Back Pain

Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide. Back pain can range from a muscle aching to a shooting, burning, or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking. Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.

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 a problem in another part of the body. 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). The causes of back pain include:

• A ruptured or herniated disc
• Osteoporosis
• Sciatica
• Inflammatory arthritis, including ankylosing spondylitis and related conditions
• Lumbar Spondylosis
• Baastrup Syndrome
• Strains
• Spinal stenosis
• Abnormal Spinal Curvature
• Infections of the spine

• Pyelonephritis
• Cauda equina syndrome
• Cancer of the spine
• Other infections
• Sleep disorders
• Shingles

• Age. Back pain is more common as you get older, starting around age 30 or 40.
• Lack of Exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
• Excess weight. Excess body weight puts extra stress on your back.
• Diseases. Some types of arthritis and cancer can contribute to back pain.
• Improper lifting. Using your back instead of your legs can lead to back pain.
• Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
• Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.

• Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices.
• Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
• Maintain a healthy weight. Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.
• Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

• Stand smart. Don't slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
• Sit smart. Choose a seat with good lower back support, armrests, and a swivel base. Placing a pillow or rolled towel on the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
• Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

• Persists past a few weeks
• Is severe and doesn't improve with rest
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness, or tingling in one or both legs
• Is accompanied by unexplained weight loss

• Causes new bowel or bladder problems
• Is accompanied by a fever
• Follows a fall, blow to your back, or another injury

• 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

• Topical rubs and ointments
• Opioids
•  Muscle relaxants
• Antidepressants
• Steroid injections
• Surgery

• Electrical stimulation and TENS (transcutaneous electrical neuromuscular stimulation)
• Cervical Traction
• Manual (hands-on) Therapy
• Core muscle strengthening
• Range of motion exercises
• Soft tissue treatment
• Joint manipulation
• Postural retraining
• Ergonomic advice/assessment
• Thermal modalities (heat therapy/Ice therapy)
• Acupuncture or other pain-relieving techniques
• Therapeutic taping