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This topic provides a general overview of low back pain. If you have been diagnosed with a herniated disc or spinal stenosis, see the topic Herniated Disc or Lumbar Spinal Stenosis.

What is low back pain?

Low back pain can happen anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body's weight. It is possible to hurt your back when you lift, reach, or twist. In fact, almost everyone has low back pain at one time or another.

What causes low back pain?

Causes of low back pain include:

• Overuse, strain, or injury.
• Aging.
• Herniated disc.
• Arthritis.
• Compression fractures.
• Illness.
• A spine problem you were born with.

Often doctors don't really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.

What are the symptoms?

Depending on the cause, low back pain can cause a range of symptoms. The pain may be dull or sharp. It may be in one small area or over a broad area. You may have muscle spasms.

Low back pain can also cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee.

A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs or you lose bladder or bowel control.

Most low back pain is short-term (acute) and will go away in a few weeks. It is more likely to become long-lasting (chronic) if you are depressed or under stress.

How is low back pain diagnosed?

The doctor will ask questions about your past health, symptoms, and activities. He or she will also do a physical exam. Your answers and the exam can help the doctor rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first exam.

X-rays, CT scans, and MRIs don't usually help.

But if you have a back pain problem that has lasted longer than 6 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for one of these tests.

How is it treated?

Most low back pain will improve with basic first aid, which includes continuing to do light activity such as walking, and taking over-the-counter pain medicine as needed.

Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.

A doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. Strengthening the muscles in your trunk can improve your posture, keep your body in better balance, and lower your chance of injury.

Certain other treatments work for some people but not for others. You may need to try different things to see which work best for you, such as:

• Massage.
• Spinal manipulation.
• Acupuncture.

If your symptoms are severe or you still have them after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from physical therapy.

Having ongoing (chronic) back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both counseling and medicine. Special counseling can help you learn stress management and pain control skills. Antidepressant medicines may help too.

How can you prevent low back pain from returning?

After you've had low back pain, you're likely to have it again. But there are some things you can do to help prevent it. And they can help you get better faster if you do have low back pain again.

To help keep your back healthy and avoid further pain:

• Practice good posture when you sit, stand, and walk. "Good posture" generally means your ears, shoulders, and hips are in a straight line.
• Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
• Wear low-heeled shoes that have good support.
• Sleep on your side. A medium-firm mattress may put the least stress on your back.
• Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
• Don't try to lift things that are too heavy for you. When you must lift, learn the right way to lift.

If you sit or stand for long periods at work:

• Pay attention to your posture. Sit or stand up straight, with your shoulders back.
• Make sure your chair fits you and has good back support.
• Take regular breaks to walk around.

If your work involves a lot of bending, reaching, or lifting:

• Talk to your human resources department to see if there are other ways you can do your work.
• Don't depend on a "back belt" to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting.

Frequently Asked Questions

Cause

The most common causes of low back pain are:

• Injury or overuse. This can include sprains or strains of soft tissues such as ligaments and muscles, fractures or compression fractures of bones, or injuries to the small joints between the bones of the spine.
• Pressure on nerve roots from conditions such as a herniated disc or spinal stenosis.
• Osteoarthritis, usually caused by getting older. When osteoarthritis affects the small joints in the spine, it can lead to back pain by making the joints themselves stiff and sore and also by creating pressure on the nerve roots. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.

Less common spinal conditions that can cause low back pain include:

• Ankylosing spondylitis, which is a form of arthritis that most often affects the spine.
• Bacterial infection. Bacteria are usually carried to the spine through the bloodstream. You may have back pain from an infection in the bone, in the spinal discs, or in the spinal cord. An infection may enter the spine from:
  • An infection somewhere else in the body.
  • Intravenous (IV) drug use.
  • Surgery or injection treatments.
  • An injury.
• Spinal tumors, which are growths on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.

Symptoms

Symptoms of low back pain depend on the cause.

Back sprain or strain

Symptoms typically include:

• Muscle spasms, cramping, and stiffness.
• Pain in the back and sometimes in the buttock. It may come on quickly or gradually. It most often occurs in episodes. Certain movements make it worse, and doing light activities such as walking makes it feel better. The worst pain usually lasts 48 to 72 hours and may be followed by days or weeks of less severe pain.

