LOW BACK PAIN AND SPASMS

CONDITION

Low back pain (LBP) is pain that occurs anywhere over your lower back between the bottom part of your rib cage and the top of your buttocks (Figure 1). Acute back pain is pain that happens right away when you are injured or soon afterward. Chronic low back pain is usually present for more than a few months, but also can come and go repeatedly over a long time. Spasms are when muscles tighten up and cause pain.

Figure 1

The back is made up of bones, muscles, nerves, ligaments (fibrous tissue that holds bones together) and discs (round, gel-filled structures that sit between the bones of the spine and act as shock absorbers or cushions.) The bones of your spine form a hollow canal through which the spinal cord and its nerves pass. Any of these can be affected in LBP.
LBP is one of the most common bone or joint problems for which people see a doctor.
Most people will have low back pain at least once. People 20 to 50 years old are most likely to have back pain, but older adults can have more severe or chronic back pain.
Regular or recurrent back pain in youngsters under age 18 is almost always abnormal and needs to be looked at by a doctor.
Most of the time, back pain goes away on its own within three to six weeks, but in a small percentage of people it can become chronic and last or recur over a long time.

Causes

Acute low back pain is usually the result of an injury involving bending or twisting, especially while lifting things. The most common of these injuries are sprains (a ligament injury) and strains (an injury to muscle) with muscle spasm.
Low back injuries also can occur in almost any sport, but are most common in contact sports such as football and hockey. Sports like gymnastics and rowing that require athletes to bend backward a lot can also cause back injuries.
Discs that have degenerated (broken down) over time and degenerative arthritis of the spine bones (vertebrae) are the most common causes of chronic low back pain.
Aside from sprains, strains and spasms, some of the more common conditions causing LBP include:
- a herniated disc, which occurs when the soft center of the disc pushes out through the firm outer covering surrounding it
- a pinched nerve (sciatica), a condition in which there is pressure on a large nerve that runs from the lower back down the legs
- a tight spinal canal, which can result from a bulging disc or bone spurs that can form as a result of arthritis
- muscle spasm (tight, painful muscles) that accompanies most acute back injuries
- myofascial pain, which is pain in muscles related to poor posture
- fractures, acute (those that happen as a result of a fall or injury), stress (those that occur with certain repeated activities such as bending backward) and compression (those caused by osteoporosis, a condition that can result in the collapse of thin, brittle vertebrae)
- pain disorders such as fibromyalgia, a problem with pain processing in the brain that affects the whole body.
Less common causes of LBP include:
- tumors or other growths that take up space in the spinal canal
- inflammatory arthritis, a type of arthritis that causes swelling in other parts of your body
- problems (such as appendicitis) in another part of your body (such as your belly) that result in pain in your lower back.
Certain things can increase your risk for back pain:
- working in a job that involves a lot of heaving lifting, bending at the waist and twisting
- long periods of sitting
- poor posture (such as slumping forward in soft chair with no low back support)
- being overweight
- not doing regular walking or aerobic exercise
- depression, a condition that leaves you feeling down most of the time
- smoking
- pregnancy.

Symptoms and Signs

You will notice pain in your lower back that can be achy or feel spastic or tight. Sometimes, it may burn. Occasionally, there may be sharp pain with movements such as bending and twisting.
Your pain may get worse when you bend forward, especially if you bend forward and lean sideways.
You may notice that your back feels stiff after you have been still for awhile, such as after sitting or upon getting up in the morning. It may feel better when you have gotten “warmed up” or started moving around.
A pinched nerve in your back can cause pain, numbness, tingling, loss of sensation and muscle weakness in almost any part of your upper leg, lower leg and foot.
You may notice that coughing, laughing, sneezing, getting up from a sitting position or straining and lifting will worsen your pain, especially if you have injured a disc or have swelling in your spinal canal.
Pain can get worse when you stand or sit for too long or when you lie on your stomach, especially when your upper body is propped up on your elbows.
Pain that happens immediately after an injury means that you may have torn something such as a muscle, tendon, ligament or disc.
Pain that starts slowly and stays the same or builds up over time can indicate an injury or medical problem that is gradually getting worse.
“Red flag” symptoms that tell you there may be a serious injury or illness causing your back pain include:
- night pain that wakes you up
- unintentional or unexplained weight loss
- fever higher than 101° F
- problems urinating or having a bowel movement, such that you can’t go or have lost control
- numbness or problems with loss of sensation in the skin around your bottom
- foot and ankle muscle weakness that causes you to suddenly trip over your toes while walking
- weakness, numbness, tingling or problems feeling both legs or feet.
Other things that you should report to your doctor right away include severe pain and/or and weakness, numbness, tingling or problems feeling one leg or foot that happens immediately after a fall (especially from a high place like a ladder) or after an injury caused by great force (such as a motor vehicle accident or a football tackle).

