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Back and Neck Pain

Back Pain

Prevention - Home Treatment - When to Call a Health Professional

Your back includes the area from below your neck to your tailbone. It is composed of the bones of the spine (vertebrae); the joints that guide the direction of movement of the spine; the discs that separate the bones of the spine and absorb shock as you move; and the muscles and ligaments that hold them all together. One or more of these structures can be injured.

A spinal disc that bulges or ruptures can put pressure on a nerve, causing pain.

Overuse or a sudden or improper movement can result in strain or sprain of the spinal ligaments, the muscles in the back, or the sacroiliac joints (the joints between the spine and either side of the pelvis). You can damage your discs the same way so that they tear, stretch, or rupture.

First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.

    First Aid #1: Ice
  • As soon as possible, apply ice or a cold pack to your injured back (10 to 15 minutes every hour). Cold applied for the first 3 days limits swelling, reduces pain, and speeds healing.


    First Aid #2: Relax
  • Lie flat on your stomach with your arms beside your body and your head to one side. If this causes more pain, try to find a more comfortable position. Relax for 1 to 2 minutes.


    First Aid #3: Pelvic tilts
  • This exercise gently moves the spine and stretches the lower back.

  • Lie on your back with knees bent and feet flat on the floor.

  • Slowly tighten your stomach muscles and press your lower back against the floor. Hold for 10 seconds (do not hold your breath). Slowly relax.


    First Aid #4: Walk
  • Take a short walk (3 to 5 minutes) on a level surface (no slopes) every 3 hours. Walk only distances you can manage without pain, especially leg pain.

If the tear is large enough, the jelly-like material inside the disc may leak out and press against a nerve. The nerve may also become irritated due to swelling or inflammation in other parts of the back.

Any of these injuries can result in 2 or 3 days of acute pain and swelling in the injured tissue, followed by slow healing and a gradual reduction in pain. The pain may be felt in the low back, in the buttock, or down the leg (this type of pain is called sciatica). The goals of self-care are to relieve pain, promote healing, and avoid reinjury.

Back pain can also be caused by conditions that affect the bones and joints of the spine. Arthritis pain may be a steady ache, unlike the sharp, acute pain of strains, sprains, and disc injuries. If you think your back pain may be caused by arthritis, combine the self-care guidelines for back pain with those for arthritis on See Home Treatment.

Osteoporosis weakens the bones of the spine, which can lead to compression fractures. Compression fractures cause vertebrae to collapse. This can cause misalignment of the spine, which may put pressure on the discs and spinal nerves and lead to varying degrees of pain.

Sciatica

Sciatica is an irritation of the sciatic nerve, which runs from the lower back down through the buttocks to the feet. Sciatica can occur when an injured disc presses against the sciatic nerve. Its main symptom is radiating pain, numbness, or weakness that is usually worse in the leg than in the back. In addition to the Home Treatment for back pain on, the following may help:

  • Avoid sitting if possible, unless it is more comfortable than standing.

  • Alternate lying down with short walks. Increase your walking distance as you are able to do so without pain.

  • Apply ice or a cold pack to the middle of your lower back. See First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.

Prevention

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The keys to preventing back pain are to use good body mechanics and to practise good health habits, such as getting regular exercise, avoiding

tobacco, and maintaining a healthy body weight. Some of the tips presented in this chapter are things you will want to do every day, not only because they are good for your back, but because they are good for your overall health. The rest will come in handy if you are ever suffering from acute back pain.

Body Mechanics

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Good body mechanics will reduce the stress on your back. Use good body mechanics all the time, not just when you have back pain.

Sitting

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  • Avoid sitting in one position for more than 1 hour at a time. Get up or change positions often.

  • If you must sit a lot, the exercises on See Extension Exercises See Hip flexor stretch (shading shows where stretch is felt) are particularly important.

  • If your chair doesn't give enough support, use a small pillow or rolled towel to support your lower back.

  • When driving, pull your seat forward so that the pedals and steering wheel are within comfortable reach. Stop often to stretch and walk around. Consider placing a small pillow or towel roll behind your lower back.

Lifting

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  • Keep your upper back straight. Do not bend forward from the waist to lift.

  • Bend your knees and let your arms and legs do the work. Tighten your buttocks and abdomen to further support your back.

  • Keep the load as close to your body as possible, even if the load is light.

  • While holding a heavy object, turn your feet, not your back. Try not to turn or twist your body.

  • If possible, don't lift heavy objects above shoulder level.

  • Use a hand truck or ask someone to help you carry heavy or awkward objects.

    Avoid back strain when lifting heavy objects by keeping your upper back straight, bending your knees, and keeping the load close to your body.

Lying Down

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If you have back pain at night, your mattress may be the problem. Try sleeping on a firmer mattress. Or, if you think your mattress is too firm, try one that's a little softer. Try these additional tips for more comfortable sleep:

  • If you sleep on your back, you may want to place a rolled towel or a pillow under your knees.

  • If you sleep on your side, try placing a pillow between your knees.

  • Sleeping on your stomach is fine if it doesn't increase your back or neck pain.

    Try placing pillows between or under your knees to relieve back pain while lying in bed.

Exercise

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Regular exercise (stretching, strengthening, and aerobic exercise) helps you maintain your overall fitness and flexibility and strengthens the muscles that support your spine. Exercising also helps you maintain a healthy body weight, which reduces the load on your lower back. If you are interested in creating a personalized fitness plan, see Fitness.

