UNC Health Talk

A Back Pain Action Plan

Nearly everyone will experience some form of back pain in his or her lifetime. Low back pain is the second most common reason Americans visit a doctor (cold and flu symptoms are first). Back pain can result from everyday wear and tear on the body, sports or recreational activities, work-related tasks and being under a lot of stress.

But if you’re experiencing back pain, knowing you’re not alone doesn’t bring you relief.

UNC Health primary care sports medicine physician Nailah Adams, MD, shares what every person with back pain needs to know to feel better.

The Basics of Back Pain

There are three types of back pain: acute, which is short term, lasting less than four weeks; subacute, which lasts four to 12 weeks; and chronic, which is long term. Pain can occur anywhere in the back, but the lower back is the most common spot, Dr. Adams says.

Low back pain can vary from sharp and stabbing, cramping in a spasm, to a burning or dull ache. It can be a consistent pain, intermittent or positional, depending on how you move.

Causes of Back Pain

Acute back pain is most often caused by sudden injury to the muscles and ligaments supporting the back. Sometimes this can happen at work—1 in 4 working adults has low back pain, though not necessarily because of their job—but acute pain can also be caused by injuries from exercise, household labor, child care and any other aspect of daily life.

“You can experience low back pain after falling, twisting, bending, lifting with poor posture, or sitting in a position that doesn’t support the spine as much,” Dr. Adams says.

Chronic back pain can be a result of underlying conditions including arthritis, herniated or bulging discs, inflammatory diseases, spinal stenosis or fibromyalgia. But for many people, the cause remains undetermined.

“About 85 percent of patients who present to the doctor’s office with low back pain are diagnosed with ‘nonspecific’ low back pain, meaning there is no clearly identified culprit such as a disease or change in anatomical structure,” Dr. Adams says. (Fortunately, you don’t necessarily need to know the cause to treat the pain.)

Smoking increases your risk of low back pain, as does having obesity, cancer or being an older adult. Some people are genetically predisposed to back problems, and stress, anxiety and depression can cause muscle tension that results in back pain.

Back Pain Red Flags

If your low back pain is accompanied by fever, night sweats or unintentional weight loss, see your doctor to rule out any type of cancer. If you experience severe numbness, tingling or weakness in the legs, it could be a sign your spinal cord is being squeezed, and you’ll want to seek care right away. The same advice applies if you have back pain along with bowel or bladder control problems.

Try This to Alleviate Low Back Pain

Dr. Adams says that if you are not experiencing any of the red flags mentioned above, then try these four steps to get relief.

1. Exercise—gently—as soon as you can.

Take some time to rest from strenuous activity but get up and move as soon as possible. Dr. Adams says bed rest is not recommended because engaging in physical activities (taking a walk or other gentle exercise) can help enhance blood flow to the tissues in your lower back and improve muscle strength. Take it easy, though; while your back is injured, you’ll want to avoid high-impact or intense workouts or physical labor. Lifting heavy things and sudden or excessive twisting are especially dangerous for an injured back.

When you feel up to it, it might help to focus on core exercises, which have been shown to reduce low back pain and build strength, Dr. Adams says. She recommends planks, side planks, bird dogs and pelvic tilt exercises.

2. Take over-the-counter medication.

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation.

“If someone does not have any stomach, kidney or liver conditions, they can take ibuprofen or naproxen. Tylenol would be a reasonable alternative to take as well,” Dr. Adams says.

3. Apply heat or ice.

Applying heat or ice may help alleviate local pain that comes from muscle and ligament strain. Some studies have shown that applying heat will help reduce a muscle spasm and it can be helpful for a patient with an acute injury, Dr. Adams says.

Ice can help with swelling and inflammation because it acts as a local anesthetic. However, heat and ice only provide temporary relief and are not enough to treat more serious causes of back pain.

4. Talk to your doctor for next steps.

If at-home care isn’t working, call or visit your doctor. He or she may order imaging tests and/or refer you to a physical therapist. A physical therapist can assess your body alignment and movement patterns to identify what actions cause pain, and then take you through exercises to improve strength and flexibility.

“Physical therapists aim to reduce fear of movement and build strength and confidence to get a person back to their active selves as quickly and safely as possible,” Dr. Adams says.

Some people also find relief with acupuncture, which is the careful insertion of very thin needles by a trained acupuncturist into the skin, where they can stimulate muscles, nerves and connective tissue, Dr. Adams adds.

“Acupuncture is one of the oldest healing practices in the world, and studies have shown it works for acute low back pain and is even more effective in relieving chronic low back pain,” she says.


If you’re experiencing back pain, contact your doctor. Need a doctor? Find one near you.