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    Back Problems and Injuries

    Back Problems and Injuries

    Topic Overview

    Most people will have a minor back problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreational activities, work-related tasks, or home projects.

    Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

    • The bones and joints of the spine ( vertebrae ).
    • The discs that separate the vertebrae and absorb shock as you move.
    • The muscles and ligaments that hold the spine together.

    Back injuries are the most common cause of back pain. Injuries frequently occur when you use your back muscles in activities that you do not do very often, such as lifting a heavy object or doing yard work. Minor injuries also may occur from tripping, falling a short distance, or excessive twisting of the spine. Severe back injuries may result from car accidents, falls from significant heights, direct blows to the back or the top of the head, a high-energy fall onto the buttocks, or a penetrating injury such as a stab wound.

    Although back pain is often caused by an injury to one or more of the structures of the back, it may have another cause. Some people are more likely to develop back pain than others. Things that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting for long periods, lifting or pulling heavy objects, and having a degenerative disease such as osteoporosis .

    Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.

    Low back pain may occur in children and teenagers, but children and teens are less likely to see a doctor for low back pain. Although most back problems occur in adults ages 20 to 50, back problems in children younger than 20 and adults older than 50 are more likely to have a serious cause.

    Sudden (acute) injuries

    Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Pain from an acute injury usually does not last longer than 6 weeks. Acute injuries include:

    • An injury to the ligaments or muscles in the back, such as a sprain or a strain .
    • A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis.
    • A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate) and press against a nerve. See a picture of a herniated disc .
    • An injury that causes the compression of nerves in the lower back ( cauda equina syndrome ).

    Overuse injuries

    You may not remember a specific injury, especially if your symptoms began gradually or during everyday activities. These injuries occur most often from improper movement or posture while lifting, standing, walking, or sitting, or even while sleeping. Symptoms can include pain, muscle spasms, and stiffness. The pain often goes away within 4 weeks without any treatment.

    Conditions that may cause back problems

    Back pain or problems may not be related to an injury.

    Treatment

    Most back pain will get better and go away by itself in 1 to 4 weeks. Home treatment will often help relieve back pain that is caused by minor injuries. It is usually a good idea to continue your regular activities while your back is healing. Avoid heavy lifting and activities that seem to make your back problems worse.

    Other treatments for a back problem or injury may include first aid measures, physical therapy, manipulative therapy (such as chiropractic), medicine, and, in some cases, surgery. Treatment depends on:

    • The location, type, and severity of the injury.
    • Your age, health condition, and activities (such as work, sports, or hobbies).

    Check your symptoms to decide if and when you should see a doctor.

    Health ToolsHealth Tools help you make wise health decisions or take action to improve your health.

    Health Tools help you make wise health decisions or take action to improve your health.


    Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
    Back Problems: Proper Lifting
    Fitness: Increasing Core Stability
    Low Back Pain: Exercises to Reduce Pain

    Check Your Symptoms

    Do you have a back injury or other back problem?
    Yes
    Back problem or injury
    No
    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
    Are you male or female?
    Male
    Male
    Female
    Female
    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
    Could you be having symptoms of a heart attack?
    If you're having a heart attack, there are several areas where you may feel pain or other symptoms.
    Yes
    Symptoms of heart attack
    No
    Symptoms of heart attack
    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 severe bleeding that has not slowed down with direct pressure?
    Yes
    Severe bleeding
    No
    Severe bleeding
    Do you have symptoms of shock?
    Yes
    Symptoms of shock
    No
    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?
    Yes
    Blood in urine
    No
    Blood in urine
    Are you able to urinate at all?
    Yes
    Able to urinate
    No
    Unable to urinate
    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
    No
    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?
    Yes
    New incontinence
    No
    New incontinence
    Is there any back pain?
    Yes
    Back pain
    No
    Back pain
    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?
    Yes
    Back pain
    No
    Back pain
    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.
    Yes
    Possible fever
    No
    Possible fever
    Do you have a new rash on only one side of your body? The rash may be in a strip or band.
    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
    Pregnancy-Related Problems
    Urinary Problems and Injuries, Age 12 and Older

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or 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.

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or other emergency services now.

    Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

    Seek Care Now

    Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

    • Call your doctor now to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care in the next hour.
    • You do not need to call an ambulance unless:
      • You cannot travel safely either by driving yourself or by having someone else drive you.
      • You are in an area where heavy traffic or other problems may slow you down.

    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 Today

    Based on your answers, you may need care soon. The problem probably will not get better without medical care.

    • Call your doctor today to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care today.
    • If it is evening, watch the symptoms and seek care in the morning.
    • If the symptoms get worse, seek care sooner.

    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, numbness, tingling, or a strange feeling in your chest or other areas.

    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.
    • 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.

    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.
    • 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.

    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.

    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 bone.

    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.

    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.

    Try Home Treatment

    You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

    • Try home treatment to relieve the symptoms.
    • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

    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.

    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.

    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.

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or 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.

    Urinary Problems and Injuries, Age 11 and Younger
    Postoperative Problems

    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.

    Home Treatment

    Home treatment may help relieve pain, swelling, and stiffness related to a back problem.

    • Return to your normal daily activities and work as soon as you can, although you may need to modify or limit some work tasks.
    • Avoid bed rest. Bed rest is not an effective treatment for back pain and may cause you to heal more slowly.
    • Apply an ice or cold pack to the injured area for the first 48 to 72 hours. Apply cold packs or ice for 15 to 20 minutes, 3 to 4 times a day or up to once an hour. Cold decreases swelling and pain. Keep a towel between your skin and the ice to prevent frostbite . Do not fall asleep with the ice on your skin.
    • Change position every 30 minutes. Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
    • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
    • After 48 to 72 hours, if swelling is gone, apply heat. Use a warm pack or heating pad set on low. Some experts recommend switching back and forth between heat and cold treatments. You can also begin gentle exercise with the aid of moist heat to help restore and maintain flexibility.
    • 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.

    Click here to view an Actionset. 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 treatment

    Call your doctor if any of the following occur during home treatment:

    • One or both legs become weak or numb.
    • You lose control of your bowels or bladder.
    • Back pain does not improve or gets worse.
    • Fever develops.
    • Symptoms become more severe or frequent.

    Prevention

    There is no clear evidence that you can prevent back pain. But there are some things you can do that may help prevent it. And they can prepare you for faster recovery if you do have back pain.

    Exercises to avoid

    Some exercises actually increase the chances of causing of low back pain. Avoid:

    • Straight-leg sit-ups.
    • Bent-leg sit-ups during acute back pain (may be safe if back is kept in neutral position).
    • Leg lifts (lifting both legs while lying on your back).
    • Lifting heavy weights above the waist (military press or biceps curls while standing).
    • Any stretching done while sitting with the legs in a V position.
    • Toe touches while standing.

    Work comfort and design

    Most back problems that occur in the workplace are caused by physical stress, such as being in an awkward position for a long time, making the same motions over and over, and simply using your back too much. These injuries can cause stress and strain on muscles, nerves, tendons, joints, blood vessels, or spinal discs.

    Arrange your work to help prevent work-related injuries. It is important to position yourself so that you can sit comfortably and minimize stress on any one area of your body. Change your positions and tasks as often as possible, and match tools to your size and preferences. If you are doing a job or task that requires you to sit for long periods, get up and stretch and move around at least once an hour.

    Preparing For Your Appointment

    To 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?

    Credits

    By Healthwise Staff
    William H. Blahd, Jr., MD, FACEP - Emergency Medicine
    David Messenger, MD
    Last Revised May 23, 2013

    This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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