Back Pain Slideshow Pictures
Good, Bad Exercises for Low Back Pain Slideshow
Causes of Low Back Pain
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Jerry Balentine, DO, FACEP

Low Back Pain Overview
Low Back Pain Causes
Low Back Pain Symptoms
When to Seek Medical Care
Low Back Pain Exams and Tests
Low Back Pain Treatment
Self-Care at Home
Medical Treatment
Low Back Pain Medications
Low Back Pain Surgery
Other Therapy
Follow-up
Low Back Pain Prevention
Low Back Pain Prognosis
Synonyms and Keywords
Authors and Editors
Read more on Back Pain from Healthwise
Viewer Comments: Back Pain - Cause
Viewer Comments: Back Pain
Back Pain in 2nd & 3rd Decades of Life
Medical Author: William C. Shiel Jr., MD, FACP, FACR
I am a rheumatologist. We are medical doctors that are responsible for the non-surgical treatments of conditions that involve the muscles and joints of the body. We do not perform surgery, but refer patients for consideration of surgical procedures to orthopaedic surgeons when appropriate.
In the course of treating many patients over the years, I have come upon many instances in which a patient had received unnecessary surgery for conditions that could have either been diagnosed or treated without surgery.
It is unfortunately too frequent that we diagnose spondylitis after a patient has already undergone a surgical procedure of the low back.
Learn more about causes of back pain »
Top Searched Back Pain Terms
sciatica, spinal stenosis, herniated disc, cauda equina syndrome, myofascial pain syndromes, osteomyelitis, chronic pain, TENS

Low Back Pain Overview

Pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease, rather it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified. America spends approximately $50 billion a year on low back pain.

Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter will review many of the causes of back pain and proper evaluation and diagnosis. Please be sure to discuss your individual symptoms as well as the suggested treatments with your health-care professional to determine the appropriate diagnostic and treatment plan for your circumstances.

Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department. It is the second most common neurologic complain in the United States, second only to headache.


For 90% of people, even those with nerve root irritation, their symptoms will improve within two months no matter what treatment is used, even if no treatment is given.


Doctors usually refer to back pain as acute if it has been present for less than a month and chronic if it lasts for a longer period of time.

Low Back Pain Causes

Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.

Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.


Herniated discs develop as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in one-third of adults older than 20 years of age. Only 3% of these, however, produce symptoms of nerve impingement.



Picture of a herniated lumbar disc, a common cause of sciatica

Spondylosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc height. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.


Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These changes in the disc and the joints produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.


Cauda equina syndrome is a medical emergency whereby the spinal cord is directly compressed. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence or the inability to begin urination.

Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.


Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.


Fibromyalgia results in widespread pain and tenderness throughout the body. Generalized stiffness, fatigue, and muscle aches are reported.


Infections of the bones (osteomyelitis) of the spine are an uncommon cause of low back pain.


Noninfectious inflammation of the spine (spondylitis) can cause stiffness and pain in the spine that is particularly worse in the morning. Ankylosing spondylitis typically begins in adolescents and young adults.


Tumors, possibly cancerous, can be a source of skeletal pain.


Inflammation of nerves from the spine can occur with infection of the nerves with the herpes zoster virus that causes shingles. This can occur in the thoracic area to cause upper back pain or in the lumbar area to cause low back pain.


As can be seen from the extensive, but not all inclusive, list of possible causes of low back pain, it is important to have a thorough medical evaluation to guide possible diagnostic tests.

Understanding Fibromyalgia Symptoms

Chronic pain is defined as pain that lasts longer than 3 months. That’s the main symptom of Fibromyalgia: widespread muscle pain that lasts longer than 3 months. Widespread pain is defined as pain both above and below the waist and on both the right and left sides of the body.
At its best, Fibromyalgia may be described as “mild.” At its worst, intense pain can get in the way of doing normal day-to-day activities.
Some Fibromyalgia sufferers describe their pain as “all over” or “everywhere.” For some people, the pain and stiffness are worst when they wake up. Then it improves during the day. Symptoms may increase again at night. But other people have all-day, non-stop pain. This could include combinations of neck pain, arm pain, shoulder pain, back pain, hip pain, knee pain, feet pain, and pain in just about every other body part.
Voices of Fibromyalgia
“My eyelashes and tips of my hair are the
only parts of me that don't hurt.”
The pain may get worse with physical activity, stress, or anxiety. Fibromyalgia patients may also be more sensitive to things around them. This may include heat/cold, bright lights, loud sounds, and more. Even a gentle hug could be painful.Read more about the unique qualities of Fibromyalgia pain.
Pain is the core symptom of Fibromyalgia, but different people feel the pain in different ways. Fibromyalgia pain may be felt as:

