaging, unless special circumstances exist that warrant their use. An electromyogram is infrequently used.

  • X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
  • Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the shape and size of the spinal canal, its contents and the structures around it.
  • Magnetic resonance imaging (MRI): A diagnostic test that produces 3-D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas as well as enlargement, degeneration and tumors.
  • Myelogram: An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
  • Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury or whether there is another site of nerve compression. This test is infrequently ordered.

Treatment

Non-Surgical Treatments

The initial treatment for a herniated disc is usually conservative and nonsurgical. A doctor may advise the patient to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease. Bedrest is not recommended.

A herniated disc is frequently treated with nonsteroidal anti-inflammatory medication, if the pain is only mild to moderate. An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.

The doctor may recommend physical therapy. The therapist will perform an in-depth evaluation, which, combined with the doctor’s diagnosis, dictates a treatment specifically designed for patients with herniated discs. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises. Pain medication and muscle relaxants may also be beneficial in conjunction with physical therapy.

Surgery

A doctor may recommend surgery if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain altogether. Doctors discuss surgical options with patients to determine the proper procedure. As with any surgery, a patient’s age, overall health and other issues are taken into consideration.

The benefits of surgery should be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help.

A patient may be considered a candidate for spinal surgery if:

  • Radicular pain limits normal activity or impairs quality of life
  • Progressive neurological deficits develop, such as leg weakness and/or numbness
  • Loss of normal bowel and bladder functions
  • Difficulty standing or walking
  • Medication and physical therapy are ineffective
  • The patient is in reasonably good health

Lumbar Spine Surgery

Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc. It is performed through a small incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc. After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.

In artificial disc surgery, an incision is made through the abdomen, and the affected disc is removed and replaced. Only a small percentage of patients are candidates for artificial disc surgery. The patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 (the first sacral vertebra). The patient must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement. The patient must be in overall good health with no signs of infection, osteoporosis or arthritis. If there is degeneration affecting more than one disc or significant leg pain, the patient is not a candidate for this surgery.

Cervical Spine Surgery

The medical decision to perform the operation from the front of the neck (anterior) or the back of the neck (posterior) is influenced by the exact location of the herniated disc, as well as the experience and preference of the surgeon. A portion of the lamina may be removed through a laminotomy, followed by removal of the disc herniation for the posterior approach. Patients, who are a candidate for posterior surgery, frequently do not need surgical fusion. For anterior surgery, after the disc is removed, the spine needs to be stabilized. This is accomplished using a cervical plate, interbody device and screws (instrumentation). In a select group of candidates, artificial cervical disc is an option vs. fusion.

Follow-up

The doctor will give specific instructions after surgery and usually prescribe pain medication. He or she will help determine when the patient can resume normal activities, such as returning to work, driving and exercising. Some patients may benefit from supervised rehabilitation or physical therapy after surgery. Discomfort is expected during a gradual return to normal activity, but pain is a warning signal that the patient might need to slow down.

Resources for More Information

  1. 1. KnowYourBack.org. (2019). Herniated Lumbar Disc. https://www.spine.org/KnowYourBack/Conditions/DegenerativeConditions/HerniatedLumbarDisc

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

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11/08/2020

What Causes Leg Pain?

Man facing Leg Pain Stretching  during exersice

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Common causes of leg pain

Pain or discomfort anywhere in the leg can range from a dull ache to an intense stabbing sensation. Most leg pain occurs due to overuse or minor injuries. The discomfort often disappears within a short time and can be eased with home remedies.

In some cases, however, a serious medical condition may be causing the pain. See your doctor if you’re experiencing severe or persistent leg pain. Getting a prompt diagnosis and treatment for any underlying conditions may prevent the pain from getting worse and improve your long-term outlook.

Some of the more common causes of leg pain are minor or temporary conditions that your doctor can treat effectively.

A primary cause of leg pain is a muscle cramp or spasm that’s often known as “a charley horse.” A cramp usually triggers sudden, sharp pain as the leg muscles contract. The tightening muscles often form a visible, hard lump beneath the skin. There may be some redness and swelling in the surrounding area.

Muscle fatigue and dehydration may lead to leg cramps, especially in the calf. Certain medications, including diuretics and statins, may also cause leg cramps in some people.