Nerve-root pressure

Symptoms typically include:

• Leg pain. If pain extends below the knee, it is more likely to be due to pressure on a nerve than to a muscle problem. Most commonly, it's a pain that starts in the buttock and travels down the back of the leg as far as the ankle or foot. This pain pattern is known as sciatica (say "sy-AT-ih-kuh"). For more information, see the topic Sciatica.
• Nerve-related problems, such as tingling, numbness, or weakness in one leg or in the foot, lower leg, or both legs. Tingling may begin in the buttock and extend to the ankle or foot. Weakness or numbness in both legs, or loss of bladder and/or bowel control, are symptoms of cauda equina syndrome, which requires immediate medical attention.

Arthritis of the spine

Arthritis of the spine usually causes pain that:

• Is worse in the back and hip region.
• Starts gradually, gets worse over time, and lasts longer than 3 to 6 months.
• Is generally worse in the morning or after prolonged periods of inactivity. Arthritis pain gets better when you move around.

Other conditions

Symptoms of diseases that affect the spine depend upon the disease. They may include:

• Pain that is worse in the affected part of the spine (for instance, if there is a compression fracture, tumor, or infection).
• Pain that starts gradually, is constant, and may be sharp or a dull ache. Bed rest doesn't help and may make it worse (tumors on the spine often cause night pain). The pain lasts longer than 2 to 3 weeks.
• Fever.
• Sensitivity of the spine to touch and pressure.
• Pain that wakes you up from sleep.

What Happens

The course of low back pain depends both on its cause and on how well you treat your back.

• Most low back pain goes away within several weeks.
• After you have had back pain once, you're more likely to have it again. Many people who recover have back pain again within a year. Most people will have it again sometime during their lives.
• Long-lasting (chronic) pain not only makes you tired, irritable, and less productive and less active but also can trigger other problems. If your back pain causes you to use your body in different ways (for example to limp or to sit differently), pain can develop in other areas of the body. Pain can also cause biochemical changes in your body that tend to keep the pain going. Without special treatment, you may get chronic pain syndrome.

What Increases Your Risk

A risk factor is something that increases your chances of having back pain. Having more risk factors means you have a higher chance of having back pain.

Risk factors that you can't change

These include:

• Being middle-aged or older.
• Being male.
• Having a family history of back pain.
• Having had a back injury before.
• Being pregnant. A woman's back is significantly stressed by carrying a baby.
• Having had compression fractures of the spine.
• Having had back surgery before.
• Having spine problems since birth.

Risk factors you can change with lifestyle changes

These include:

• Not getting regular exercise.
• Doing a job or other activity that requires long periods of sitting, heavy lifting, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment.
• Smoking. People who smoke are more likely than people who don't smoke to have low back pain.
• Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proved. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility. These can lead to low back pain.
• Having poor posture. Slumping or slouching on its own 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.
• Being under stress. Stress and other emotional factors are believed to play a major role in low back pain, particularly chronic low back pain. Many people unconsciously tighten their back muscles when they are under stress.

Risk factors you might change with medical treatment

These include:

• Having long periods of depression.
• Using medicines long-term that weaken bones, such as corticosteroids.
• Having an illness or disease that causes chronic coughing.

When to Call a Doctor

Call 911 or other emergency services immediately if:

• Back pain occurs with chest pain or other symptoms of a heart attack.
• A person has signs of damage to the spine after an injury (such as a car accident, fall, or direct blow to the spine). Signs may include:
  • Being unable to move part of the body.
  • Severe back or neck pain.
  • Weakness, tingling, or numbness in the arms or legs.

Call your doctor now or seek immediate medical care if:

• You have new numbness in your legs or numbness in your legs that is getting worse.
• You have new weakness in your legs or weakness in your legs that is getting worse. (This could make it hard to stand up.)
• You lose control of your bladder or bowels.
• You have new or increased back pain with fever, painful urination, or other signs of a urinary tract infection.
• You have long-term back pain that suddenly gets much worse, and you did not cause it by being more active.
• You have a history of cancer or HIV infection, and you have new or increased back pain.
• Pain wakes you from sleep.

For more information, see the topic Back Problems and Injuries.

Watchful waiting

Most low back pain does not require a visit to a doctor.

