• BACK PAIN

Back strain is a fairly broad category called “soft tissue injury,” which covers muscles, tendons and ligaments. About 80% of back and neck pain is muscle-related.

The stomach muscles, or abdominals, enable the back to bend forward. They also assist in lifting. The abdominals work with the buttock muscles to support the spine. The oblique muscles go around the side of the body to provide additional support to the spine.

Another type of strain relates to spinal ligaments that run in front and in back of the vertebral bodies. Tendons, which also connect muscles in the spine, can develop inflammation, or tendonitis.

CAUSES

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:

• Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back can cause painful muscle spasms.
• Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
• Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
• Osteoporosis. Your spine’s vertebrae can develop painful fractures if your bones become porous and brittle.

SYMPTOMS

Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking.

When to see a doctor

Most back pain gradually improves with home treatment and self-care, usually within a few weeks. Contact your doctor if your back pain:

• Persists past a few weeks
• Is severe and doesn’t improve with rest
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness or tingling in one or both legs
• Is accompanied by unexplained weight loss

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

• Causes new bowel or bladder problems
• Is accompanied by a fever
• Follows a fall, blow to your back or other injury

Risk factors

Anyone can develop back pain, even children and teens. These factors might put you at greater risk of developing back pain:

• Age. Back pain is more common as you get older, starting around age 30 or 40.
• Lack of exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
• Excess weight. Excess body weight puts extra stress on your back.
• Diseases. Some types of arthritis and cancer can contribute to back pain.
• Improper lifting. Using your back instead of your legs can lead to back pain.
• Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
• Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.

Prevention

You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics.

To keep your back healthy and strong:

• Exercise. Regular low-impact aerobic activities — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities you might try.
• Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
• Maintain a healthy weight. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain.
• Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

Avoid movements that twist or strain your back. Use your body properly:

• Stand smart. Don’t slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
• Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
• Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Diagnosis

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. Your doctor might also ask you to rate your pain on a scale of zero to 10 and talk to you about how well you’re functioning with your pain.

These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They can also help rule out more-serious causes of back pain.

If there is reason to suspect that a specific condition is causing your back pain, your doctor might order one or more tests:

• X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won’t show problems with your spinal cord, muscles, nerves or disks.
• MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
• Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
• Bone scan. In rare cases, your doctor might use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
• Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

TREATMENT

Surgery is never appropriate for muscle strain.

As with any muscle injury, it’s natural for an individual to stop moving the injured area and wait for it to heal. Ironically, this is counter-productive. Restricting movement causes the muscle to weaken, become less flexible and receive less circulation. In fact, gentle stretching and exercise is the best way to resolve the injury by getting it moving and increasing circulation.

RECOMMENDATIONS:

• Rest.
• Apply ice for 15-20 minutes (not directly on the skin) at a time for the first 48 hours, then switch to heat.
• Take anti-inflammatories.
• Try home remedy exercises. But remember, no exercise should be painful. Stop if they cause an increase in pain or symptoms.
• An appointment with a spine specialist is most appropriate for muscle-related back pain.
• Call us immediately if you experience any emergency, red-flag symptoms.