Leg pain is also frequently a sign of injury, such as the following:

  • Muscle strain is a common injury that happens when the muscle fibers tear as a result of overstretching. It often occurs in the larger muscles, such as the hamstrings, calves, or quadriceps.
  • Tendinitis is inflammation of a tendon. Tendons are thick cords that join the muscles to bone. When they become inflamed, it can be difficult to move the affected joint. Tendinitis often affects tendons in the hamstrings or near the heel bone.
  • Knee bursitis happens when the fluid-filled sacs, or bursa, surrounding the knee joint become inflamed.
  • Shin splints cause pain along the inner edge of the shinbone, or tibia. The injury can occur when the muscles around the shinbone tear as a result of overuse.
  • Stress fractures are tiny breaks in the leg bones, particularly those in the shinbone.

Certain medical conditions commonly lead to leg pain. These include:

  • Atherosclerosis is the narrowing and hardening of the arteries due to a buildup of fat and cholesterol. Arteries are the blood vessels that carry oxygen-rich blood throughout your body. When there’s a blockage, it reduces blood flow to various parts of your body. If the tissues in the leg don’t receive enough oxygen, it can result in leg pain, particularly in the calves.
  • Deep vein thrombosis (DVT) occurs when a blood clot forms in a vein located deep inside the body. A blood clot is a clump of blood that’s in a solid state. DVTs typically form in the lower leg after long periods of bed rest, causing swelling and cramping pain.
  • Arthritis is an inflammation of the joints. The condition may cause swelling, pain, and redness in the affected area. It often affects joints in the knees and hips.
  • Gout is a form of arthritis that can occur when too much uric acid builds up in the body. It usually causes pain, swelling, and redness in the feet and lower part of the legs.
  • Varicose veins are knotted and enlarged veins that form when the veins overfill with blood due to incompetent valves. They usually appear swollen or raised and can be painful. They most often occur in the calves and ankles.
  • Infection in the bone or tissues of the leg can cause swelling, redness, or pain in the affected area.
  • Nerve damage in the leg may cause numbness, pain, or tingling. It often occurs in the feet and lower part of the legs as a result of diabetes.

The following conditions and injuries can also lead to leg pain, but they’re less common causes:

  • A slipped (herniated) disk occurs when one of the rubbery disks in between the vertebrate slips out of place. The disk can compress nerves in the spine. This may trigger pain that travels from your spine to your arms and legs.
  • Osgood-Schlatter disease occurs when the tendon that connects the kneecap to the shinbone becomes strained. It pulls on the cartilage of tibia where it attaches to the bone. It causes a painful lump to form below the knee, resulting in tenderness and swelling around the knee. It primarily occurs in adolescents experiencing growth spurts during puberty.
  • Legg-Calve-Perthes disease occurs due to an interruption of the blood supply to the ball of the hip joint. The lack of blood supply severely damages the bone and can deform it permanently. These abnormalities often result in pain, especially around the hip, thigh, or knee. This primarily occurs during adolescence.
  • Slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thighbone, causing hip pain. The condition only occurs in children, particularly those who are overweight.
  • Noncancerous, or benign, tumors can also develop in the thighbone or shinbone.
  • Malignant, or cancerous, bone tumors may form in the larger leg bones, such as the thighbone or shinbone.

You can usually treat leg pain at home if it’s due to cramps or a minor injury. Try the following home treatments when your leg pain is from muscle cramps, fatigue, or overuse:

  • Rest your leg as much as possible, and elevate your leg with pillows.
  • Take an over-the-counter pain reliever, such as aspirin or ibuprofen, to help ease discomfort as your leg heals.
  • Wear compression socks or stockings with support.

Apply ice

Apply ice to the affected area of your leg at least four times per day. You can do this even more frequently in the first few days after the pain appears. You can leave the ice on for as long as 15 minutes at a time.

Take a warm bath and stretch

Take a warm bath, and then gently stretch your muscles. If you have pain in the lower part of your leg, try pointing and straightening your toes when sitting or standing. If you have pain in the upper part of your leg, try to bend over and touch your toes.

You can do this while sitting on the ground or standing up. Ease into each stretch, holding each position for five to 10 seconds. Stop stretching if your pain gets worse.