If the pain doesn't get better after 1 or 2 days and you can't do your normal daily activities, call your doctor.

If you still have mild to moderate pain after at least 2 weeks of home treatment, talk with your doctor. He or she may want to check for problems that may be causing your back pain.

Who to see

The following health professionals can diagnose the cause of back pain, evaluate back injuries, and start treatment:

• Primary care providers:
  • Family medicine doctor
  • Internist
  • Nurse practitioner
  • Physician assistant
• Orthopedic surgeon
• Osteopathic doctor
• Emergency medicine specialist
• Chiropractor

You may also be referred to one of the following specialists:

• Physical therapist
• Physiatrist
• Neurosurgeon
• Rheumatologist
• Pain management specialist if low back pain has lasted for more than 3 months
• Cognitive-behavioral therapist

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor will begin by asking questions about your medical history, your symptoms, and your work and physical activities. He or she will also do a physical exam. The questions and exam can help him or her rule out a serious cause for your pain. Your doctor may also ask questions about stress at home and at work that may make you more susceptible to chronic pain.

If your back pain has lasted for less than 6 weeks, your doctor may hold off on testing. This is because most back pain goes away on its own in a month or so.

But if you have a back pain problem that has lasted longer than 6 weeks, or if your doctor thinks you may have more than muscle pain, it might be time for a test.

Which tests are used?

Tests for low back pain include:

• X-rays.
• MRIs.
• CT scans.

Sometimes other tests can be useful, such as a bone scan or electromyogram and nerve conduction. These are used to look for bone, nerve, and muscle/nerve problems that might be causing low back pain.

If you're still thinking about testing, here's some information that may help you make a decision:

Low Back Pain: Should I Have an MRI?

Treatment Overview

Doctors divide low back pain into two categories:

• Acute: This is pain that has lasted less than 3 months. Most people get better with home treatment.
• Chronic: This is pain that has lasted longer than 3 months. People with chronic back pain are usually helped with more intensive treatment.

After you have had low back pain once, the pain is likely to come back. To avoid further problems, keep your back and stomach muscles strong, use good posture, learn the safest way to lift heavy objects, and learn to manage stress.

Treatment for acute low back pain

Learn about the first aid steps you can take when you first get back pain, such as using heat or ice, taking medicine, and not resting too much.

Sometimes acute low back pain lasts longer than a few days, even after you try these treatments. Then your doctor may suggest other treatments, such as physical therapy or stronger pain medicine.

If your pain is very bad, your doctor may recommend short-term use of an opiate painkiller or a muscle relaxant. Some people consider epidural steroid shots.

Answers From an Expert: "Stay as active as you can. Doctors used to say to rest, but it turns out that this is not the case. The more active you are, the better you will be, and the faster you will heal."—Dr. Robert Keller Read more advice from this back specialist.

One Woman's Story: "I thought, 'Okay, it will hurt for a day or two, and that's it.' But it lasted a lot longer. It took about 3 weeks. I guess we're used to fast cures. We take an aspirin, and the headache goes away. We take the antibiotic, and the infection disappears." —Lorna Read more about how Lorna learned to be patient with her back.

Treatment for chronic low back pain

If you have chronic back pain, you know that one type of treatment by itself doesn't always stop your pain.

Think of your treatment plan as a recipe. You and your doctor may need to add or take out ingredients to make it work.

Here are some choices to think about:

• Acupuncture is a treatment based on traditional Chinese medicine. Very thin needles are inserted into the skin at certain points on the body to produce energy flow.
• Biofeedback is a way to train your mind to control a body function that is normally not under your control.
• Cognitive-behavioral therapy can teach you stress management and pain control skills.
• Spinal manipulation and chiropractic are treatments that affect the muscles and bones.
• Massage involves rubbing the soft tissues of the body, such as the muscles, to help reduce tension and pain, improve blood flow, and help you relax.
• Comprehensive rehabilitation programs offer a variety of treatments and specialists. They are considered one of the best ways to treat chronic low back pain, and they may be your best bet for finding the right combination of treatments.¹

Prevention

There is no clear evidence that you can prevent low 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 low back pain.

• Exercise to keep your back healthy and strong. Exercise programs that include aerobic conditioning and strengthening exercises can help keep low back pain from coming back.

