American Medical Association Family Medical Guide - American Medical Association [707]
Common Sites of Back Pain
Back pain is usually centered in three common places: the lower back, the coccyx, and the area around the sciatic nerve. See your doctor whenever you have back pain that persists for more than 3 or 4 days.
Lower Back Pain
Pain in the lower part of the back is centered in the small of the back and spreads out from there. It is often caused by unusual exertion, such as moving furniture or digging in the garden. It may develop suddenly or gradually and can be mild or severe. Sometimes you may be completely unable to move. Doctors disagree about the exact cause of lower back pain, but it probably results from a combination of pulled or strained muscles (see page 983), muscle spasms, and sprained ligaments (see page 983).
Coccyx
Pain in the area of the coccyx, at the base of the spine, can be continuous and worsen when you sit. Pain in the coccyx may be caused by falling on or otherwise hitting the base of the spine. Women may temporarily experience pain in this area after giving birth. You may be able to relieve the pain by sitting on a soft cushion designed specifically for this purpose.
Sciatic Nerve
The sciatic nerve is the longest nerve in the body. It branches out to the lower part of the body through the buttocks and down each leg. Sciatica is pain caused by pressure on the sciatic nerve as it leaves the spinal cord. The pressure is usually caused by a prolapsed disk (see next page) or osteoarthritis (see page 996) in the spine. You may feel burning pain shooting into your buttocks and down the back of your thigh, along with numbness and tingling. The pain may get worse if you cough, sneeze, or move your back in any way.
Common sites of back pain
Nonspecific Backache
Backaches are a common health problem. The pain occurs most frequently in the lower back, around the coccyx (a small, triangular bone at the base of the spine), and around the sciatic nerve (the longest nerve in the body, which extends from the lower end of the spine to the foot).
The vast majority of backaches have no specific cause—many different factors can be involved. Most nonspecific backaches are caused by muscle strain and injury to the surrounding ligaments (bands of tough, elastic tissue that hold bones together) or joints in the spine. The pain may begin after lifting a heavy object, falling, holding your body in an awkward or cramped position for some time, or performing an exercise or activity that you have never done before. Some people have back pain when they are under stress, just as other people get tension headaches.
Symptoms
A nonspecific backache is often very painful and can interfere with your daily routine. The pain, usually with stiffness, may develop slowly or suddenly, may be continuous or occur sporadically, or may occur only when you are in a particular position. Coughing, sneezing, or bending and twisting your back may worsen the pain. The pain may be localized in only one region of the back or travel from one area to another.
Diagnosis and Treatment
The cause of a backache can be difficult to determine. After examining your back, your doctor may order X-rays of your spine to rule out osteoarthritis (see page 996) or another disorder. The doctor probably will recommend the self-help measures at right to try for a few days to see if the pain goes away. Gentle massage performed by someone who is well trained and experienced may provide temporary relief of your symptoms. If the pain persists for more than 3 or 4 days, your doctor may prescribe pain relievers or a muscle-relaxing drug. Although nonspecific backaches may recur, they usually heal without treatment or complications. Exercising to stretch and strengthen the abdominal and back muscles can help prevent recurring backaches (see next page).
Prolapsed Disk
Between each vertebra is a disk made up of a fibrous outer layer surrounding a jellylike inner substance