It can sometimes be difficult to determine when leg pain warrants a trip to the doctor or the emergency room. Schedule a doctor’s appointment if you’re experiencing:

  • swelling in both legs
  • varicose veins that are causing discomfort
  • pain while walking
  • leg pain that continues to get worse or persists beyond a few days

Go to the hospital immediately if any of the follow occurs:

  • You have a fever.
  • You have a deep cut on your leg.
  • Your leg is red and warm to the touch.
  • Your leg is pale and feels cool to the touch.
  • You’re having difficulty breathing and you have swelling in both legs.
  • You’re unable to walk or put any weight on your leg.
  • You have a leg injury that occurred along with a pop or grinding noise.

A number of serious conditions and injuries may cause leg pain. Never ignore leg pain that doesn’t seem to be going away or that’s accompanied by other symptoms. Doing so could be dangerous. See your doctor if you’re concerned about your leg pain.

You should always take time to stretch your muscles before and after exercising to prevent leg pain due to physical activity. It’s also helpful to eat foods that are high in potassium, such as bananas and chicken, to help prevent injuries of the leg muscles and tendons.

You can help prevent medical conditions that may cause nerve damage in the legs by doing the following:

  • Exercise for 30 minutes per day, five days per week.
  • Maintain a healthy weight.
  • Avoid smoking.
  • Monitor your cholesterol and blood pressure, and take steps to keep them under control.
  • Limit your alcohol consumption to one drink per day if you’re a woman or two drinks per day if you’re a man.

Talk to your doctor about other ways to prevent the specific cause of your leg pain.

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11/08/2020

Back Pain Guide: Causes, Symptoms and Treatment Options

Medically reviewed by Drugs.com. Last updated on Jan 22, 2020.

What is Back Pain?

Harvard Health Publications

Back pain can be a symptom of many different illnesses and conditions. The main cause of the pain can be a problem with the back itself or by a problem in another part of the body. In many cases, doctors can’t find a cause for the pain. When a cause is found, common explanations include:

  • Stress or injury involving the back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; and short term overload of back muscles caused by any unusual stress, such as lifting or pregnancy
  • Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the bone-thinning disease osteoporosis
  • Degenerative arthritis, a “wear and tear” process that may be related to age, injury and genetic predisposition.
  • Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disk (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)

Back Pain

  • Kidney stones or a kidney infection (pyelonephritis)
  • Inflammatory arthritis, including ankylosing spondylitis and related conditions
  • A spinal tumor or a cancer that has spread (metastasized) to the spine from elsewhere in the body
  • Infection, which may be in the disk space, bone (osteomyelitis), abdomen, pelvis or bloodstream
  • Rarer causes include:

     

Symptoms

Back pain varies widely. Some symptoms (often called “red flag” symptoms) may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer and neurological symptoms, such as numbness, weakness or incontinence (involuntary loss of urine or stool).

Back pain is often accompanied by other symptoms that may help point to its cause. For example:

  • Back sprain or strain – Back pain typically begins on the day after heavy exertion or an activity that requires twisting. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.
  • Fibromyalgia – In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. People usually complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful to touch, called tender points.
  • Degenerative arthritis of the spine – Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.
  • Inflammatory arthritis, including ankylosing spondylitis and related conditions – In these disorders, there is pain in the lower back, together with morning stiffness in the back, hips or both.  Back pain in these condition tends to improve with exercise. Other features may include psoriasis, eye pain and redness, or diarrhea, depending on the specific disorder causing back pain. This group of diseases is a relatively rare cause of back pain.
  • Osteoporosis – This common condition is characterized by thinned, weakened bones that fracture easily. It is most common in postmenopausal women. When vertebrae become compressed because of fracture, posture may become stooped over or hunched along with back pain. Osteoporosis is not painful unless a bone fractures.
  • Cancer in the spinal bones or nearby structures – Back pain is consistent and may become worse when you are lying down. Numbness, weakness or tingling of the legs that continues to get worse. If cancer spreads to spinal nerves that control the bladder and bowel, there may be bowel or bladder incontinence (loss of control).
  • Protruding disk – People with significant disk disease sometimes have severe pain in the lower back. If a disk compresses a nerve, the pain may spread down one leg. The pain gets worse during bending or twisting.

 

  • Spinal stenosis – Pain, numbness and weakness affect the back and legs. Symptoms get worse when you are standing or walking, but are relieved by sitting or leaning forward.
  • Pyelonephritis – People with a kidney infection typically develop sudden, intense pain just beneath the ribs in the back that may travel around the side toward the lower abdomen or sometimes down to the groin. There also can be a high fever, shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. There may be additional bladder related symptoms, such as the need to urinate more often than normal or pain or discomfort during urination.

