Most people have low back pain at some point in their lives, but it usually doesn't cause much trouble. Low back pain typically starts suddenly and lasts a few days or weeks. Sometimes the pain does last longer, though, or keeps returning after short symptom-free periods.
Longer-lasting pain is called "chronic" pain. Coping with chronic low back pain can pose a great challenge both at home and at work. The cause often remains unknown, making it harder to find a suitable treatment.
Low back pain affects the lumbar region of the spine. This is the lower part of the back between your hips and the bottom of your ribcage. The pain is usually associated with muscle tension, and often limits your range of movement.
Low back pain that radiates to your buttocks or to one leg is called sciatica.
Most of the time, no specific cause is found. Low back pain is often the result of a combination of several factors. Other factors influence how things continue. Possible triggers of "non-specific" low back pain include physical factors such as weak core muscles, overstraining certain muscles by sitting still for a long time or doing repetitive physical labor, tense muscles or wear and tear of the spine. Emotional stress – such as pressure at work, severe anxiety or conditions like depression – are also sometimes associated with low back pain, especially if it is chronic.
Specific causes of low back pain include a slipped disk, a broken bone or conditions like osteoporosis or ankylosing spondylitis. If a cause is identified, other types of treatments are sometimes considered. Low back pain is only rarely a sign of serious injury or disease.
There are three categories of low back pain depending on how long it lasts:
- Acute low back pain (less than six weeks)
- Subacute low back pain (six to twelve weeks)
- Chronic low back pain (more than twelve weeks)
Acute low back pain that is non-specific usually goes away after a short while even without treatment.
If the pain lasts longer, the severity may change over time. Chronic low back pain may get worse at times, and then somewhat better again, or might even go away completely for a while. If a symptom-free period lasts more than six months, it is considered to be returning (recurrent) chronic low back pain. In about half of all people who have recurring low back pain, the pain returns within a year.
At your first visit your doctor or orthopedist will usually start by asking you a few questions. They may want to know whether this is the first time you have had low back pain, where exactly you feel the pain, and whether it is only painful during exercise or when you are resting too. It is also important to let them know whether you have recently had an accident or have other symptoms like numbness or paralysis. And they will probably ask you about any specific emotional or physical stress that may be contributing.
As part of the physical examination the doctor will test your muscle strength and mobility, and check for any areas that feel numb or tingly. Your answers to the questions (anamnesis) and the physical examination are usually enough to rule out any major health problems. If that is the case, no further x-ray, CT (computed tomography) or MRI (magnetic resonance imaging) examinations are needed. X-ray images are not that helpful for non-specific low back pain because they show bone or spine abnormalities that many people have without having back pain. These irregularities are usually caused by normal and mostly harmless wear and tear of the bones. For instance, one study that carried out MRI tests on adults who had no symptoms showed that about half of the adults had a protruding spinal disk.
Too much testing can even do more harm than good. Imaging techniques might find an apparent cause of back pain that actually has nothing to do with the symptoms. This kind of misdiagnosis can lead to unnecessary treatments.
Examinations using x-ray, MRI or CT scans may be helpful if your doctor believes that there may be a specific underlying cause or disease, or if there is no real improvement within twelve weeks despite treatment.
Regular exercise is an effective way to prevent low back pain from returning Exercises for low back pain might include muscle strengthening exercises, stretching exercises and endurance training.
There are a number of different treatment approaches for low back pain. But many of them are not very effective, have only a short-term benefit, or have not been tested enough. The treatment options for non-specific acute and chronic low back pain include relaxation exercises, heat packs, painkillers, special mobility exercises, massages, physiotherapy, manual therapy, acupuncture and osteopathy. Psychological treatments can also be considered.
Some treatments have been proven to be an effective treatment for low back pain in the long term too. But because low back pain can have many different causes and usually goes away after a while even without treatment, it is difficult to tell how effective each particular treatment approach really is.
Many people try out different things to see what helps when they have acute symptoms. Relaxation exercises, heat packs and painkillers are commonly used. Getting into the following position can help to ease acute pain: While lying on your back, you put your lower legs on a raised platform high enough so that your knees are bent at a 90-degree angle. The main thing is to avoid spending too much time lying down and to stay as active as possible.
How to elevate your legs
Frequently recurring or chronic low back pain can mean having to take long periods of time off work. People who find themselves in this situation may be able to participate in an outpatient or inpatient rehabilitation program. The aim of rehabilitation is to manage your symptoms well enough to be able to return to your everyday activities. So it is not just a way to ensure that you can continue to work.
It often consists of a multidisciplinary treatment program with specialists from different fields working together. The team may include medical professionals such as doctors, physiotherapists and psychologists. The different program modules - for instance, drug therapy, physiotherapy, exercise and behavioral therapy - should be tailored to the patient's needs as much as possible. Rehabilitation programs typically last three weeks.
Chronic low back pain can take a great physical and emotional toll. A lot of people find it helpful to develop strategies for coping with the pain and the symptoms over time. Psychological treatments like cognitive behavioral therapy can help with this.
In Germany there are numerous options for finding help if you have chronic back pain, including self-help groups and information centers. There are many regional differences in how these services are organized, and they are not always easy to find. You can use our list to help find and make use of local services.
Agency for Healthcare Research and Quality (AHRQ). Complementary and Alternative Therapies for Back Pain II. 10.2010 (Evidence Report, Technology Assessment; Band 194).
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Kreuzschmerz – Langfassung. Version 5.2010, last update October 2015.
Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011; (2): CD008112.
Rubinstein SM, van Middelkoop M, Kuijpers T, Ostelo R, Verhagen AP, de Boar MR et al. A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. Eur Spine J 2010; 19(8): 1213-1228.
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011; 20(1): 19-39.
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