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WHAT IS IT?
Almost all of us can expect to have pains in the lower back at least once in our lives. Low back pain strikes in many ways. You might feel a dull ache, sometimes along with burning, or even numbness or tingling. The pain may shoot down your buttocks and into your legs.
Low back pain can come on quickly, or it can get worse slowly over many days or weeks. Some people may have bouts of back pain on and off for weeks or months. It can be so severe that it turns daily life into a painful chore.Many things can bring it on. Simple muscle strains are among the most common causes. Stress is another common source: Just as some of us get headaches when we’re feeling tense and on edge, others get backaches. Disk problems are another cause of low-back woes. Disks are tough pads of tissue that act as shock absorbers in the spine. Sometimes a disk will weaken, bulge out, and press on a nerve.

The good news: You can do a lot to prevent low back pain. If your back does begin to hurt, be patient. Ninety percent of all low back pain goes away within a month or so. There’s also plenty you can do yourself to speed your recovery. Only rarely do people need treatment. If you do, your doctor can help with drugs and physical therapy. Surgery can be an option when the pain is very bad and the doctor can find a clear cause for it.
WHAT IS HAPPENING?
Though people talk about the “backbone,” in fact the spine is not one bone but a stack of 26 separate bones called vertebrae. It reaches from the base of your skull to your buttocks.

Between the vertebrae are the disks, flat pads with tough, fibrous covers and soft insides. The spinal cord, part of your central nervous system, extends from your brain down a channel-the spinal canal-that runs through the vertebrae. A network of nerves branches from the cord throughout your body. The entire spinal structure is held together by muscles, tendons, and ligaments.

The spinal column is somewhat flexible, within limits. Because the lower part of it supports much of the body’s weight, even a small problem there can cause major pain. If you bend the wrong way, twist too much, or even slouch too long in a chair, you can strain a muscle and end up stiff and sore. A disk can go bad when the tough cover weakens or tears. Then the soft inside will bulge out and pinch nearby nerves.

Because many of the nerves that run through the spinal column connect to other parts of the body, a problem in the back that causes pain there can also cause pain to show up elsewhere. A bulging disk in the low back, for instance, may cause pain that shoots down your buttocks and into one or both legs.
WHAT CAUSES IT?
No one can say exactly why one person gets low back pain and another doesn’t, but we do know of many things that can increase your risk. Some-such as your age and some illnesses-are beyond your control. But you can do plenty about many others.

THINGS YOU CAN’T CHANGE

Age
Low back pain is most common in the middle-aged. Experts don’t know why.

Health problems
Many health problems can cause back pain. They include osteoporosis, or thinning of the bones; scoliosis, an extreme curve of the spine from a birth defect or weak muscles; and spinal stenosis, narrowing of the spinal canal. Even some minor illnesses such as the flu can cause backaches, above all if you spend lots of time in bed.

Injury
A fall or blow to the back can strain or tear tissues around the spine, or even break a bone.

THINGS YOU CAN CHANGE

Stress or anger
Strong emotions can cause your back muscles to tighten, and tight muscles can lead to cramps. Tight muscles are also prone to strains. You can’t always avoid the things that make you tense, but you can take steps to relieve tension and reduce your risk of back trouble.

How you move
Awkward movements, twisting, or reaching too far can pull or tear a tendon, ligament, or muscle in your back, above all when the muscle is tight. Lifting heavy objects by bending your back and not your legs is another common source of back pain.

Lack of exercise
Your spine needs the support of strong muscles, front as well as back, to protect it. If you don’t exercise enough, the muscles around your middle get weak, and that leaves you open to injury.

The wrong exercise
If you tend to get lots of back pains, think about whether you engage in many sports or tasks that involve twisting or bending.

Sleep habits
The way you sleep may be causing your back to ache. If you sleep on your stomach, if your mattress is too soft, or if your pillow is too big, you may be curving your spine too much. If your mattress is too firm, it may keep your back too straight for comfort.

Skipping warmups
Anyone who exercises without warming up first is asking for trouble. That’s because muscles are more prone to strains and tears when they’re cold and stiff than when they’ve been loosened up.

Too much weight
If you weigh more than you should, your risk of low back pain goes way up. Extra pounds mean a bigger load for the low back to support. If you carry lots of weight around your waist, then your risk of back problems goes even higher. That’s because a big stomach pulls the low back out of its proper alignment.

Bad posture
Your risk of back pain goes up if you slouch a lot or stand or sit for hours at a time with your back curved and your shoulders bent. Watch out for high heels, too. A normal spine is slightly S-shaped, and your low back has an inward curve. High heels can increase the curve, and that puts extra strain on the muscles and disks.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to prevent back pain by making smart choices about stress relief and your diet, posture, and exercise habits. If your back already hurts, these same choices will speed your recovery.