Although there is no clear evidence that specific exercises can help prevent back pain, the exercises presented here are a common, practical approach to helping you maintain strength and flexibility. You may choose to make the exercises a part of your regular fitness routine. If you never do them until you experience back pain, they will help you feel that you are doing something positive to take charge of your body.

Do not do these exercises if you have just injured your back. Instead, see "First Aid for Back Pain" on See First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.

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

Extension Exercises

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Press-Ups

Begin and end every set of exercises with a few press-ups.

Backward Bend

Practise the backward bend at least once a day and whenever you work in a bent-forward position.

Flexion Exercises

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Curl-Ups

Curl-ups strengthen your abdominal muscles, which work with your back muscles to support your spine.

Knee-to-Chest Stretch

The knee-to-chest exercise stretches the lower back and hamstring muscles (in the back of the thigh) and relieves pressure on the joints where the vertebrae come together.

Additional Strengthening and Stretching Exercises

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Prone Buttocks Squeeze

This exercise strengthens the buttocks muscles, which support the back and help you lift with your legs. You may need to place a small pillow under your stomach for comfort.

  • Lie flat on your stomach with your arms at your sides.

  • Slowly tighten your buttocks muscles and hold for 5 to 10 seconds (don't hold your breath). Relax slowly.


Pelvic Tilts

See instructions on See First Aid for Back Pain When you first feel a catch or strain in your back, try these steps to avoid or reduce pain. These are the most important Home Treatments for the first few days of back pain.


Hamstring Stretch

This exercise stretches the muscles in the back of your thigh, which will allow you to bend your legs without putting stress on your back.

  • Lie on your back in a doorway with one leg through the doorway on the floor. Put the leg you want to stretch straight up with the heel resting on the wall next to the doorway.

  • Keep the leg straight and slowly move your heel up the wall until you feel a gentle pull in the back of your thigh. Do not overstretch.

  • Relax in this position for 30 seconds; then bend the knee to relieve the stretch. Repeat with the other leg.

    Hamstring stretch (shading shows where stretch is felt)


Hip Flexor Stretch

This exercise stretches the muscles in the front of your hip.

  • Kneel on one knee with your other leg bent in front of you.

  • Slowly sink your hips so your weight shifts onto your front foot. The knee of your forward leg should be aligned over the ankle. Hold for 10 seconds. You should feel a stretch in the groin of the leg you are kneeling on. Repeat with the other leg.

    Hip flexor stretch (shading shows where stretch is felt)

Exercises to Avoid

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Many common exercises actually increase the risk of low back pain. Avoid the following:

Home Treatment

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Immediately after an injury and for the next few days, the most important Home Treatment includes the following:

For bed rest, try one of the following positions (see illustrations on Try placing pillows between or under your knees to relieve back pain while lying in bed.):

After 2 to 3 days of Home Treatment:

When to Call a Health Professional

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  • If you lose bowel or bladder control.

  • If you cannot walk or stand.

  • If you have new numbness in the genital or rectal area.

  • If you have leg weakness that is not solely due to pain. Many people with low back pain say their legs feel weak. However, if leg weakness is so severe that you are unable to bend your foot upward, get up out of a chair, or climb stairs, you should see a doctor.

  • If you have new or increased back pain with unexplained fever, painful urination, or other signs of a urinary tract infection. See Urinary Tract Infections.

  • If you have a dramatic increase in your chronic back pain, especially if it is unrelated to a new or changed physical activity.

  • If you have a history of cancer or HIV infection and you develop new or increased back pain.

  • If you have new back pain that does not improve after a few days of Home Treatment, contact your doctor for advice.

  • If you develop a new, severe pain in your lower back that does not change with movement and is not related to stress or muscle tension.

  • If back pain does not improve after 2 weeks of Home Treatment.

    Back Surgery

    Doctors recommend back surgery much less often now than in the past. Rest, pain relievers, and exercise can relieve almost all back problems, even disc problems.

    Surgical procedures are appropriate for certain conditions that do not improve with time, exercise, and pain medication. Getting all the facts and thinking about your own needs and values will help you make a wise decision about treatment. If you do plan to have surgery, the body mechanics guidelines and exercises in this chapter are still important. A strong, flexible back will help you recover more quickly after surgery.

Your Family Doctor

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In addition to diagnosing the cause of back pain and evaluating back injuries, a doctor may also:

  • Help you develop an individualized exercise and home care plan or modified work plan if needed.

  • Prescribe muscle relaxants, anti-inflammatory drugs, and pain relievers. Note: If you do get a strong painkiller or muscle relaxer, it is especially important to avoid postures and activities that could cause you to reinjure your back.

  • Suggest physical therapy.

  • Recommend back surgery.

Physical Therapists

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After the initial first aid treatments, a physical therapist with training in orthopaedic treatment can:

Other Health Professionals

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Chiropractors and osteopaths can provide relief from some types of back pain through spinal manipulation. Spinal manipulation usually works best if you have had symptoms for fewer than 4 weeks. If your symptoms don't improve after 1 month of spinal manipulation treatment, stop the treatment and have your pain reevaluated.

Acupuncturists, massage therapists, and others can also provide treatments that may give short-term relief. For more information, See Complementary Medicine.

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