In most episodes of low back pain, a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain.[1][4] If the pain does not go away with conservative treatment or if it is accompanied by "red flags" such as unexplained weight loss, fever, or significant problems with feeling or movement, further testing may be needed to look for a serious underlying problem.[5] In most cases, imaging tools such as X-ray computed tomography are not useful and carry their own risks.[9][10] Despite this, the use of imaging in low back pain has increased.[11] Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause.[5] In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events.[12]
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
Low and lower back pain can vary from dull pain that develops gradually to sudden, sharp or persistent pain felt below the waist. Unfortunately, almost everyone, at some point during life will experience low back pain that may travel downward into the buttocks and sometimes into one or both lower extremities. The most common cause is muscle strain often related to heavy physical labor, lifting or forceful movement, bending or twisting into awkward positions, or standing in one position too long.
Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back.[4] Pain can vary from a dull constant ache to a sudden sharp feeling.[4] Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).[3] The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.[5] The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people completely better by six weeks.[2]
Nonsteroidal anti-inflammatory drugs (NSAIDS) relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
How to: Stand tall, feet slightly wider than shoulder-width apart, toes pointed out at 45-degree angles (a). Keep your back straight, knees over toes and your weight in the heels of your feet (b). Engage your glutes and thighs as you lower into a deep squat until thighs parallel to the ground (or as close as you can get them) (c). Powering through your heels, push up to return to starting position (d). Repeat.

Initial management with non–medication based treatments is recommended.[6] NSAIDs are recommended if these are not sufficiently effective.[6] Normal activity should be continued as much as the pain allows.[2] Medications are recommended for the duration that they are helpful.[13] A number of other options are available for those who do not improve with usual treatment. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects.[4][13] Surgery may be beneficial for those with disc-related chronic pain and disability or spinal stenosis.[14][15] No clear benefit has been found for other cases of non-specific low back pain.[14] Low back pain often affects mood, which may be improved by counseling or antidepressants.[13][16] Additionally, there are many alternative medicine therapies, including the Alexander technique and herbal remedies, but there is not enough evidence to recommend them confidently.[17] The evidence for chiropractic care[18] and spinal manipulation is mixed.[17][19][20][21]


Coccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
The discs are pads that serve as "cushions" between the individual vertebral bodies. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central, softer component (nucleus pulposus) and a surrounding, firm outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating as in a herniated disc) through the outer ring, causing irritation of adjacent nervous tissue and sciatica as described below. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.
Along with these exercises, it's also important to do some supplementary exercises to work your hip's supporting muscles. You've probably heard of your shoulder's rotator cuff. Well, your hip also has a cuff, or a group of muscles that help stabilize and support movement. For these exercises, you'll need a mini-band, a longer thera-band or tubing (both are sold at many sporting goods stores, or can be purchased online), and a cable-column unit.
Initial management with non–medication based treatments is recommended.[6] NSAIDs are recommended if these are not sufficiently effective.[6] Normal activity should be continued as much as the pain allows.[2] Medications are recommended for the duration that they are helpful.[13] A number of other options are available for those who do not improve with usual treatment. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects.[4][13] Surgery may be beneficial for those with disc-related chronic pain and disability or spinal stenosis.[14][15] No clear benefit has been found for other cases of non-specific low back pain.[14] Low back pain often affects mood, which may be improved by counseling or antidepressants.[13][16] Additionally, there are many alternative medicine therapies, including the Alexander technique and herbal remedies, but there is not enough evidence to recommend them confidently.[17] The evidence for chiropractic care[18] and spinal manipulation is mixed.[17][19][20][21]
Long periods of inactivity in bed are no longer recommended, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work. 

Marvelously progressive, concise, and cogent guidelines for physicians on the treatment of low back pain. These guidelines almost entirely “get it right” in my opinion, and are completely consistent with recommendations I’ve been making for years on PainScience.com. They are particularly to be praised for strongly discouraging physicians from ordering imaging tests only “for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected.”

Swimming is a low impact form of exercise that can help to relieve the pressure on your joints. It’s thought that water aerobics may help to reduce the impact on your joints by up to 75%!2  Be careful though; start with a beginner’s class and always do only what you’re comfortable with – try to avoid over-exercising or pushing your muscles too far!

If you have a stiff, tight or painful hip then www.HipFlexors.info will unlock your hip flexors and restore movement the way it should be. Unlocking your hip flexors instantly breathes new life, energy, and strength into your body! I experienced immediate results. I've been able to loosen up my hips, decrease back tightness, and even workout harder. With so many people suffering with hip pain out there, this program is a great tool for anybody that wants to reduce pain while improving strength, performance, and overall health. Hip flexibility, mobility and strength is one of the most important things you can do to keep your overall body healthy. The video presentation and visuals in the exercise program give me confidence that I am doing the exercises correctly which for me is key with no personal trainer. The website is very complete in listing the possible causes of tight hip flexors and other factors that can lead to the issue. It has detailed, descriptive information regarding the anatomy of the hip, causes of such injuries, and a very progressive and well explained exercise and stretching schedule that will assist to re-balance the hip and pelvic region, safely stretch and strengthen the muscle group. Best of luck to you! :) Report
Place a mini band around your ankles and spread your feet about shoulder-width apart. Keeping your legs relatively straight (you want the motion to come from your hips) and toes pointing forward, walk forward 10 steps, then backward 10 steps. Take a short break and then walk to the right 10 steps, then to the left 10 steps. Again, focus on keeping your legs straight and toes pointing forward.