  Fitness: Increasing Core Stability

  Low Back Pain: Exercises to Reduce Pain

• Learn how to lift objects safely to protect your back.

  Back Problems: Proper Lifting

• Think about your posture, whether you are sitting or standing. 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.
• Try different sleeping positions that protect your back. If you sleep on your side, try putting a pillow between your knees. If you sleep on your back, use a pillow under your knees. You can also try rolling up a small towel and using it to support your lower 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. Smoking increases your risk of bone loss (osteoporosis) and increases your sensitivity to pain. Smoking also interferes with blood circulation by tightening the arteries, which makes it harder for blood to flow, and by decreasing the amount of oxygen the red blood cells can carry. Spinal discs don't have their own blood supply, but they receive nutrition in part from the blood supply to the vertebral bones above and below them. Decreased circulation may increase the speed of degeneration and/or slow the healing of the discs. For more information on how to quit, see the topic Quitting Smoking.
• Eat a healthy diet. Getting plenty of calcium and vitamin D may help prevent osteoporosis, which can lead to compression fractures and low back pain.
• Manage the stress in your life, both at home and at work.

Living With Low Back Pain

Almost everyone has low back pain at some time. The good news is that most low back pain will go away in a few days or weeks with some basic self-care.

Some people are afraid that doing too much may make their pain worse. In the past, people stayed in bed, thinking this would help their backs. Now doctors think that, in most cases, getting back to your normal activities is good for your back, as long as you avoid things that make your pain worse.

One Man's Story: "Some people get better fast, but others take a lot of time. That was my case. If you have back pain, do what you can for it, but don't be in a hurry. It usually gets better."—Jack Read more about how Jack learned that he didn't need surgery.

Ease back into your daily activities

• For the first day or two of pain, take it easy. But as soon as possible, get back to your normal daily life and activities.
• Movement helps your muscles stay strong. Staying in bed for more than 1 or 2 days can make your problem worse.
• If you are an athlete, return to your activity carefully. Choose a low-impact option until your pain is under control.
  • First Aid for Low Back Pain
  • Getting Help Around the House
  • Get Chores Done Without Making Your Pain Worse
  • Low Back Pain and Sex
  • Back To Work?

Avoid or change activities that cause pain

• Try to avoid bending, lifting, or reaching. These movements put extra stress on your back.
• In bed, try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees.
• When you sit, place a small pillow, a rolled-up towel, or a lumbar roll in the curve of your back for extra support.
• When you brush your teeth, put one foot on a stool.
• Do not bend over when you put on pants or stockings. Instead, stand with your back against a wall. Then slide your shoulders down the wall, and bring your knee up. Gently step into your pants or stockings, one leg at a time.
  • Self-Massage
  • Use Heat or Ice to Relieve Low Back Pain
  • Protect Your Back as You Lie Down
  • Protecting Your Back While Sitting
  • Moving From Sitting to Standing
  • Sleeping With Back Pain
  • Posture: Standing and Walking

Pay attention to your body mechanics and posture

Body mechanics are the way you use your body. Posture is the way you sit or stand.

• To prevent a return of low back pain, you will need to take extra care when you lift. When you must lift, bend your knees and flex from your hips. Don't let your spine slump.
• Stand or sit tall without slumping or arching your back too much. Slouching and slumping increase stress on your back.

Stretch and strengthen your back

When you no longer have acute pain, you may be ready for gentle strengthening exercises for your stomach, back, and legs, and perhaps for some stretching exercises. Exercise may not only help decrease low back pain but also may help you recover faster, prevent reinjury to your back, and reduce the risk of disability from back pain.

Walking is the simplest and perhaps the best exercise for the low back. Your doctor or a physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and decrease your chance of injury.

Fitness: Increasing Core Stability

Low Back Pain: Exercises to Reduce Pain

One Man's Story: "I discovered that what you have to do is this: You do as much as you can."—Robert Read more about how Robert controls his back pain by staying active.

Take care of stress

Stress and low back pain can create a vicious circle. You have back pain, and you begin to worry about it. This causes stress, and your back muscles begin to tense. Tense muscles make your back pain worse, and you worry more ... which makes your back worse ... and so on.

There are lots of ways to teach yourself to relax.