Description Real Voices of Fibromyalgia
Chronic pain “I feel pain all over my body. Some days are better than others, but the pain is always there.”
Deep pain “It is in the deep tissues. You can’t massage it out. It’s not just the surface. I can’t penetrate to where the pain is originating from.”
Widespread pain “It is hard to explain where my pain is, it seems like it is everywhere else except some specific place.”
Aching pain “Sometimes it is like a constant ache that is there, then you get up, you move around, it goes away and then it pops up someplace else.”
Radiating pain “There are days that I have sharp pains that radiate down from my neck to my arm like a lightning bolt that strikes higher up, down to my arms, my hands.”
Shooting pain “...shooting pain that sometimes I get in my shoulders and my neck, like a stabbing pain.”
Tender pain “My body is so sensitive and tender that it hurts to be hugged.”

Other Common Fibromyalgia Symptoms
Additional common Fibromyalgia symptoms may be felt as:
Description Real Voices of Fibromyalgia
Sleep disruptions “I wake up feeling unrefreshed even after a full night’s sleep.”
Fatigue “I feel very tired at times. Sometimes I feel so worn out and drained that I can’t take care of my family like I want to.”
Problems with memory and thinking clearly (sometimes called "fibro fog") “Sometimes I have difficulty focusing. It’s like my mind is in a fog.”
Problems with
depression and/or
anxiety “For so long the doc had told me I was depressed and I said, ‘Well I'm in pain all the time, of course I'm depressed.’”
Overlapping conditions such as irritable bowel syndrome, restless leg syndrome, migraines, and others “It feels like I have this aura of pain that follows me wherever I go.”
In a survey conducted by the National Fibromyalgia Association, people with Fibromyalgia reported the symptoms in the chart below. Most of these symptoms are on top of their widespread chronic pain. Some of these symptoms may come from additional conditions that can occur in patients with Fibromyalgia.

Massage — Good for What Ails You

Ask the average person what they think of when you say massage therapy and they most likely will mention getting sore or tight muscles rubbed, getting relaxed or reducing tension. These are probably the main reasons most people seek out massage treatments.

This article reviews the very broad scope of treatment that massage addresses every day. Many of these conditions may not directly apply to you, but you may know someone — a family member or friend — who is affected. At the very least, you should find it interesting to learn just how beneficial massage therapy is to all of us in our quest to lead a happy and healthy life.

The medical conditions that people find therapeutic massage can help include:

allergies
anxiety
arthritis
asthma & bronchitis
carpal tunnel syndrome
chronic & temporary pain
circulatory problems
depression
digestive disorders
headache, especially due to tension
insomnia
myofascial pain (where the muscles connect)
reduced range of motion
sinusitis
sports injuries
stress
TMJ (noise and/or pain in the jaw joint)
As interest in massage therapy grows, more studies are being conducted to verify the anecdotal results clients have reported for years.

As an example, several studies offer evidence that immune function is strengthened by massage therapy — in both healthy people as well as those who are fighting disease.

"‘In one study after another, research is suggesting that massage therapy has a positive impact on immune function,’ said Diane Zeitlin, research associate at the Center for Research in Complementary and Alternative Medicine, Kessler Medical Rehabilitation & Education Corporation, West Orange, N.J.

"‘An increase in white blood cells and natural killer-cell activity better prepares the body to fight off possible invading cells,’ said Zeitlin. ‘These cellular changes suggest the immune system benefited from the massages, and these findings fall in line with previous research.’"

In a study conducted by the Touch Research Institute (TRI) at the University of Miami on women who had been diagnosed with breast cancer, the women received regular massage therapy (three times a week for five weeks), with 80 percent showing improved immune function.

"‘These are the first studies that show an effect of massage therapy on an immune function test, which can support the use of massage therapy to alleviate stress, relax muscles and now possibly serve as an alternative medical practice,’ said Michael Ruff, Ph.D., research associate professor at Georgetown University Medical School."