When you tell your doctor your hip hurts, the first thing she should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is that they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, says Stephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, New York, and a spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.
Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any longterm benefits for people with low back pain.

Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

The hip joint is designed to withstand a fair amount of wear and tear, but it’s not indestructible. For example, when you walk, a cushion of cartilage helps prevent friction as the hip bone moves in its socket. With age and use, this cartilage can wear down or become damaged, or the hip bone itself can be fractured during a fall. In fact, more than 300,000 adults over 65 are hospitalized for hip fractures each year, according to the Agency for Healthcare Research and Quality.


AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.


Veritas Health publishes original and accessible health related content written by more than 100 physician authors and peer-reviewed by a 16 member Medical Advisory Board. The Veritas Health platform comprising of Spine-health.com, Arthritis-health.com, Sports-health.com, and Pain-health.com, provides comprehensive information on back pain, arthritis, sports injuries, and chronic pain conditions. For more information visit Veritashealth.com.
Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
^ Jump up to: a b c d e f g Hughes SP, Freemont AJ, Hukins DW, McGregor AH, Roberts S (October 2012). "The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain" (PDF). J Bone Joint Surg Br. 94 (10): 1298–304. doi:10.1302/0301-620X.94B10.28986. PMID 23015552. Archived from the original (PDF) on 4 October 2013. Retrieved 25 June 2013.
The treatment of lumbar strain consists of resting the back (to avoid reinjury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Initial treatment at home might include heat application, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and avoiding reinjury and heavy lifting. Prescription medications that are sometimes used for acute low back pain include anti-inflammatory medications, such as sulindac (Clinoril), naproxen (Naprosyn), and ketorolac (Toradol) by injection or by mouth, muscle relaxants, such as carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and metaxalone (Skelaxin), as well as analgesics, such as tramadol (Ultram).
Bridge: Still lying on your back with your feet flat on floor, lift your hips and torso off the floor into a bridge. Then interlace your hands underneath your hips and press your shoulders and upper arms into the floor, lifting your hips higher. Hold for 10 seconds. Lower yourself slowly back down, rolling down from the top of your spine to your tailbone. Repeat three times.
Swimming is a low impact form of exercise that can help to relieve the pressure on your joints. It’s thought that water aerobics may help to reduce the impact on your joints by up to 75%!2  Be careful though; start with a beginner’s class and always do only what you’re comfortable with – try to avoid over-exercising or pushing your muscles too far!
Bursitis is inflammation of the fluid-filled sacs, called bursa, that cushion areas of pressure between joints, muscles, and tendons. Bursitis is due to overuse or repetitive actions around the joints of the body. This inflammation results in pain that is experienced during movement or pressure. Treatment involves performing stretches and strengthening exercises to help relieve pressure from the bursa.
Degenerative bone and joint conditions: As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk.
The medication typically recommended first are NSAIDs (though not aspirin) or skeletal muscle relaxants and these are enough for most people.[13][6] Benefits with NSAIDs; however, is often small.[67] High-quality reviews have found acetaminophen (paracetamol) to be no more effective than placebo at improving pain, quality of life, or function.[68][69] NSAIDs are more effective for acute episodes than acetaminophen; however, they carry a greater risk of side effects including: kidney failure, stomach ulcers and possibly heart problems. Thus, NSAIDs are a second choice to acetaminophen, recommended only when the pain is not handled by the latter. NSAIDs are available in several different classes; there is no evidence to support the use of COX-2 inhibitors over any other class of NSAIDs with respect to benefits.[70][13][71] With respect to safety naproxen may be best.[72] Muscle relaxants may be beneficial.[13]
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Disk tear. Small tears to the outer part of the disk (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.
2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.

2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.
The condition is cauda equina syndrome. It involves “acute loss of function of the neurologic elements (nerve roots) of the spinal canal below the termination (conus) of the spinal cord,” where the nerves spread out like a horse (equina) tail. Again, this condition causes symptoms in the “saddle” of the body: butt, groin, inner thighs. BACK TO TEXT
Stop listening to other people’s horror stories. You know the scenario: You are bent over in obvious pain, waiting to see the doctor, and the person next to you tells you a 10-minute tale of how their Uncle Gordon had low back pain that required injections and surgery. But the pain still didn’t go away. Stop listening to these terrible stories. Most low back pain is short-lived and can be managed quite effectively with exercise and postural correction. Of course, some low back conditions are serious and require surgery, but that is a conversation you should have with your doctor, not the guy in the waiting room.

If your hips are killing you, you probably spend a lot of time sitting – in the car, at work, on that spinning seat – which puts your hips in near-constant “flexion”, says Cori Lefkowith, NASM-certified personal trainer and owner of Redefining Strength in Orange County, California. Even running involves a repetitive flexion movement that can cause pain.
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