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Back Problems and Injuries
Topic Overview
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. Things 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, and having a degenerative disease such as osteoporosis.
Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. “Good posture” generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.
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 ages 20 to 50, back problems in children younger than 20 and adults 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.
- 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.
- An injury that causes the 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 pain or problems may not be related to an injury.
- Conditions that weaken the spine, such as ankylosing spondylitis, 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).
Check your symptoms to decide if and when you should see a doctor.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Bladder or bowel trouble can include:
- Trouble emptying your bladder.
- Leaking urine.
- Blood in your urine.
- Not being able to have a bowel movement.
- Leaking stool.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Pain in children 3 years and older
- Severe pain (8 to 10): The pain is so bad that the child can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
- Moderate pain (5 to 7): The pain is bad enough to disrupt the child’s normal activities and sleep, but the child can tolerate it for hours or days.
- Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.
Major trauma is any event that can cause very serious injury, such as:
- A fall from more than 10 ft (3.1 m)[more than 5 ft (1.5 m) for children under 2 years and adults over 65].
- A car crash in which any vehicle involved was going more than 20 miles (32 km) per hour.
- Any event that causes severe bleeding that you cannot control.
- Any event forceful enough to badly break a large bone (like an arm bone or leg bone).
With severe bleeding, any of these may be true:
- Blood is pumping from the wound.
- The bleeding does not stop or slow down with pressure.
- Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may be true:
- The bleeding slows or stops with pressure but starts again if you remove the pressure.
- The blood may soak through a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be true:
- The bleeding stops on its own or with pressure.
- The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
Urinary tract infections may occur in the bladder or kidneys. Symptoms may include:
- Pain or burning when you urinate.
- A frequent need to urinate without being able to pass much urine.
- Pain in the flank, which is either side of the back just below the rib cage and above the waist.
- Blood in the urine.
- Fever.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.
Babies and young children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Being very sleepy or hard to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused. The child may not know where he or she is.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Sweating.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
The more of these symptoms you have, the more likely it is that you’re having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don’t have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
Do not move the person unless there is an immediate threat to the person’s life, such as a fire. If you have to move the person, keep the head and neck supported and in a straight line at all times. If the person has had a diving accident and is still in the water, float the person face up in the water.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.
Call 911 Now
Based on your answers, you need emergency care.
Call911or other emergency services now.
After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Home Treatment
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.
- There isn’t strong evidence that heat or ice helps. But you can try using them to see if they help you.
- Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours. Try a warm shower in place of one session. You can also buy single-use heat wraps that last up to 8 hours.
- You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours.
- Change position every 30 minutes. Gently massage or rub the area to help relieve pain and to encourage blood flow. Do not massage the injured area if it causes pain.
- 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.
More 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 C-shaped pillow with the open space under your tailbone 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 Smoking.
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Try a nonprescription medicine to help treat your fever or pain: |
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Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine. |
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Be sure to follow these safety tips when you use a nonprescription medicine: |
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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 helps prevent back pain from coming back.
- Take a yoga class or get a massage.
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
Call your doctor 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 does not improve or gets worse.
- Fever develops.
- Symptoms become more severe or frequent.
Prevention
There is no clear evidence that you can prevent back pain. But there are some things you can do that may help prevent it. And they can prepare you for faster recovery if you do have back pain.
- Exercise to keep your back healthy and strong.
- Learn how to lift objects safely to protect your back.
- Think about your posture, whether you are sitting or standing.
- Try different sleeping positions that protect your back.
- Wear low-heeled shoes.
- Stay at a healthy weight to avoid excess strain on your lower back. For more information, see the topic Weight Management.
- If you’re a smoker, quit.
- Eat a healthy diet.
- Manage stress.
- Make sure children and teenagers use school bags and backpacks correctly.
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.
Preparing For 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 belly 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?
- Do you have a fever?
- 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?
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
Medical Review:William H. Blahd, Jr., MD, FACEP – Emergency Medicine & Kathleen Romito, MD – Family Medicine & E. Gregory Thompson, MD – Internal Medicine & Adam Husney, MD – Family Medicine
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