WHEN TO CALL YOUR DOCTOR

Call 911 if:

You have severe back pain after a fall or an injury resulting from an incident such as a motor vehicle accident and/or weakness in your legs or feet, loss of urine control, problems controlling your bowel movements OR numbness, tingling or loss of sensation in your legs and feet.
You have such severe pain after an injury that you cannot get up and walk.

Call your doctor right away (night or day) if:

You have any of the “red flag” symptoms listed above.
You have not had a fall or other injury but you suddenly develop weakness, numbness, tingling or problems feeling one leg or foot.
You have not had a fall or other injury but you have had chronic back problems and sciatica, and suddenly develop a worsening of symptoms such as weakness, numbness, tingling or problems feeling one leg or foot.
You are more than 50 years old or you have been taking steroid medication and you suddenly notice back pain, especially after coughing, sneezing or bending over. This can be caused by a compression fracture of your vertebrae.
You have redness or swelling over the back or spine, which can signal infection.
You notice that it burns when you urinate, you urinate more frequently, have blood in your urine, have nausea or vomiting and have back pain located above the area of your lower back that is over your lower ribs .
You have had chronic back pain and it suddenly gets worse, especially if you did not injure or re-injure your back.

Call your doctor during regular office hours if:

You have had chronic problems with (and may have been seen by a doctor for) weakness, numbness, tingling or difficulty feeling one leg or foot that persist but are not getting worse.
Your back pain has lasted more than a week or two, started slowly without an injury and you do not have pain, numbness, tingling, loss of sensation or weakness in your legs or feet.
You have mild, tolerable pain that lasts more than a week or two but does not limit your daily activities. The pain may have started slowly or begun right away after an injury, it stays in your back only and does not go into your legs or feet.

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SELF-CARE AT HOME

Avoid positions and activities that increase your pain, such as bending forward and twisting or leaning sideways.
Avoid lifting anything over five pounds until your back is better or you have been seen by a doctor.
Do not stay in bed. Bed rest is an outdated recommendation that can make your pain worse. Stay gently active, if you can, by doing simple things like walking or moving around your house and engaging in activities of daily living. It is okay to decrease some activities for a few days.
Avoid athletic activities that require bending, twisting or straining such as weightlifting, football, basketball, dancing, golf, jogging, gymnastics and skiing.
The lower back is an area where you may use cold, heat or both to help relieve pain and spasm. There are many recommendations, but you may start by using a cold pack over the most painful area in your back for 10 to 15 minutes, then using a heat pack for 10 to 15 minutes. You may repeat this as often as you need to. If your pain gets better, gradually back off using cold and heat.
You may take ibuprofen (Motrin®, Advil®), naproxen (Aleve®), or acetaminophen (Tylenol®) as directed for pain. (See labels for dosing and risks.)
Be creative to find a comfortable sleeping position. You may need to put a pillow under your knees while lying flat on your back. You can use a small pillow under the curve of your lower back or, if lying down is uncomfortable, you may try sleeping in a recliner for a few days. Also, lying curled on your side with your hips and knees bent and a pillow between your knees sometimes helps.
Stretching and strengthening exercises can often help back pain, but starting these too soon after injury or pain that begins abruptly can set you back or make your injury worse. Time is what resolves most acute back pain, but as mentioned above, if your pain is not getting better over one to two weeks, your doctor will help guide you to exercises that can help your back.

PREVENTION

Stay active and do aerobic or cardiovascular exercise regularly. Walking is especially good.
Keep your hamstrings (the muscles on the back of your upper legs) flexible. Do stretches (Figure 2) daily, repeat them two to three times and hold each stretch for 20 to 30 seconds without bouncing. Gradually pull each leg straight until you feel a stretch in your muscles. Without causing too much discomfort, try to pull your leg slightly straighter each time you exhale.

Figure 2

Lift things using proper technique. Get close to the object you want to lift and directly face it. Bend at the knees and hips while keeping your back relatively straight. Grasp and hold the object close to your body, then pick it up using your legs and hips. Avoid any twisting. Ask for help lifting very heavy things so as not to exceed your limits.
When you are moving heavy objects by sliding or rolling them, push rather than pull, and use a partner to stabilize the object.
Practice good posture when you are sitting for a long time, especially at a desk or in a car. Sit as straight as possible and maintain the curve in your lower back. Using a lumbar support or a back pillow in your seat can sometimes help. Avoid slumping forward. Take frequent breaks to walk around.
Wear good-quality athletic shoes and avoid high heels when you have back pain.
Avoid smoking, eat a healthful diet and keep your weight at a level appropriate for your height.

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FOR MORE INFORMATION

REFERENCES

Carragee EJ: Diagnostic evaluation of low back pain. Orthopaedic Clinics of North America 35(1) 7-16, 2004.
McKamey K: Low back pain. Primary Care 34(1) 71-82, 2007.
Press J, Young J: Low back pain. In Mellion M, Putukian M, Madden C: Sports Medicine Secrets, p 344-347, Hanley & Belfus, Philadelphia, 2003.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.