11/09/2020

Herniated Disc Treatment, Symptoms, Surgery, Causes & Rehap

Herniated disc facts

Picture of herniated disc between L4 and L5

• The discs are pads that serve as “cushions” between the vertebral bodies, which minimize the impact of movement on the spinal column.
• Each disc is designed like a jelly donut with a central softer component (nucleus pulposus).
• Abnormal rupture of the central portion of the disc is referred to as a disc herniation.
• The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumbar vertebrae in the low back.
• If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation.
• The physical examination, imaging tests, and electrical tests can aid in the diagnosis of a herniated disc.
• Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medication, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations.

How are the spine and its discs designed?

The vertebrae are the bony building blocks of the spine. Between each of the largest parts (bodies) of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum, followed by the tailbone (coccyx).

The bony spine is designed so that vertebrae “stacked” together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a spinous process, which is a bony prominence behind the spinal cord that shields the cord’s nerve tissue. The vertebrae also have a strong bony “body” in front of the spinal cord to provide a platform suitable for weight-bearing.

The discs are pads that serve as “cushions” between the vertebral bodies that serve to minimize the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Herniated Disc Treatment

Epidural Cortisone Injections for Sciatica and Herniated Disc…Beneficial?

A majority of patients with sciatica from disc herniation have resolution of their pain with various conservative measures, including antiinflammatory and muscle-relaxant medications, exercises, physical therapy, and time. However, some 10%-15% of affected patients require surgical procedures to relieve the pain.

Learn if a cortisone injection can reduce the need for surgery »

What is a herniated disc? What causes a herniated disc?

Cross-section picture of herniated disc between L4 and L5

As described above, each disc of the spine is designed much like a jelly donut. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. This is commonly referred to as a “slipped disc.”

The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumbar vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body. This is especially important when we are standing or sitting. The lower back is also critically involved in our body’s movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting.

IMAGES

Herniated Disc See a medical illustration of the sciatica plus our entire medical gallery of human anatomy and physiology See Images

What are risk factors for a herniated disc?

Risk factors for a herniated disc include degeneration of the spine and heavy lifting or bending of the spine.

What are symptoms of a herniated disc?

The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. A disc herniation may not cause any symptoms. However, disc herniation can cause local pain at the level of the spine affected.

If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body and is referred to as sciatica. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low back can cause a shooting pain down the buttock into the back of the thigh and down the leg. Sometimes this is associated with numbness, weakness, and tingling in the leg. The pain often is worsened upon standing and decreases with lying down. This is often referred to as a “pinched nerve.”

If the disc herniation occurs in the cervical spine, the pain may shoot down one arm and cause a stiff neck or muscle spasm in the neck.

If the disc herniation is extremely large, it can press on spinal nerves on both sides of the body. This can result in severe pain down one or both lower extremities. There can be marked muscle weakness of the lower extremities and even incontinence of bowel and bladder. This complication is medically referred to as cauda equina syndrome.

How do health care professionals diagnose a herniated disc?

The doctor will suspect a herniated disc when symptoms described above are present. The neurologic examination can reveal abnormal reflexes. Often pain can be elicited when the straight leg is raised when lying or sitting. This is referred to as a “positive straight leg raising test.” There can be abnormal sensation in the foot or leg.

A variety of blood tests are frequently done to determine if there are signs of inflammation or infection.

Plain film X-rays can indicate “wear and tear” (degeneration) of the spine. They do not, however, demonstrate the status of discs. In order to determine whether or not a disc is herniated, an MRI scan or CT scan is performed for diagnosis. Sometimes a CT myelogram is used to further define the structures affected by a herniated disc. A CT myelogram is a CT that is performed after contrast dye is injected into the spinal canal. This allows for better visualization of the discs in certain cases. An electromyogram (EMG) can be used to document precisely which nerves are being irritated by a disc herniation.

What is the treatment for a herniated disc?

Picture of the stapled incision after surgery

Occasionally, disc herniation is incidentally detected when a test such as an MRI is performed for other reasons. If no symptoms are present, no particular treatment is necessary.

Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication (such as methylprednisolone or prednisone), without the need for surgical intervention.

There are now a variety of surgical approaches to treat disc herniation. Each type of operation is customized to the individual situation and depends a great deal on the condition of the spine around the disc affected. Surgical options include microdiscectomy using small surgical instruments and open surgical repair (either from a posterior or anterior approach). The urgent operation can be necessary when cauda equina syndrome is present (reviewed above).

SLIDESHOW

Lower Back Pain: Symptoms, Stretches, Exercise for Pain Relief See Slideshow

What are home remedies for a herniated disc?

Home remedies for disc herniation can be very effective in relieving the pain. These include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), as well as the application of heat and ice. Alternating heat and ice is very effective for pain relief for many people. Activity modification is also important, which includes avoidance of activities that aggravate pain and may worsen the nerve impingement. Bed rest and complete inactivity are unnecessary; they hinder recovery and are not advised.

What exercises and stretches can be done for a herniated disc?

Exercising is not advised for new symptoms of a herniated disc. On the other hand, building and maintaining strength in the back muscles and abdominal muscles is very important to prevent and treat chronic back problems. Exercises such as walking, physical therapy, and yoga have been proven to be very beneficial for those with chronic back pain.

Simple stretching can be very beneficial for symptoms of a herniated disc. Stretching should be started slowly and carefully. Stretching generally involves stretching the back in a backward bending position, called extension.

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What kind of health care professionals treat herniated discs?

Many different health care providers treat herniated discs. Usually patients will see their primary care provider initially, who may be a general practitioner or specialist in internal medicine or family practice. Other physicians who frequently see patients with herniated discs include emergency-medicine physicians, pain-management specialists, orthopedists, neurosurgeons, rheumatologists, and neurologists.

What is the prognosis (outlook) for a herniated disc?

The outlook for herniated disc depends on the severity and accompanying symptoms. While it is often possible to have full recovery with conservative treatment measures, sometimes surgical intervention is necessary because of persistent symptoms.

Is it possible to prevent a herniated disc?

A herniated disc can only be prevented by avoiding injury to the spine.

From

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Medically Reviewed on 9/2/2020

References

Kasper, D.L., et al., eds. Harrison’s Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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11/08/2020

Lower Back Pain Symptoms, Diagnosis, and Treatment

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11/08/2020

Causes of Back Pain

Is Your Back Pain Ankylosing Spondylitis?

Articles OnBack Pain

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

Herniated Disc – Symptoms, Causes, Prevention and Treatments

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.

Source

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?

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)

• 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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