WHEN YOU’RE IN PAIN:
Take over-the-counter drugs
Ease the pain with acetaminophen (Tylenol), ibuprofen (Advil or Motrin), naproxen (Aleve), or aspirin. Acetaminophen may be best for backaches since it doesn’t upset the stomach.

Apply heat or ice
When your back begins to hurt, put an ice pack where it hurts the most. A bag of frozen peas works well. Wrap it in a thin cloth towel and leave it on for 10 to 15 minutes every hour. This eases pain and swelling. After two days switch to heat-a warm towel or heating pad. The heat brings blood to the area and speeds healing of injured tissues.

Rest
If the pain is bad and moving makes your back hurt, stay in bed at first. But don’t rest for more than two days. Lying around weakens bones and muscles, so the pain gets even worse.

Try this: Lie flat on the floor with your knees bent and your calves and feet up on a chair or a pile of pillows. This flattens the lower back and eases the strain on tender back tissues.

If pain disturbs your sleep, lie on your back with pillows under your knees. If you sleep on your side, bend your knees and put a pillow between them. Don’t lie on your stomach. And make sure that your mattress is the correct firmness. When you lie on your side, your spine shouldn’t curve. If your mattress is too soft, your midsection will sink too far; if too firm, your shoulders and hips will not sink in far enough to keep the spine straight.

Stay active
When you can, get up and move around as much as possible. Do gentle exercise that doesn’t hurt your back, such as swimming or walking, but don’t overdo it. Try exercising 10 to 15 minutes per day at first, and slowly build up to more.

Protect your lower back
You may need to change the way you sit, stand, and recline to ease the pain.

Limit the amount of time you sit. Many people with back pain find that sitting feels worse than standing or lying down.

If you do have to sit, choose a firm chair with a straight back. Avoid low, soft furniture such as sofas. Put a cushion or a rolled-up towel behind the small of your back when you sit, and sit with your shoulders back and your back straight. Your buttocks should be up against the back of the chair.

If you must sit for long hours on the job, make sure your chair supports your back and your chair and work surface are the right heights for you.

Your knees and waist should be bent at right angles as you sit.
Your feet should be flat on the floor or placed on an inclined footrest.
Your armrests should support your elbows without making you hunch your shoulders.
Your desktop should be about the same level as your armrests, so you don’t have to reach up or down. You shouldn’t have to bend over to do your work.
If you read at work, use a typing stand or a slantboard so you don’t slouch.
If you use a computer, make sure the top of the screen is about eye level or a bit lower. Rest your wrists on a pad when typing.
If you have to stand for a long time, put one foot up on a low block or stool. This takes some strain off the low back. Don’t let your shoulders slump forward. Keep them back and relaxed; imagine a weighted string hanging straight down from them to your hipbone.
Don’t wear high heels.
Get a massage
Massages can help. They loosen tight muscles and ligaments and help you relax.

TO PREVENT BACKACHES:
Exercise
Exercise often to strengthen your back and stomach muscles. Your doctor or physical therapist can show you how to strengthen the muscles, front and back, that support your lower spine. Many doctors and therapists also advise yoga. Yoga helps build strength and keeps you flexible. If tension causes your back pain, yoga can also help prevent the pain by helping you relax.

Exercise is not only good for your back, it may help prevent heart disease, osteoporosis, and a host of other health problems-perhaps even some types of cancer.

Aim for 20 to 30 minutes most days of the week. Brisk walking, swimming, cycling, and jogging are all ideal. If you tend to have back pain, stay away from sports that twist or wrench your body, such as tennis or golf, or any other sport that has given you problems.

Start by being a little more active each day. Take the stairs instead of the elevator. Walk the dog for 15 minutes each evening. Your pooch and your back will thank you. When you’re used to being more active, add some activities that are more aerobic to your routine. These should get your heart beating faster and make you sweat a bit. Find an activity you enjoy-it’s much easier to keep exercising when you like to do it.

Before any exercise, always warm up for at least 10 minutes with gentle stretching and anything that gets your heart rate up, such as walking or slow jogging.

Maintain good posture
Good posture eases stress on your muscles and joints. It not only relieves pain when your back hurts, it helps keep back pain from starting. Follow the guidelines listed above for sitting, lying, and standing.

Avoid injury
Learn how to lift and carry things the right way. Lift with your back straight, bending your legs. Hold the object close to your body. Don’t try to lift or carry anything that’s too heavy for you. Ask for help.

Lose weight
If you weigh more than you should, lose the extra pounds. Taking off weight may sound daunting, but it doesn’t have to be. The best approach? Combine smart eating with exercise.

