Back Pain

Overview

Back pain is one of the most common reasons people seek medical care and miss work. It can occur anywhere along the spine but most often affects the lower back, which carries much of the body's weight. The pain may be a dull ache, a sharp stab, or a burning sensation, and it can be brief or long-lasting.

The great majority of back pain is mechanical, meaning it comes from the muscles, ligaments, joints, and discs rather than from a serious disease. Most episodes improve within a few weeks with simple measures. Less often, back pain signals a problem that needs prompt attention, so it helps to know the difference between ordinary back pain and warning signs.

Symptoms

Back pain itself is a symptom, but the way it behaves gives clues to its cause. Features may include:

• Lower back pain, neck pain, or pain in the mid-back
• Aching or stiffness, often worse after rest or with certain movements
• Sharp pain triggered by lifting, bending, or twisting
• Muscle tightness or spasm
• Pain that radiates into the buttock or leg, sometimes with tingling or numbness (suggesting nerve involvement)

Some symptoms suggest a more serious cause and are covered in the warning-signs section below.

Causes

Back pain has many possible causes, most of them not serious:

• Muscle and ligament strain: from lifting, sudden movements, or overuse, the most common cause.
• Disc problems: a bulging or herniated disk can press on nerves and cause leg pain.
• Age-related changes: spondylosis, degenerative disc disease, and spinal stenosis.
• Joint and structural conditions: osteoarthritis, scoliosis, or inflammatory conditions such as ankylosing spondylitis.

Less common causes include fractures from osteoporosis, infection, kidney problems, and, rarely, tumors.

Risk Factors

• Heavy lifting, repetitive bending, or poor lifting technique
• Prolonged sitting or a sedentary lifestyle
• Excess body weight
• Weak core and back muscles
• Older age
• Smoking, which is linked to back problems and slower healing

Diagnosis

Diagnosis starts with a history and physical examination, which are often enough to guide care.

• History: when and how the pain started, what makes it better or worse, and whether there are warning signs.
• Examination: checking movement, muscle strength, reflexes, and sensation to look for nerve involvement.
• Imaging: X-rays, CT, or MRI are used mainly for severe, persistent, or worsening pain, or when warning signs are present.
• Blood or other tests: occasionally needed if infection, inflammation, or another underlying condition is suspected.

Treatment

Treatment depends on the cause, but most back pain responds to conservative care.

• Stay active: gentle movement and a gradual return to normal activity speed recovery; avoid prolonged bed rest.
• Pain relief: acetaminophen or anti-inflammatory medicines (NSAIDs) as advised, sometimes with short-term muscle relaxants.
• Heat and cold: can ease muscle tightness and discomfort.
• Physical therapy: stretching and strengthening exercises, posture training, and education.
• Other measures: for nerve-related or persistent pain, injections or, rarely, surgery may be considered after specialist assessment.

Addressing contributing factors such as posture, weight, and activity helps both recovery and prevention.

Prevention

• Exercise regularly to keep back and core muscles strong
• Lift correctly: bend the knees, keep the load close, and avoid twisting
• Maintain good posture and take breaks from prolonged sitting
• Keep a healthy body weight
• Set up an ergonomic workspace and a supportive mattress
• Avoid smoking

When to See a Doctor

See a doctor if back pain is severe, lasts more than a few weeks, or keeps returning. Seek urgent or emergency care if you have:

• Loss of bladder or bowel control, or numbness around the groin or inner thighs
• New or worsening leg weakness, numbness, or trouble walking
• Back pain after a serious fall or accident
• Fever, chills, or unexplained weight loss with back pain
• Constant pain that is worse at night, especially with a history of cancer

These features can indicate nerve compression, infection, fracture, or another serious problem that needs prompt evaluation.

Related Topics

Frequently Asked Questions

References

1. National Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain.
2. Mayo Clinic. Back pain — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Back pain.
4. Centers for Disease Control and Prevention (CDC). Back pain.