Diagnosis

Your doctor will ask about your symptoms and your medical history. He or she will examine your back muscles and spine and will move you certain ways to check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg.

Your symptoms and the physical examination may give your doctor enough information to diagnose the problem. However, with back pain, your doctor may only be able to tell you that the problem is not serious. If your doctor determines that your back pain is caused by muscle strain, obesity, pregnancy or another cause that is not urgent, you may not need any additional tests. However, if he or she suspects a more serious problem involving your vertebrae or spinal nerves, especially if your back pain has lasted longer than 12 weeks, you may need one or more of the following tests:

  • X-rays of your back
  • Blood test
  • Urine tests
  • Spinal magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Nerve conduction studies and electromyography to determine whether nerves, muscles or both may be injured
  • Bone scan, especially if you have a previous history of cancer

Expected Duration

How long back pain lasts depends on its cause. For example, if your pain is caused by strain from overexertion, symptoms usually subside over days or weeks and you may be able to return gradually to your normal activities. However, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back gets better.

Women who have back pain caused by the added weight of pregnancy almost always will get better after delivery. People who are obese may need to lose weight before back pain eases.

People with back pain caused by pyelonephritis often begin to feel better within days after they start taking antibiotics, although they usually need to continue taking antibiotics for up to two weeks.

People with more serious forms of back pain caused by problems with the vertebrae or spinal nerves may have more persistent back pain that lasts for months and may last for years.

Prevention

You can help prevent some forms of back pain by strengthening your back with exercises and by avoiding activities that lead to back injury. Measures that may help prevent back pain include:

  • Maintaining good posture.
  • Sleeping on your side or on your back with a pillow under your knees if you can.
  • Exercising regularly, but stretch before and after.
  • Practicing abdominal crunches to strengthen abdominal muscles, which support your lower back. Also, walk or swim regularly to strengthen your lower back.
  • Always lifting objects from a squatting position, using your hips and your legs to do the heavy work. Avoid lifting, twisting and bending at the same time.

  • Avoiding sitting or standing for extended periods of time.
  • Wearing soft soled shoes with heels that are less than 1 and one-half inches high.

 

To help prevent osteoporosis, make sure you get enough calcium and vitamin D daily to meet the dietary requirements for your age group. Follow a routine program of weight-bearing exercise. Avoid smoking and limit the amount of alcohol you drink. If you are a woman who has entered menopause, speak with your doctor about testing for osteoporosis and medications that can help to prevent or reverse it.

Treatment

Most episodes of back pain are not serious and may be treated with:

People with back pain are encouraged to return to their normal activities gradually, and to temporarily avoid heavy lifting, prolonged sitting, or sudden bending or twisting.

If you are recovering from back pain, your doctor may ask you to call or return to his or her office for a follow-up visit in about two weeks to confirm that your symptoms are gone and that you can safely resume all of your normal activities.

If your back pain is related to more serious disorders of the vertebrae or spinal nerves or if it hasn’t improved over a few weeks, you may be referred to a specialist, such as a pain specialist, an orthopedic surgeon (a doctor who specializes in diseases of the bones), a neurologist (a doctor who specializes in diseases of the nerves and brain) or a rheumatologist (an arthritis specialist).

When To Call a Professional

Contact your doctor if:

  • Severe back pain makes it impossible for you to do your normal daily activities.
  • Your back pain follows significant trauma.
  • Mild back pain gets worse after a few days or persists more than a week or two.
  • Back pain is accompanied by weight loss, fever, chills or urinary symptoms.
  • You develop sudden weakness, numbness or tingling in a leg.
  • You develop numbness in the groin or rectum or difficulty controlling bladder or bowel function.
  • You have had cancer previously and you develop persistent back pain.

Prognosis

More than 90% of people with back pain get better after conservative treatment. Only 5% of people with back pain will have symptoms for more than 12 weeks and even among these people, the cause is usually not serious.

Learn more about Back Pain

Associated drugs

IBM Watson Micromedex

Mayo Clinic Reference

External resources

American Academy of Orthopaedic Surgeons (AAOS)
http://orthoinfo.aaos.org/

American College of Rheumatology
http://www.rheumatology.org/

Arthritis Foundation
http://www.arthritis.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

 

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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