Extra calories-those you don’t use for energy right away-pack on the pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 calories more than you take in. That’s because one pound of fat has 3,500 calories. (A fast-food lunch of burger, fries, and a shake is loaded with about 1,700 calories; an apple has only 80.)

Here are some tips for a program that works:

Check with your doctor to find out how much you should weigh.
Take your time. When you lose weight slowly-no more than 1 percent of your body weight each week-it’s easier to keep it off.
Be realistic. Don’t aim for a weight you can’t reach and maintain.
Keep an eye on your total calories and cut down on fats. Build your meals around fruits, vegetables, and grains. They have little fat and no cholesterol and are loaded with vitamins, minerals, and fiber. Don’t fry foods. Bake, broil, steam, or saute with water or vegetable broth in a nonstick pan. Switch to low- or nonfat cheeses, skim or 1 percent milk, and ice milk or sherbet instead of ice cream.
Stay as active as you can.
Ease stress
Brief bouts of stress aren’t harmful, but a lot of stress day after day can take a toll. It increases your risk for back pain as well as health problems such as heart disease, depression, and headaches. If you think the way you react to pressure could be giving you a pain in the back, learn to spot-and avoid-situations that make you tense. Here are some tips for staying on an even keel, even in the most stressful times:

Exercise. People who exercise often tend to feel less anxious and more relaxed.
Laugh more. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and ask whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is “no,” take a few deep breaths and tell yourself to calm down. If any answer is “yes,” don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do as long as it’s a time-out. Aim for at least 20 minutes a couple of times a day.
Relax through yoga, deep breathing, stretching exercises, or meditation. Try this meditation exercise:
Find a quiet place. Sit in a comfortable position, with your hands in your lap and your feet flat on the floor. Close your eyes. After a minute or two, start to say a simple word or phrase to yourself. It can be anything. Some experts suggest just the word one. If thoughts intrude, ignore them and return to the word. You don’t have to repeat it all the time, though; let it come and go. Don’t concentrate too hard on it, but try to make it the focus of your attention. After 20 minutes or so (you can open your eyes to check your watch), stop saying the word. Sit with your eyes closed for two or three more minutes.
WHAT YOUR DOCTOR CAN DO FOR YOU
Sometimes it’s hard to find the cause of back pain, but if your doctor thinks your problem is a muscle strain or a pulled tendon or ligament, your treatment may differ from treatment for a problem disk.

Drugs
If the problem is a strain, your doctor may prescribe a stronger version of an over-the-counter painkiller for severe back pain. Some experts advise against prescription drugs to relax tight muscles. They work no better than OTC versions, and they often have side effects such as drowsiness. Your doctor may also give you an epidural steroid injection, which works by delivering steroids directly into the painful area to reduce inflammation. A steroid injection may provide relief for up to a year, and it is generally used to relieve the pain that sometimes occurs if you are doing rehabilitation exercises with a physical therapist (see below). These injections are successful in about 50 percent of patients, and doctors usually do not give more than three injections to each patient per year.

Physical therapy
A physical therapist may use massage, gentle movement, or ultrasound-heat from sound waves-to ease the pain. The therapist can also give you exercises to do at home.

Chiropractic care
Chiropractors work on the spine to straighten the way the bones align. This can help relieve strain on muscles and ligaments. Studies show chiropractic treatment can speed recovery. Your doctor may refer you to a chiropractor if you’re still bothered by pain after a week or two of other treatments.

TENS
TENS stands for transcutaneous electric nerve stimulation. Small electrodes are placed on the skin over the painful area. They deliver tiny electrical impulses that trigger a natural reaction in the spinal cord that seems to lessen the pain. Experts don’t know exactly how TENS works, but some think that it stimulates the production of endorphins, the body’s natural painkillers.

Surgery
If you have a disk problem with signs of pressure on a nerve, such as numbness, tingling, or persistent pain or weakness in a leg, or if no other treatments help relieve the pain, your doctor may suggest surgery to remove part or all of the disk to relieve pressure on the nerve roots. The operation is called a lumbar (for low-back) diskectomy. During recovery, you may need to wear a back brace and sleep on an extra-firm mattress. Most people return to work and normal activities within a couple of weeks after surgery.

Another option is a spinal fusion. The goal of this operation is to join two vertebrae together to eliminate the source of painful movement. This is done by a bone graft, usually with bone taken from the pelvis. Fusion stabilizes painful motion in the area by stimulating growth of new bone between the vertebrae and stiffening the back. A variety of metallic implants (screws, plates, or cages) help keep the vertebrae together until the new bone grows. If the pain is caused by more than one set of vertebrae, a fusion is unlikely to work, because it can restrict back motion and put added stress on the remaining joints.

In very rare cases, your back may hurt because of a tumor on the spine, or because of a fractured vertebra. Surgery can remove the tumor or help repair the broken bone