Stress Management: Practicing Yoga to Relax

Stress Management: Doing Guided Imagery to Relax

Stress Management: Breathing Exercises for Relaxation

Stress Management: Doing Progressive Muscle Relaxation

Stress Management: Relaxing Your Mind and Body

Stress Management: Managing Your Time

Stress Management: Doing Meditation

One Woman's Story: "I had too much to do and too little time. That means stress. And when I start stressing, my back starts aching. Before I knew it, my back was screaming at me."—Cathy Read more about how Cathy made time to deal with her stress.

Manage your weight

Extra body weight, especially around the waist, may put strain on your back.

If you want to get to a healthy weight and stay there, lifestyle changes will work better than dieting.

Here are the three steps to reaching a healthy weight:

• Improve your eating habits. Do it slowly. You may be tempted to do a diet overhaul and change everything about the way you eat. But you will be more successful at staying with the changes you make if you pick just one eating habit at a time to work on.

  Healthy Eating: Starting a Plan for Change

• Get moving. Try to make physical activity a regular part of your day, just like brushing your teeth. Start small, and build up over time. Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before you start an exercise program.
• Change your thinking. Our thoughts have a lot to do with how we feel and what we do. If you can stop your brain from telling you discouraging things and have it start encouraging you instead, you may be surprised at how much healthier you'll be—in mind and body.

  Weight Management: Using Positive Thinking

Quit smoking

People who smoke take longer to heal—from any injury, not just back pain. If you stop smoking, you may feel better sooner.

People who smoke are also much more likely to have back pain than people who don't smoke. This is because the nicotine and other toxins from smoking can keep spinal discs from getting all the nutrients they need from the blood, making disc injury more likely. These discs cushion the bones in your spine. An injured disc can cause low back pain.

Interactive Tool: Are You Ready to Quit Smoking?

Quitting Smoking: Getting Support

Medications

Medicine can decrease low back pain and reduce muscle spasms in some people. But medicine alone is not an effective treatment for low back pain. It should be used along with other treatments, such as exercise and physical therapy.

Medication choices

There are several medicines your doctor may recommend, depending on how long you have had pain, what other symptoms you have, and your medical history.

The medicines recommended most often are:

• Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. You can buy these medicines without a prescription. Some of them also come in stronger doses. For those, you'll need a prescription.
• Muscle relaxants. These medicines can help when you get bad muscle spasms along with low back pain. Side effects, such as drowsiness, are common.
• Opiate pain relievers . These are very strong medicines that are sometimes tried to ease sudden, severe back pain that has not been controlled by other medicines. They are usually taken for only 1 to 2 weeks.
• Antidepressants. Some of these medicines, such as amitriptyline and duloxetine, not only treat depression but also may help with chronic pain.

Other medicines sometimes used for low back pain are:

• Anesthetic or steroid injections. These have been prescribed for chronic low back pain, but they have not been researched enough to know if they work well for back pain. They may give short-term relief from leg pain related to a back problem.
• Anticonvulsants. These are sometimes used to treat low back pain, even though there isn't strong evidence that they help.
• Botox injection. This is a shot into the back muscles. It has not been well tested for chronic low back pain.

Medicines that work for some people don't work for others. Let your doctor know if the medicine you are taking doesn't work for you. You may be able to take another medicine for your back pain.

Surgery

When you're in a lot of pain, you might wonder if you need surgery to fix what's wrong so that you can feel better.

Every case is different. But most people don't need surgery for low back pain.

Most back surgeries are done to treat nerve pain from herniated discs.

• Most herniated discs heal—and pain eases—after a few weeks or months of treatment.
• About half of people with herniated discs get better within a month without surgery.
• After 6 months, most people with herniated discs have recovered. Only about 10 out of 100 end up having surgery.²

When surgery may help

Surgery might be an option when a disc problem causes pain in your leg that prevents you from doing everyday tasks. You may have pain, numbness, or tingling through your buttock and down the back of your leg (sciatica) or in the front of your thigh. Other problems that may require surgery include:

• A spinal fracture caused by an injury.
• An infection in your spine.
• A problem that causes your spine to be unstable.
• A tumor in your spine.
• Spinal stenosis.
• Loss of feeling or weakness in your back or legs that gets worse over time.
• Loss of control of your bowel or bladder.

