Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What makes up the spine?

The lower spine consists of five bones, called the lumbar vertebrae. The vertebrae support the body and protect the spinal core and nerves. Between each vertebra is a disc filled with a jelly-like material. The discs act as shock absorbers for the vertebrae. Along the spine are many nerves. Injury to these nerves can cause pain.

What can cause low back injuries?

Many things can cause low back injuries - muscle strain or spasm, sprains of ligaments (which attach bone to bone), joint problems or a "slipped disk." The most common cause of low back pain is using your back muscles in activities you’re not used to, like lifting heavy furniture, playing basketball or doing yard work.

A slipped disk happens when the disk between the bones bulges and presses on nerves. This is often caused by twisting while lifting; however, many people won’t know what caused their slipped disk.

Back pain can also follow normal activities such as bending over the sink to brush your teeth.

Back pain may be made worse by stress, long periods of inactivity or being in an unusual position for a long time.

Call your doctor if

	Pain goes down your leg below your knee.
	Your leg, foot, groin or rectal area feels numb.
	You have fever, nausea or vomiting, stomach-ache, weakness, or sweating.
	You lose control over going to the bathroom.
	Your pain was caused by an injury.
	Your pain is so intense you can’t move around.
	Your pain doesn’t seem to be getting better after two to three weeks.

What should I do when I’ve hurt my lower back?

The best position for relief when your back hurts is to lie on your back on the floor with pillows under your knees, with your hips and knees bent and your feet on a chair or just with your hips and knees bent. This takes the pressure and weight off your back. If you’re resting a hurt back, you may need a day or two of this sort of rest. Resting longer than this can cause your muscles to weaken, which can slow down your recovery. Even if it hurts, walk around for a few minutes every few hours.

If you’re resting a tired back, stay in one of these positions for five to 25 minutes at a time. Heating pads can help to relax painful muscle spasms. Use heat for 20 to 30 minutes at a time. Ice packs and massages may also give relief. Medicines that reduce pain or swelling include ASA (some examples are Aspirin, Entrophen), ibuprofen (some examples are Advil, Medipren, Motrin IB) and acetaminophen (some examples are Panadol, Tylenol).

Is there relief for ongoing back problems?

Treatment of ongoing back problems must be directed at the cause. This may mean losing weight (because being overweight can make back pain worse), getting your muscles in better shape, and improving your posture when you’re standing, sitting and sleeping. Stretching and strengthening exercises are most effective in improving pain and function respectively. Most people feel much better within a few weeks. Serious problems are rare.

Tips for preventing back strain

	Don’t lift by bending over. Lift an object by bending your hips and knees and then squatting to pick up the object. Keep your back straight and hold the object close to your body. Avoid twisting your body while lifting.
	Push rather than pull when you must move heavy objects.
	If you must sit at your desk or at the wheel of a car or truck for long hours, break up the time with stops to stretch.
	Think about your posture.
	Wear flat shoes or shoes with low heels 2.5 cm (1 inch) or lower.

What’s the best position for standing?

If you must stand for long periods, rest one foot on a low stool to relieve pressure on your lower back. Every five to 15 minutes, switch the foot you’re resting on the stool. Move around as much as you can. Maintain good posture: keep your ears, shoulders and hips in a straight line, with your head up and your stomach pulled in.

What’s the best way to sit?

Sitting puts more pressure on your back than any other position, even more than standing. To reduce this pressure, sit in chairs with straight backs or low-back support. Keep your knees a little higher than your hips. Adjust the seat or use a low stool to prop your feet on.

Turn by moving your whole body rather than by twisting at your waist. Use a swivel chair to help reduce twisting.

When driving, sit straight and move the seat forward. This helps you not lean forward to reach the controls. You may want to put a small pillow or rolled towel behind your lower back if you must drive or sit a long time. However, these measures may not prevent back pain entirely.

What’s the best position for sleeping?

The best way to sleep to reduce the pressure on your back is on your side with your knees bent. You may put a pillow under your head to support your neck. You may also put a pillow between your knees.

If you sleep on your back, put pillows under your knees and a small pillow under your lower back. Don’t sleep on your stomach unless you put a pillow under your hips.

Use a firm mattress. If your mattress is too soft, use a board of 1.3 cm (1/2 inch) plywood under the mattress to add support.

What exercises can I do to help my back?

Some specific exercises can help your back. One is to gently stretch your back muscles. Lie on your back with your knees bent and slowly raise your left knee to your chest. Press your lower back against the floor. Hold for five seconds. Relax and repeat the exercise with your right knee. Do 10 of these exercises for each leg, switching legs.

While some exercises are specific for your back, it’s also important to stay active in general. Bicycling or walking are good overall exercises to improve your fitness.

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.