Back Problems and Injuries

Most people will have a minor back problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreational activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

• The bones and joints of the spine (vertebrae).
• The discs that separate the vertebrae and absorb shock as you move.
• The muscles and ligaments that hold the spine together.

Back injuries are the most common cause of back pain. Injuries frequently occur when you use your back muscles in activities that you do not do very often, such as lifting a heavy object or doing yard work. Minor injuries also may occur from tripping, falling a short distance, or excessive twisting of the spine. Severe back injuries may result from car accidents, falls from significant heights, direct blows to the back or the top of the head, a high-energy fall onto the buttocks, or a penetrating injury such as a stab wound.

Although back pain is often caused by an injury to one or more of the structures of the back, it may have another cause. Some people are more likely to develop back pain than others. Factors that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting for long periods, lifting or pulling heavy objects, or having a degenerative disease such as osteoporosis.

Low back pain may occur in children and teenagers, but children and teens are less likely to see a doctor for low back pain. Although most back problems occur in adults who are between the ages of 20 and 50, back problems in children who are younger than 20 and adults who are older than 50 are more likely to have a serious cause.

Sudden (acute) injuries

Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Pain from an acute injury usually does not last longer than 6 weeks. Acute injuries include:

• An injury to the ligaments or muscles in the back, such as a sprain or a strain.
• A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis. See first aid for a spinal injury.
• A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate) and press against a nerve. See a picture of a herniated disc or pressure on a nerve root.
• Compression of nerves in the lower back (cauda equina syndrome).

Overuse injuries

You may not remember a specific injury, especially if your symptoms began gradually or during everyday activities. These injuries occur most often from improper movement or posture while lifting, standing, walking, or sitting, or even while sleeping. Symptoms can include pain, muscle spasms, and stiffness. The pain often goes away within 4 weeks without any treatment.

Conditions that may cause back problems

Back problems may not be related to an injury.

• Conditions that weaken the spine, such as osteoarthritis, osteoporosis, spinal stenosis, or Paget's disease, can cause back pain. These conditions are most common in older adults. In rare cases, tumors or infections can develop in or around the spine.
• Some medical conditions can cause pain to spread to the back from other parts of the body (referred pain). Many health problems that can cause back pain have nothing to do with the bones, joints, muscles, or ligaments of the back.
• Spinal deformities such as scoliosis, kyphosis (Scheuermann's disease), and spondylolisthesis can cause back pain.
• Chronic pain syndrome caused by a previous injury or degenerative disease with aging can cause back pain.

Treatment

Most back pain will get better and go away by itself in 1 to 4 weeks. Home treatment will often help relieve back pain that is caused by minor injuries. It is usually a good idea to continue your regular activities while your back is healing. Avoid heavy lifting and activities that seem to make your back problems worse.

Other treatments for a back problem or injury may include first aid measures, physical therapy, manipulative therapy (such as chiropractic), medicine, and in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury.
• Your age, health condition, and activities (such as work, sports, or hobbies).

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Pain in the upper back with chest pain that is crushing, squeezing, or feels like a heavy weight on your chest or that occurs with any other symptoms of a heart attack
• Signs of shock
• Back pain that follows a severe injury, such as a:
  • Motor vehicle accident
  • Fall from a height of 15 ft (5 m) or higher
  • Major sports-related injury
  • Direct blow to the spine with a moving object
  • Forceful strike on top of the head
  • Very hard fall on the buttocks that sent pain into your back
  • Penetrating injury, such as a gunshot wound or stab wound
• Symptoms of a spinal cord injury immediately following a back injury, including:
  • Loss of bowel or bladder control
  • Weakness in the legs
  • Numbness or tingling in the buttocks, genital area, or legs

Note: If you think that a person has injured his or her spine, do not move the person unless there is an immediate threat to his or her life, such as a fire. If there is immediate danger, keep the person's head, neck, and back supported and in a straight line while you move him or her to a safe place. See first aid for a spinal injury.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Back pain with flank pain and urinary problems: Go to the topic Urinary Problems, Age 12 and Older.
• Bleeding: Go to the topic Cuts.
• Pregnant and a back problem not caused by an injury: Go to the topic Pregnancy-Related Problems.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Back pain and abdominal problems: Go to the topic Abdominal Pain.
• Cramping back pain that may be caused by your menstrual period: Go to the topic Menstrual Cramps.
• Neck pain: Go to the topic Neck Problems and Injuries.
• Shoulder pain: Go to the topic Shoulder Problems and Injuries.
• A burn, scrape, or bite: Go to the topic Burns, Scrapes, or Animal and Human Bites.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may help relieve pain, swelling, and stiffness related to a back problem.