Having surgery for a herniated disc or another back problem is a big decision. Talk to your doctor about it.

Rehabilitation after surgery

A comprehensive rehabilitation program is very important after most back surgery. As you regain flexibility, recondition your back and stomach muscles, and increase your endurance for activity, you increase your chances of treatment success.

If you are unable or unwilling to commit to physical therapy after surgery, you may not be a good candidate for surgery.

Surgery choices

There are several types of back surgery. Some, like a discectomy, can help people who have severe symptoms. Others have not been proved to work.

If you do need surgery, you and your doctor will decide which type is best for you. Types of surgeries include:

• Discectomy.
• Percutaneous discectomy.
• Laminectomy for spinal stenosis.
• Kyphoplasty and vertebroplasty.
• Surgeries for tumors and infection.
• Spinal fusion.

What to think about

Back surgery is not always successful. Depending on the condition, you may still have back pain after surgery.

If you and your doctor are considering surgery, get as much information as you can about possible results, and consider whether you will be willing to do physical therapy after surgery. It is also a good idea to get a second opinion before you decide to have surgery.

Interactive Tool: Should I Consider Surgery for My Low Back Problem?

Herniated Disc: Should I Have Surgery?

Other Treatment

You can choose from a number of alternative treatments for your low back pain. Because many of these treatments are new or not yet well researched, they may not be covered by health insurance.

The following complementary treatments are often used for low back pain.

• Massage may reduce low back pain. It is probably most effective if you also learn to do exercises for your back and learn the best ways to lift and move to protect your back.³
• Spinal manipulation is likely to help chronic low back pain, but probably no more than other treatments such as physical therapy, exercise, or pain medicine.⁴ It is not clear whether it helps acute low back pain or not.⁵ Even though they differ in their training, osteopaths, chiropractors, physiatrists, and specially trained physical therapists can all do spinal manipulation. Learn more about chiropractic and spinal manipulation.

  Low Back Pain: Should I Have Spinal Manipulation?

• Biofeedback has not been well studied as a treatment for low back pain. But recent research has not shown that biofeedback is effective for controlling low back pain.
• Acupuncture may help reduce pain and increase the ability to be active for a short time after treatment but not any more than other treatments.⁶
• Acupressure uses pressure on certain points in the body to decrease symptoms. Small studies suggest that acupressure reduces pain and allows a person to be more active.⁷
• Relaxation techniques can help reduce muscle tension, stress, and depression.
• Yoga is another way to stay active and to also get help with relaxation and managing stress. Small studies suggest that yoga classes may help people with chronic low back pain control their symptoms and stay more active.^{8, 9} It is not clear whether yoga is more helpful than other activity or treatment for chronic low back pain. There are different types of yoga. Talk to your doctor or physical therapist before you start a yoga program.

Here are some other treatment choices to think about:

• Learning about your back:
  • Back school teaches you all about back care, how to stand and sit, and how to move your body in a safer way. It also teaches you how to prevent long-term back problems.
  • A pain management clinic is a place where you can learn how to cope with chronic pain. You also can get treatment there.
• Electric currents:
  • Transcutaneous electrical nerve stimulation (TENS) gives brief pulses of electricity to nerve endings in the skin to relieve pain. Although TENS may help some people, there is no evidence that it works.
  • Spinal cord stimulation uses an electrical current to treat chronic pain. A doctor puts an electrical generator under the skin. This device sends pulses through electrodes placed in the spinal canal. There is not strong evidence that it works.¹⁰
• Other procedures:
  • Intradiscal electrothermal therapy (IDET) gets rid of nerve fibers that have grown from the outer layers of the disc to the inside of the disc. There is no consistent evidence that this treatment works, and most experts do not recommend it.¹
  • Nerve blocks may numb certain nerves.

Experimental treatments

New and experimental treatments are constantly being developed and offered to people who have low back pain. If you are considering such a treatment, be sure to ask your doctor for two things:

1. The scientific evidence that shows that the treatment works and is safe.
2. The results that your doctor has seen in his or her own practice.

