Prevention of Low Back Pain
People can reduce their risk of developing low back pain by doing the following:
Exercising
Strengthening and stretching muscles
Maintaining a healthy weight
Maintaining good posture
Using proper lifting techniques
The most effective way to prevent low back pain is to exercise regularly. Aerobic exercise and specific muscle-strengthening and stretching exercises can help.
Aerobic exercise, such as swimming and walking, improves general fitness and generally strengthens muscles.
Specific exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) can help stabilize the spine and decrease strain on the disks that cushion the spine and the ligaments that hold it in place.
Muscle-strengthening exercises include pelvic tilts and abdominal curls. Stretching exercises include the knee-to-chest stretch. Stretching exercises can increase back pain in some people and therefore should be done carefully. As a general rule, any exercise that causes or increases back pain should be stopped. Exercises should be repeated until the muscles feel mildly but not completely fatigued. Breathing during each exercise is important. People who have back pain should consult a doctor before beginning to exercise.
Exercises to Prevent Low Back Pain
Pelvic Tilts
Lie on the back with the knees bent, the heels on the floor, and the weight on the heels. Press the small of the back against the floor, contract the buttocks (raising them about half an inch [1 cm] from the floor), and contract the abdominal muscles. Hold this position for a count of 10. Repeat 20 times.
Exercises to Prevent Low Back Pain
Abdominal Curls
Lie on the back with the knees bent and feet on the floor. Place the hands across the chest. Contract the abdominal muscles, slowly raising the shoulders about 10 inches (25 cm) from the floor while keeping the head back (the chin should not touch the chest). Then release the abdominal muscles, slowly lowering the shoulders. Do 3 sets of 10.
Exercises to Prevent Low Back Pain
Knee-to-Chest Stretch
Lie flat on the back. Place both hands behind one knee and bring it to the chest. Hold for a count of 10. Slowly lower that leg and repeat with the other leg. Do this exercise 10 times.
Exercises to Prevent Low Back Pain
Exercise can also help people maintain a desirable weight. Weight-bearing exercise can help people maintain bone density. Thus, exercise may reduce the risk of developing two conditions that can lead to low back pain—obesity and osteoporosis .
Maintaining good posture when standing and sitting reduces stress on the back. Slouching should be avoided. Chair seats can be adjusted to a height that allows the feet to be flat on the floor, with the knees bent up slightly and the lower back flat against the back of the chair. If a chair does not support the lower back, a pillow can be used behind the lower back. Sitting with the feet on the floor rather than with the legs crossed is advised. People should avoid standing or sitting for long periods. If prolonged standing or sitting is unavoidable, changing positions frequently may reduce stress on the back.
Learning to lift correctly helps prevent back injury. The hips should be aligned with the shoulders (that is, not rotated to one side or the other). People should not bend over with their legs nearly straight and reach out with their arms to pick up an object. Instead, they should bend at the hips and knees. Bending this way keeps the back straighter and brings the arms down to the object with the elbows at the side. Then, keeping the object close to the body, they lift the object by straightening their legs. This way, the legs, not the back, lift the object. Lifting an object over the head or twisting while lifting increases the risk of back injury.
Treatment of Low Back Pain
If a specific cause can be diagnosed, that disorder is treated. For example, antibiotics are used to treat a prostate infection . However, there is no specific treatment for musculoskeletal pain due to sprains or strains nor for many other musculoskeletal causes. But many general measures can help. Usually, these general measures are also used when a spinal nerve root is compressed.
General measures for back pain
Measures include
Modifying activities
Taking drugs that relieve pain
Applying heat or cold to the painful area
Light exercise as tolerated
For low back pain that has recently developed, treatment begins with avoiding activities that stress the spine and cause pain—such as lifting heavy objects and bending. Bed rest does not hasten the resolution of the pain, and most experts recommend continued light activity. Bed rest, if required to relieve severe pain, should last no more than 1 or 2 days. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Spinal corsets and traction are not helpful. Traction may delay recovery.
Acetaminophen is usually recommended for pain relief unless inflammation is present. Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. If acetaminophen or NSAIDs do not provide sufficient pain relief, opioid analgesics are occasionally prescribed but, if so, should be used only for a short duration because long-term use of opioid analgesics can actually increase sensitivity to pain, cause side effects, and risk the development of a substance use disorder .
Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes given to relieve muscle spasms, but their usefulness is controversial. These drugs are not recommended for older people, who are more likely to have side effects such as drowsiness and confusion. Doctors try not to prescribe muscle relaxants unless people have visible and palpable muscle spasms. If prescribed, muscle relaxants should be used for no more than 72 hours. Doctors sometimes tell people to take them only at bedtime.
Application of heat or cold may help (see Treatment of Pain and Inflammation ). Cold is usually preferred to heat during the first 2 days after an injury. Ice and cold packs should not be applied directly to the skin. An ice pack should be enclosed (for example, in plastic) and placed over a towel or cloth. The ice is removed after 20 minutes, then reapplied for 20 minutes over a period of 60 to 90 minutes. This process can be repeated several times during the first 24 hours. Heat, using a heating pad, can be applied for the same periods of time. Because the skin on the back may be insensitive to heat, heating pads must be used cautiously to prevent burns. People should not use a heating pad at bedtime to avoid the risk of falling asleep with the pad still on their back.
Massage may provide some temporary relief of low back pain. Some studies suggest that acupuncture may have similar benefits, but others suggest little or no benefit. Spinal manipulation, done by chiropractors or some other doctors (such as osteopathic doctors), may also provide relief when combined with an exercise program. However, spinal manipulation may increase the risk of further injury and should be avoided in people who have inflammatory arthritis, neck problems that cause instability of neck vertebrae, or a herniated disk .
After the pain has subsided, light activity, as recommended by a doctor or physical therapist , can speed healing and recovery. In some cases, a course of treatment with a physical therapist can help. Specific exercises to strengthen and stretch the back and to strengthen core muscles are usually recommended to help prevent low back pain from becoming chronic or recurring.
Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so.
Sleeping Positions for Back Pain
Sleeping Positions for Back Pain
Other preventive measures (maintaining good posture, lifting correctly) should be continued or started. In response to these measures, most episodes of back pain resolve in several days to 2 weeks. Regardless of treatment, 80 to 90% of such episodes resolve within 6 weeks.
Treatment of chronic back pain
Additional measures are needed for chronic low back pain. Aerobic exercise may help, and weight reduction, if necessary, is advised. If analgesics are ineffective, other treatments can be considered.
Transcutaneous electrical nerve stimulation (TENS) may be used. The TENS device produces a gentle tingling sensation by generating a low oscillating current. This current can block transmission of some pain sensation from the spinal cord to the brain. The current can be applied to the painful area several times a day for 20 minutes to several hours at a time, depending on the severity of the pain.
Facet Joint Injection
Facet Joint Injection
Epidural Corticosteroid Injection
Epidural Corticosteroid Injection
Sometimes a corticosteroid (such as dexamethasone or methylprednisolone) plus a local anesthetic (such as lidocaine) can be periodically injected into facet joints in the spine or the epidural space—between the spine and the outer layer of tissue covering the spinal cord. The epidural injections may be more effective for sciatica caused by a herniated disk than for lumbar