• Return to your normal daily activities and work as soon as you can, although you may need to modify or limit some work tasks.
• Avoid bed rest. Bed rest is not an effective treatment for back pain and may cause you to heal more slowly.
• Apply an ice or cold pack to the injured area for the first 48 to 72 hours. Apply cold packs or ice for 15 to 20 minutes, 3 to 4 times a day or up to once an hour. Cold decreases swelling and pain. Keep a towel between your skin and the ice to prevent frostbite. Do not fall asleep with the ice on your skin.
• Change position every 30 minutes. Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
• For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
• After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend switching back and forth between heat and cold treatments. You can also begin gentle exercise with the aid of moist heat to help restore and maintain flexibility.
• Avoid sitting up in bed, sitting on soft couches, and twisting or sitting in other positions that make your symptoms worse.
• Try one of the following sleep positions if you have trouble sleeping at night:
  • Lie on your back with your knees bent and supported by large pillows, or lie on the floor with your legs on the seat of a sofa or chair.
  • Lie on your side with your knees and hips bent and a pillow between your legs.
  • Lie on your stomach if it does not increase your pain.
• Begin moderate aerobic exercise. Take short walks (3 to 5 minutes every 3 hours) on level surfaces as soon as you can to help keep your muscles strong. Avoid hills and stairs. Walk only distances that you can manage without pain, especially pain in your legs. Add to your exercise program every week to continue your progress.
• Do pelvic tilt exercises to gently move the spine and stretch the lower back. Lie on your back with your knees bent and feet flat on the floor. Slowly tighten your stomach muscles and press your lower back against the floor. Hold the position for 10 seconds. Do not hold your breath. Slowly relax.

Additional home treatment for a tailbone (coccyx) injury

• A warm sitz bath for 20 minutes, 3 to 4 times per day after the first 48 to 72 hours, can be soothing to the tailbone area. Sitting in a hot tub or warm bath may also feel good, as long as you are not sitting directly on your tailbone.
• Do not sit on hard, unpadded surfaces.
• Sit on a doughnut-shaped pillow to take pressure off the tailbone area.
• Avoid constipation. Straining to have a bowel movement will increase tailbone pain. For more information, see the topic Constipation, Age 12 and Older.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Home treatment 2 to 3 days after the injury

• Continue with daily walks, increasing the walks to 5 to 10 minutes 3 to 4 times a day.
• Try swimming, which is good for your back. It may be painful immediately after a back injury, but lap swimming or kicking with swim fins often help prevent back pain from coming back.
• Take a yoga class or get a massage.
• Avoid acupuncture, which has not been proven to effectively treat back pain.

Back pain often gets better when you gradually increase your physical activity. Try to get back to your normal routines and activities as soon as possible. Resting and not doing anything may actually increase back pain or make it last longer.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• One or both legs become weak or numb.
• You lose control of your bowels or bladder.
• Back pain is getting worse.
• Back pain does not improve after 1 to 2 weeks.
• Symptoms become more severe or frequent.

Back pain affects many people. The more time you spend sitting at a desk, in a car, or in front of the television or a computer, the more you must do to prevent back pain. Good posture, proper body mechanics, and exercise will help you prevent back pain.

General tips to prevent back problems

• Maintain an ideal body weight. This reduces the load on your lower back. Lose weight if you need to. For more information, see the topic Healthy Weight.
• Practice good posture and body mechanics. For tips on how to reduce stress on your back, see:
  • Body mechanics.
  • Proper lifting techniques.
  • Sleeping positions that protect your back.
• Adjust your car seat so that you are not reaching for the steering wheel when you drive. Your arms should be in a slightly flexed, comfortable position.
• Always wear your seat belt while you are in a motor vehicle.

Exercises to prevent back pain

The exercises in this topic and general aerobic exercise, such as walking, swimming, and cycling, will help prevent back injury and pain. They also will help you recover more quickly from injuries and decrease your chances of having chronic pain. For more information, see the topic Fitness.

Do not do these exercises if you have just injured your back. Instead, see the Home Treatment section of this topic.

• You do not need to do every exercise. Do the ones that help you the most.
• If any exercise increases your back pain, stop the exercise and try something else. Stop any exercise that causes the pain to radiate away from your spine into your buttocks, legs, or feet, either during or after the exercise.
• Start with 5 repetitions, 3 to 4 times a day, and gradually increase to 10 repetitions. Do all exercises slowly.

Extension exercises

Extension exercises strengthen your lower back muscles and stretch the stomach muscles and ligaments.

