Get a Diagnosis

Understanding what causes a sore lower back is the first step toward recovery—and prevention. Here are the most common injuries.

Feb 16, 2007
Outside Magazine
Q & A

How long should I stay in bed after a back injury?
As little as possible. Inactivity reduces blood flow essential to healing and, most significantly, prevents your back muscles from staying strong. "There's no danger in getting up and moving around," says Dr. Marjorie Eskay-Auerbach, a Tucson-based orthopedic surgeon and expert in lower-back care. "Use your pain as a guide and do whatever you can tolerate. That might mean putting the mountain biking on hold, but you can probably still go for a walk." Swimming and riding a stationary bike are other recommended low-impact recovery activities.

Human Back


1. Lumbar Strain
WHAT IT IS: An unfortunately vague diagnosis that accounts for about 90 percent of all lower-back injuries. It's caused by a pull or tweak of any of the muscles, ligaments, connective tissue, joint capsules, or cartilage in your lower back. HOW IT HAPPENS: Lift something heavy without bending your knees, land awkwardly, wake up with a random soreness—all are probably strains or sprains. WHAT IT FEELS LIKE: A hard-to-pinpoint ache or stiffness that can radiate into your rear end. PROGNOSIS: With proper rest and low-impact exercise, most cases remedy themselves within three months. The bad news: It often recurs.

2. Herniated Disc
WHAT IT IS: A tear in the outer fibers of a disc, the shock-absorbing pad between the vertebrae, which may cause the disc's jellylike nucleus to push through the fibers. Also called a slipped or ruptured disc. HOW IT HAPPENS: Causes can be similar to those of a strain or sprain. Discs also lose fluidity with age. WHAT IT FEELS LIKE: If minor, you'll feel the type of ache associated with a lumbar strain. The discomfort becomes worse if the slipped disc presses against a nerve; even more acute if the disc rubs against the sciatic nerve, causing shooting pain (called sciatica) and possible numbness in one leg. PROGNOSIS: More than 95 percent of people recover through rest and therapy. Steroid injections, which control pain and swelling for several months, are a common treatment for the hardest to cure.

3. Compression Fracture
WHAT IT IS: A break in the bone structure of the vertebra. It's most common in the vertebrae about two-thirds of the way down your back. HOW IT HAPPENS: A sudden impact coupled with flexing your back—think of lurching forward when smacking hard on the landing of a big jump on a bike or skis. WHAT IT FEELS LIKE: Intense pain directly on the spine where the fracture has occurred. PROGNOSIS: You'll typically wear a back brace for upwards of six weeks while the fracture heals.

4. Spondylolysis
WHAT IT IS: Something as bad as it sounds, unfortunately: a crack in the solid part of the vertebra. Like a herniation, it occurs at the base of the spine. Worse still is isthmic spondylolisthesis, a crack that forces a vertebra to slip over the one below it. HOW IT HAPPENS: Some 4 to 8 percent of people are born with the defect. It can develop into isthmic spondylolisthesis, which can occur during growth spurts or as a result of repetitive exercise, like a stress fracture. WHAT IT FEELS LIKE: Either one can cause pain that's no different from the typical strain or sprain; amazingly, in some cases there are no symptoms at all. PROGNOSIS: Taking a break from pain-causing activities and doing core-strengthening exercises is usually sufficient, though surgery may be required.

Filed To: Back, Injury Prevention

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