Approximately 4 out of 5 Americans will have back pain at some point in their life.  90% of these episodes will resolve on their own within 6 weeks with rest, medication and exercise.  Approximately 63% of patients with one episode of back pain will have another episode.  Additional episodes of pain are also likely to improve with appropriate management.  Back pain is the second most common reason for people to visit their family doctor.

Common causes of back pain are: trauma, such as from a fall; illness, such as an infection; degenerative or "wear and tear changes" of the discs or joints; or spinal deformity, such as scoliosis.

Low back pain can be from a number of causes but the two most common causes are strains or sprains.  A strain of the muscle (muscles provide power and strength) can occur when the muscle is poorly conditioned or overworked.  A sprain of the ligaments (ligaments provide support or stability) can occur when a sudden, forceful movement injures a ligament, which has become stiff or weak through poor conditioning or overuse.

The following risk factors can increase the likelihood of a flare-up of pain: 1) lack of exercise, 2) poor posture, 3) continuous lifting, bending, or sitting, 4) emotional or mental stress, 5) being overweight and 6) smoking.

After the first week of "taking it easy", as much activity as possible is important to help the healing process.  Staying inactive in fear of "hurting something" in the back will slow your recovery.  Prolonged inactivity will cause further weakness in your back thus adding to your problem.  It is normal to have some pain when exercising but excruciating pain should be avoided.

You should see your doctor if you have any weakness in your legs, loss of bladder control, numbness or pain radiating down your legs, abdominal pain or vomiting or if your back pain does not improve after a few days.

Strengthening the muscles around the spine provides support and takes the stress off the bones, ligaments and discs.  Aerobic exercise increases blood flow to the tissues and speeds up healing while increasing endorphin levels.

Narcotic medications may be helpful for short-term pain relief such as after a surgery or a procedure, but they are not effective in treating long-term pain.   Through anti-inflammatories, exercise and proper rest, most patients can limit their pain.  Narcotic pain medication is addictive and patients become tolerant to the medication requiring greater dosages over time.  In addition, narcotics can impede the body's ability to make its own pain medicine (endorphins).

1) Use proper body mechanics during lifting, 2) avoid excess body weight, 3) avoid cigarette smoking and 4) exercise for both general conditioning and specifically for the back and abdominal pain.

X-rays show bones but do not show soft tissues such as muscles, discs and nerves.  X-rays will show arthritis and bone disease.   MRI studies are helpful for patients who require surgery.  They demonstrate soft tissue such as the disc, nerves and non-bony structures

Most people with back problems do not need an MRI or CAT scan.   Approximately 30% of normal volunteers without back pain have significant abnormalities on MRI/CT Scan.  MRI's or CAT Scans are usually ordered if pain persists for several months or if surgery is being considered

An epidural steroid injection is an injection of an anti-inflammatory medication.   By placing the anti-inflammatory medication in the exact location around the irritated nerves, the patient gets the greatest amount of relief.  This is done as an outpatient procedure and may be repeated two or three times a year.

These injections are similar to the epidural steroid injection, however, the medication is placed into the small joints of the spine instead of the epidural space.  The blocks serve in the diagnosis of the pain generator and may relieve pain that is arising from the joint

The majority of patients (80-90%) with a herniated disc will recover within twelve weeks.  The recovery process can be made less symptomatic through conservative care measures.  In those that do not improve, surgery for a herniated disc can relieve the leg pain but it cannot prevent future back problems

In some instances the herniated disc resorbs or dries up.  Most often the herniated disc will remain where it is but the associated nerve irritation stops and it is no longer painful.  Twenty to thirty percent of the population has a herniated disc that they are unaware of because it does not cause pain

The nicotine found in cigarettes has been shown to increase the risk of disc degeneration and back pain.  It can also slow or prevent recovery because it reduces the amount of blood flow to the tissues that are trying to heal.  After surgery, it reduces the rate of bone healing and increases the risk of complications from anesthesia.