• Shoulder lifts
• Backward bends

Flexion exercises

• Curl-ups
• Knee-to-chest exercise

Strengthening and stretching exercises

• Prone buttocks squeeze
• Pelvic tilts
• Hamstring stretch
• Hip flexor stretch

Exercises to avoid

Some exercises actually increase the chances of causing of low back pain. Avoid:

• Straight-leg sit-ups.
• Bent-leg sit-ups during acute back pain (may be safe if back is kept in neutral position).
• Leg lifts (lifting both legs while lying on your back).
• Lifting heavy weights above the waist (military press or biceps curls while standing).
• Any stretching done while sitting with the legs in a V position.
• Toe touches while standing.

Work comfort and design

Most back problems that occur in the workplace are caused by physical stress, such as being in an awkward position for a long time, making the same motions over and over, and simply using your back too much. These injuries can cause stress and strain on muscles, nerves, tendons, joints, blood vessels, or spinal discs.

Arrange your work to help prevent work-related injuries. It is important to position yourself so that you can sit comfortably and minimize stress on any one area of your body. Change your positions and tasks as often as possible, and match tools to your size and preferences. If you are doing a job or task that requires you to sit for long periods, get up and stretch and move around at least once an hour.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms?
• How long have you had your symptoms?
• If you were injured, how and when did the injury occur? How was it treated?
• What were you doing at the time the back pain started?
• Have you been in a fight or been punched or kicked in the back?
• Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
• If you have chronic back pain, has the pain changed significantly?
• Do you have leg weakness; numbness in the buttocks, genitals, or legs; or loss of bladder or bowel control?
• Do you have any other symptoms, such as abdominal pain, urinary problems, or fever?
• Have you recently been treated for a kidney or bladder infection or other problem?
• Have you had any recent, unexplained weight loss?
• What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
• Do you think that activities related to your job or hobbies caused your symptoms?
• What home treatment measures have you tried? Did they help?
• What nonprescription medicines have you taken? Did they help?
• Are you using alcohol or other drugs, such as marijuana or heroin, to control your pain?
• Do you have any health risks?

• Abdominal Pain, Age 12 and Older
• Animal and Human Bites
• Appendicitis
• Burns
• Chest Pain
• Chronic Pain
• Constipation, Age 12 and Older
• Cuts
• Endometriosis
• Gallstones
• Herniated Disc
• Influenza
• Kidney Stones
• Low Back Pain
• Menstrual Cramps
• Neck Problems and Injuries
• Office Ergonomics
• Osteoarthritis
• Osteoporosis
• Pelvic Inflammatory Disease
• Prostatitis
• Puncture Wounds
• Rash, Age 12 and Older
• Scoliosis
• Scrapes
• Shingles
• Shoulder Problems and Injuries
• Stress Management
• Urinary Problems and Injuries, Age 12 and Older
• Urinary Tract Infections in Teens and Adults

When to See a Doctor

See significance of leg weakness if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have new weakness in both legs?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Do you have new weakness in one leg?
Yes	Is ongoing weakness in one leg getting worse?
Yes	Do you have back pain and leg weakness that causes you to limp?

	You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	Have you had ongoing leg weakness for longer than 1 week?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of urinary or bowel problems after an injury if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Are you unable to urinate?
Yes	Do you have blood in your urine?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Are you having any trouble urinating?
Yes	Are you having trouble having a bowel movement?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of numbness or tingling if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Do you have new numbness or tingling in both legs?
Yes	Do you have new numbness or tingling around the anus or in the genital area?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Do you have new numbness or tingling in 1 buttock or 1 leg?
Yes	Is numbness or tingling getting worse?
Yes	Is numbness or tingling affecting a larger area?

	You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	Have you had numbness or tingling that comes and goes without other symptoms for the past 24 hours?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of back pain or tenderness if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Note:

The following questions apply whether you have had a recent injury, do not remember being injured, or have a history of back pain.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have severe pain?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Do you have moderate pain?
Yes	Do you have new back or flank pain and a fever?
Yes	Do you have pain and a rash of small, itchy blisters that has spread in a band from your back around your body?
Yes	Have you had pain and symptoms of sciatica for longer than 4 hours?

	You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Yes	Have you had mild pain for longer than 48 hours after an injury?
Yes	Has back pain prevented you from participating in your daily activities, such as school or work, for longer than 48 hours after an injury?
Yes	Do you have pain that comes and goes and symptoms of sciatica that have not improved after 2 to 3 days of home treatment?
Yes	Do you have mild to moderate pain without other symptoms that has not improved after 2 to 3 days of home treatment?

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.
Yes	Do you have chronic back problems that are slowly getting worse?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of a tailbone injury if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Have you had severe pain for 4 hours or longer?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Is the skin over your tailbone area cut, scraped, or punctured?
Yes	Have you had rectal bleeding or are you unable to have a bowel movement?
Yes	Have you had moderate pain for 12 hours or longer?

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.
Yes	Have you had tailbone mild pain for more than 1 week that has not improved with home treatment?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.