Experimental treatments include:

• Surgery to replace a ruptured or herniated disc with an artificial disc. This treatment has been approved by the U.S. Food and Drug Administration (FDA). Long-term studies have not been done.
• Botulinum toxin (Botox) injection. This may relax painful muscle spasms in the low back.
• Radiofrequency ablation of nerves. This may reduce chronic low back pain in some people by preventing pain signals from reaching the brain. It is sometimes used for pain from problems with the small joints in the spine called facet joints.
• An intrathecal pain pump. This is a small tube inserted under the skin and deeper tissues along the midline of the back and into the spinal canal. The tube connects to a small reservoir of medicine inserted under the skin of your belly. The medicine is regularly delivered to the area of pain through the tube.

Coping With Chronic Back Pain

Low back pain can take a toll on your mental health. You may feel fear, frustration, and anger or have depression and anxiety because of ongoing pain. Those common reactions can make your pain last even longer. If pain is starting to get you down:

• Let people know when you need a helping hand. Ask family members or friends to help out with physical tasks you can't do right now.
• Be honest with your doctor about how pain is affecting you. Ask for a referral to a counselor or pain management specialist. Your doctor may also see a need to prescribe antidepressant or antianxiety medicine.
• Work with your health professionals and your work supervisor to make a return-to-work plan, if needed. Ask for an ergonomic consultation if you need to learn how to do some of your job duties differently to avoid hurting your back again.

One Man's Story: "I started feeling sad and angry a lot. I didn't want to do anything. My back was hurting more. I was having trouble focusing on my work. My life just started feeling smaller and smaller."—Ravi Read more about how Ravi learned he had depression and how he fought back.

Emotional support is important

Depending on others for emotional support is a normal part of life. You may have to lean on friends and family when facing difficult situations caused by chronic pain or other problems. Your loved ones can play an important role in supporting your recovery. Your doctor and community also may give you extra support.

Asking for support from others is not always easy. It can be hard to tell someone about your problems. But you should not be afraid to ask for help.

Where you can get support

• Family. Family members can help you cope by giving you comfort and encouragement.
• Friends. Building strong relationships with others is important for your emotional well-being. Don't be afraid to ask your friends for support. Helping is a big part of friendship. At times you may be the one who encourages a friend.
• Counseling. Professional counseling can help you cope with situations that interfere with your life and cause stress. Counseling can help you understand and deal with your pain. You can learn ways to think positively and stop negative thoughts. See the topic Positive Thinking With Cognitive-Behavioral Therapy.

  Depression: Using Positive Thinking

  Anxiety: Using Positive Thinking

  Positive Thinking: Stopping Unwanted Thoughts

• Your doctor. Find a doctor you trust and feel comfortable with. Be open and honest about your fears and concerns. Your doctor can help you get the right treatments, including treatment for depression or other problems.
• Religious groups. Religious or spiritual groups may help you meet people and get involved in the community. Some religious organizations can help you get counseling or other social support services.
• Social groups. Social groups can help you meet new people and get involved in activities you enjoy.
• Community support groups. In a support group, you can talk to others who have dealt with the same problems or illness as you. You can encourage one another and learn ways of coping with tough emotions.

One Woman's Story: "I really work at finding the good things in my day. It helps me get through the day, and I think it makes my pain not bother me as much."—Patty Read more about how Patty used positive thinking to help her back pain.

Supportive relationships

Your loved ones can offer support by:

• Giving encouragement. This can keep you from feeling hopeless or alone.
• Offering to help. Getting a helping hand can keep you from feeling overwhelmed. This may include helping with small daily tasks or bigger problems.
• Going to doctor visits. Your loved ones can offer support by being involved in your medical care.
• Being honest and realistic. Make sure your loved ones understand how serious the problem is. They can help by not setting unreachable goals or by not acting like the problem will just go away.
• Respecting your wishes. You are responsible for your decisions. Your loved ones can offer support and encouragement without interfering with your major decisions.

Having trouble getting support from friends and family? There are steps you can take to make your social support stronger.

Keep moving

Having chronic back pain can make exercising, even walking, difficult. Being active is often the last thing you want to think about.

But the truth is that easing back into daily activity and physical therapy exercises can help relieve back pain and can lead to long-term improvement for low back pain.¹¹

So be as active as you can. Take short walks as often as you can. Talk to a physical therapist about exercises you can do.

Fitness: Increasing Core Stability

Low Back Pain: Exercises to Reduce Pain