Another TRI study addressed fibromyalgia (a chronic condition characterized by muscular pain, aching, and/or stiffness and afflicting an estimated 3 – 6 million Americans). A portion of the study group received 30 minute massages twice a week for five weeks. The rheumatologists that evaluated the results determined that this group experienced decreases in pain, fatigue, stiffness and improvements in the quality of sleep.

If you are fortunate enough to have excellent health, consider what benefits massage can provide for you. What is becoming evident from the growing number of studies on massage benefits is that massage is helping people to enjoy more optimal physical functioning. And this in turn can lead to a better mental outlook.

The next time you hear someone say that massage is only a luxury, you’ll know that massage is really a tool that can help improve a body’s ability to regain and maintain proper function. Making you feel terrific is just a wonderful bonus!

Physical Benefits of Therapeutic Massage
Helps relieve stress and aids relaxation
Helps relieve muscle tension and stiffness
Alleviates discomfort during pregnancy
Fosters faster healing of strained muscles and sprained ligaments; reduces pain and swelling; reduces formation of excessive scar tissue
Reduces muscle spasms
Provides greater joint flexibility and range of motion
Enhances athletic performance; Treats injuries caused during sport or work
Promotes deeper and easier breathing
Improves circulation of blood and movement of lymph fluids
Reduces blood pressure
Helps relieve tension-related headaches and effects of eye-strain
Enhances the health and nourishment of skin
Improves posture
Strengthens the immune system
Treats musculoskeletal problems
Rehabilitation post operative
Rehabilitation after injury

(Source: AMTA)

Mental Benefits of Massage Therapy
Fosters peace of mind
Promotes a relaxed state of mental alertness
Helps relieve mental stress
Improves ability to monitor stress signals and respond appropriately
Enhances capacity for calm thinking and creativity
Emotional Benefits
Satisfies needs for caring nurturing touch
Fosters a feeling of well-being
Reduces levels of anxiety
Creates body awareness
Increases awareness of mind-body connection

(Source: AMTA)

The agonizing pain associated with the migraine has been reported for centuries. And while many studies have been performed, migraines are a poorly understood condition affecting millions.
Massage therapy has long been described as a non-invasive way to manage pain and bring about some degree of relief for the migraine sufferer.

Migraine History
Migraines have been associated with vascular abnormalities since the late 1600's. However, early cultures thought migraines were a curse from the gods. Treatments have varied over the course of history to include such things as tying a clay crocodile to the head with linen inscribed with the names of the gods (ancient Egypt, approximately 1200 BC) to dripping coca juice containing cocaine into an incision in the scalp (ancient Incas) to willow bark extract (Native Americans).

As studies and modern medicine progressed migraines remain beguiling. Migraines can attack for any of a variety of reasons, including things like hormones, stress, hunger, weather changes, visual or auditory stimuli, change in sleep patterns, medications, certain smells, certain foods and additives or allergies.

Typically, migraines are treated with prescription medications. However, improper or prolonged use of medications can actually perpetuate the pain. The best treatment for migraines is promoting an optimal environment.

How Can Massage Help?
Massage by a qualified, trained massage therapist can address a multitude of problems that may contribute to migraine pain. Massage coupled with an in-depth look into lifestyle habits and environmental causes with positive actions to take control over triggers can alleviate pain, decrease the duration or intensity of pain - even eliminate the migraine.

Take stress for example. Physical or mental stress impedes your quality of life. It can perpetuate or initiate sickness. A relaxing massage can decrease stress and promote a sense of overall wellness.

We as therapist try to make a session interesting. Some times we forget the basics. When we get a new client we get all excited and we really want to help them, but instead of setting them down and really getting to know them and talking to them we get them on our table and start to work on the problem.

One of the main reasons why they come to us in the first place is not only our mannerisms but our genuine concerns of they health. We must not for get that they come to us because of an injury of some sort.

What is Deep Tissue?
Deep tissue focuses on realigning deeper layers of connective and muscle tissue.

It is helpful for chronically tense and contracted ares such as stiff necks, low back pain or tightness.

Some similar strokes are used in a classic massage, but it is in a slower motion and the pressure in a more concentrated on areas of tension and pain.

How does deep tissue work?

When there is chronic muscle tension there are usually adhesion's in muscles, tendons, and ligaments

Will deep tissue massage hurt?

Some discomfort and pain can at certain points in the massage.
It is important to tell the therapist when things are outside your comfort zone.