Low back pain: causes, treatment and warning signs

Acute low back pain usually starts with a sudden injury to the muscles or ligaments that support the back. It can come from lifting something heavy, a sudden movement or sitting for a long time.

Other causes include muscle spasms, a herniated disk and sciatica (pain that runs down the leg). Staying active helps more than bed rest. If the pain is higher up, see neck pain.

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The most common symptoms of low back pain are:

• Pain or stiffness in the lower back
• Muscle spasms
• Pain that gets worse when you move, bend or lift
• Pain that runs down one leg (sciatica)

These steps, based on MedlinePlus and NICE guidance, help most people:

• Cut back a little for the first few days, but avoid bed rest: ease back into your normal activities.
• Use ice for the first 48 to 72 hours, then heat.
• Sleep in a comfortable position, with a pillow between your knees if you sleep on your side.
• After 2 to 3 weeks, start gentle aerobic activity such as walking, cycling or swimming.
• Physical therapy can teach you exercises and how to move safely.
• Back belts and corsets are not recommended for low back pain.

Medication. Over-the-counter pain relievers such as ibuprofen or acetaminophen can help when used as directed. Anti-inflammatories are not right for everyone (for example with stomach, kidney or heart problems), so the doctor checks which is safe for you. If appropriate, she prescribes another medicine. We do not prescribe controlled substances.

Tests. X-rays and MRIs are usually not needed in the first 4 to 6 weeks if there are no warning signs; clinical guidelines advise against routine imaging. If the pain lasts more than 4 weeks, spreads below the knee, is worse when lying down, or comes with numbness or weakness in your legs, the doctor gives you an order for the imaging or lab test you need, or guides you to physical therapy.

Sciatica is not a disease but a symptom: pain, weakness, numbness or tingling down the leg because something presses on the sciatic nerve. According to MedlinePlus, the most common causes are a herniated disk, spinal stenosis and piriformis syndrome. It usually affects one leg, can reach the foot and gets worse after sitting or standing for a long time.

It often gets better on its own, though it can come back. Staying active instead of resting in bed, ice or heat, core exercises and over-the-counter pain relievers help; the doctor evaluates you by video and tells you what fits your case. Go to the ER if you lose control of urine or stool, the groin or buttocks go numb, or the leg is very weak.

Back pain is less common in children, and we see children of all ages with a parent or legal guardian on camera. If your child has back pain with fever, weight loss or pain that wakes them at night, the doctor evaluates them and, if needed, gives you a lab or imaging order. For their safety, if the pain started after a fall or a hard blow, go to the emergency room.

For your safety, call 911 or go to the emergency room if you have any of these signs. More in when to go to the ER.

• Loss of bladder or bowel control
• Numbness in the groin, buttocks or inner thighs
• Weakness in the legs or trouble walking
• Fever with back pain
• Pain after a fall or a hard blow