Low back pain is the #2 reason that Americans see their doctor, with colds and flu being the #1 reason.

The spine is surrounded by many muscles and ligaments which give it great strength and flexibility.  Most often low back pain is triggered by some nonspecific combination of overuse, muscle strain, or injury to these muscles and ligaments.   Less commonly, low back pain is caused by a spinal condition (such as spinal stenosis, sciatica, or vertebral compression fracture) or a serious illness such as cancer.(1)

Acute back pain is the most common type of back pain. It comes on quickly and often leaves just as quickly. Pain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example – is acute pain. To be classified as acute, pain should last no longer than 6 weeks.

Chronic pain is much less common than acute pain. Chronic pain last more than 3 months. It may come on either quickly or slowly.(2)

In most cases, it is not necessary to see a doctor for back pain because pain usually goes away with or without treatment. However, it's a good idea to consult with your doctor if you have:

• Numbness or tingling
• Severe pain
• Pain that doesn't improve with medications and rest, or
• Pain after a fall or an injury.
  
  The following problems along with back pain could signal a serious problem that requires immediate medical attention:
  
  
• Trouble urinating;
• Weakness, pain, or numbness in your legs;
• Fever; or
• Unintentional weight loss.

Acute back pain usually gets better on its own and without treatment, although the following general measures will be helpful to relieve the pain and speed recovery.

• Greatly reduce normal physical activity for the first few days to help relieve the acute stage of pain and reduce inflammation. Long-term bed rest is no longer recommended for most cases of back pain. In fact, after 2 to 3 days of inactivity, the muscles supporting the spine start to weaken which can actually contribute to recurrent back problems.   In most cases, you will be expected to progress back to nonstrenuous activity within 24 to 72 hours.  At this time,  controlled exercise, preferably supervised by a physical therapist should begin.
  
  
• Apply ice for the first 48-72 hours  for 20 minutes at a time with a towel under an ice packs or 10 minutes at a time for ice directly on the injured area, for example, ice in a pillow case. This is a recommended technique used by physical therapists. With either method, apply ice approximately 4 times daily.  After the first 2-3 days, apply either ice  (as above) or warm, moist heat for 20 minutes at a time, approximately 4 times daily.  At this point, whether it's best to use ice or heat varies with the individual.  Some people do better with ice and some do better with heat.
    
• Over-the counter pain relievers can be helpful for the pain (unless you are allergic to them, have contraindications, or have been advised to avoid these medications by your doctor. Read more)
  • ibuprofen (Advil),
  • naproxen sodium (Aleve)
  • aspirin
  • acetaminophen (Tylenol)
  • Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable
     
• Avoid the following when recovering from low back pain
  • Prolonged sitting or standing--take frequent breaks, walking around slowly.
  • Heavy lifting or twisting of the back--especially lifting and twisting at the same time.
  • Weight lifting, jogging, football, golf, ballet,
  • Leg lifts when lying on your stomach, or sit-ups with straight legs (rather than bent knees).
    
    
• Many people find that some simple changes in their posture and positioning can make a huge difference in their back pain.
  • While sitting place a lumbar support pillow, small throw pillow or a rolled up towel behind your lower back. Place your feet on a small foot rest so that your knees are at the same level as your hips.
  • Remove items from back pockets while sitting.  Men who drive for long distances with thick wallets in their back pockets can have back problems as a result.
  • Avoid high-heeled shoes  High heels pitch you forward, forcing your back muscles to arch unnaturally.
  • While sleeping, try lying in on your side in a curled-up position with a pillow between your legs. If you usually sleep on your back, place a pillow under your knees to relieve pressure.  Avoid sleeping on your stomach.
  • Assess your mattress--An old worn mattress makes and old worn back. It should be comfortable and supportive but not hard.  Many people find adding 1-2 inches of extra padding on top of a firm mattress provides comfort without losing support.    This padding is available at most stores that sell linens or mattresses.  When testing for a mattress, don't push on it or bounce up and down, as many people do. The only way to tell if the mattress is comfortable, is to lie on it for 10 minutes or so -- on your back, on your side, every way.

1) American College of Physicians and the American Pain Society Guidelines For Low Back Pain Annals of Internal Medicine, October 2007
2) Back Pain from the National Institute of Arthritis and Musculoskeletal Skin Diseases
3) Low Back Pain and Surgeryfrom the American Association of Neurological Surgeons