Back Problems and Injuries
                                                                        
                                                                        
                                                                        
                                                                        
                                                                        
		
			
				
				
				
				
				
				Back Problems and InjuriesSkip to the navigationTopic OverviewMost 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) injuriesPain 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 injuriesYou 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 problemsBack 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.
 
 TreatmentMost 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. Check Your SymptomsDo you have a back injury or other back problem? Yes Back problem or injury How old are you? Less than 5 years Less than 5 years 5 to 11 years 5 to 11 years 12 to 55 years 12 to 55 years 56 years or older 56 years or older Have you had back surgery in the past month? Yes Back surgery in the past month No Back surgery in the past month Are you pregnant? Yes, you know that you're pregnant. Pregnancy No, you're not pregnant, or you're not sure if you're pregnant. Pregnancy Urinary tract infections can sometimes cause back pain. Yes Possible urinary tract infection No Possible urinary tract infection Have you had a  major trauma in the past 2 to 3 hours? Yes Major trauma in past 2 to 3 hours No Major trauma in past 2 to 3 hours Do you have symptoms of shock? Have you had any kind of a back injury in the past month? Yes Back injury in the past month No Back injury in the past month Are you having trouble moving your back, legs, or feet normally? Yes Difficulty moving back, legs, or feet No Difficulty moving back, legs, or feet Is there any part of your legs or feet that you cannot move? Yes Unable to move legs or feet No Unable to move legs or feet Have you had trouble moving for more than 2 days? Yes Difficulty moving for more than 2 days No Difficulty moving for more than 2 days Do you have numbness, tingling, or weakness in your leg that has lasted more than an hour? Weakness is being unable to use the leg normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness. Yes Numbness, tingling, or weakness for more than 1 hour No Numbness, tingling, or weakness for more than 1 hour Did the numbness and weakness start right after the injury? Yes Numbness and weakness began immediately after injury No Numbness and weakness began immediately after injury Have you had any  bladder or bowel trouble after the injury?  Yes Difficulty with bladder or bowels No Difficulty with bladder or bowels Are you having new trouble with urinating or having a bowel movement? Yes New difficulty urinating or having bowel movement No New difficulty urinating or having bowel movement Is there any blood in your urine? Are you able to urinate at all? Have you noticed any weakness or severe numbness or tingling in your legs or feet? Weakness is being unable to use the leg or foot normally no matter how hard you try. Pain may make it hard to move, but that's not the same as weakness. Yes Weakness, numbness, or tingling in legs or feet No Weakness, numbness, or tingling in legs or feet Are you unable to walk or move your legs? Yes Unable to walk or move legs No Unable to walk or move legs Are you having trouble moving your back? Yes Difficulty moving back Is it very hard to move or somewhat hard to move? "Very hard" means you can't move it at all in any direction without causing severe pain. "Somewhat hard" means you can move it at least a little, though you may have some pain when you do it. Very hard Very hard to move Somewhat hard Somewhat hard to move How long have you had trouble moving your back? Less than 2 days Difficulty moving back for less than 2 days 2 days to 2 weeks Difficulty moving back for 2 days to 2 weeks More than 2 weeks Difficulty moving back for more than 2 weeks Has the loss of movement been: Getting worse? Difficulty moving is getting worse Staying about the same (not better or worse)? Difficulty moving is unchanged Getting better? Difficulty moving is improving Have you recently started having problems with bladder or bowel control? How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 5 to 10: Moderate to severe pain Moderate to severe pain 1 to 4: Mild pain Mild pain Has the pain: Gotten worse? Pain is increasing Stayed about the same (not better or worse)? Pain is unchanged Gotten better? Pain is improving Do you have any pain in your back? How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?  8 to 10: Severe pain Severe pain 5 to 7: Moderate pain Moderate pain 1 to 4: Mild pain Mild pain How long has the pain lasted? Less than 2 full days (48 hours) Pain less than 2 days 2 days to 2 weeks Pain 2 days to 2 weeks More than 2 weeks Pain more than 2 weeks Has the pain: Gotten worse? Pain is getting worse Stayed about the same (not better or worse)? Pain is unchanged Gotten better? Pain is getting better Do you think that the back problem may have been caused by abuse? Yes Back problem may have been caused by abuse No Back problem may have been caused by abuse Do you think the problem may be causing a fever?  Some bone and joint problems can cause a fever. Do you have a new rash in the shape of a band or a strip on just one side of the body? Yes New band-shaped rash on one side No New band-shaped rash on one side How long have you had back symptoms? Most back problems will start to get better within a week. Home treatment can help.  Less than 1 week Symptoms for less than one 1 week 1 to 2 weeks Symptoms for 1 to 2 weeks More than 2 weeks Symptoms for more than 2 weeks 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 TreatmentYou 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.  Symptoms of shock (most of which will be present) 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.  Symptoms of shock in a child may 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 TodayBased 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 NowBased 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  NowBased 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  NowBased 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  NowBased 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. Urinary Problems and Injuries, Age 11 and Younger Postoperative Problems Urinary Problems and Injuries, Age 12 and Older Pregnancy-Related Problems Home TreatmentHome 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.
 
 Exercises to reduce pain 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. Medicine you can buy without a prescription|  Try a nonprescription
			 medicine to help treat your fever or pain: | 
|---|
 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.  |   Safety tips|  Be sure to follow these
				safety tips when you use a nonprescription medicine: | 
|---|
 - Carefully read and follow all directions
					 on the medicine bottle and box.
 - Do not take more than the
					 recommended dose.
 - Do not take a medicine if you have had an
					 allergic reaction to it in the past.
 - If
					 you have been told to avoid a medicine, call your doctor before you take
					 it.
 - If you are or could be pregnant, do not take any medicine other
					 than acetaminophen unless your doctor has told you to.
 - Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
 
  |   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 treatmentCall  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.
 
 PreventionThere 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. Exercises to avoidSome 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 designMost 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 AppointmentTo prepare for your appointment, see the topic Making the Most of 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?
 
 CreditsByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine Kathleen Romito, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Current as ofMarch 20, 2017 Current as of:
                March 20, 2017  Last modified on: 8 September 2017  
				
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