80% of people have sought help for an aching back at least once. The commonest cause for low back pain is muscle strains or injury to the soft tissues in the back. Other causes include degeneration (breakdown) of the discs that cushion your spine. These discs may slip forward and press on nerves. Inflammatory chemicals are released with injury or degeneration of the discs. These chemicals irritate and inflame the spinal (sciatic) nerves causing numbness and tingling down the legs. The symptoms of back injury are pain in the lower back that may sometimes spread down either or both legs. Leg pain is called sciatica. Back pain may also result from injuries from a fall or heavy lifting. Sometimes back pain may be due to tightening (spasm) of the back muscles due to inflammation and excessive firing of the motor nerves that supply the back muscles. Stress, Infection, cancer and damage to the nerves result in inflammation and may also produce back pain.

The technique of proper lifting is important. The farther from your body you hold an object you are lifting, the greater the potential for damage to your disc. Bend from your knees and keep the object close to your body when you lift. Do not twist, bend or reach while lifting as this can increase stress on the back. Back muscles play an important part in stabilizing the spine; enabling it to carry the body's weight and to withstand stress. Most back problems are related to muscle strength. When these muscles are strong the chances of injury are much less. Aerobics or regular exercise e.g. walking or biking for up to 20 30 minutes daily can build strength and flexibility in the back muscles. Water aerobics (in a swimming pool) enable you to exercise your back with less discomfort because in water, you weigh only 10% of your body weight. If you are overweight, you need to lose weight to reduce the stress on your joints. For every ten pounds you lose, you save 200 pounds of stress on your joints. Avoid sitting too long and try standing at intervals. If you drive long distance, stop frequently to walk around. On the other hand, if your work requires you to stand for prolonged periods of time, then shoe insoles may be helpful. Correct posture is important. Use a firm mattress or bed board while you sleep or rest in bed. Whenever possible sit in recliners or straight back chairs that have armrests and adjustable lumbar supports. If you do not have such a chair, you may use a regular chair and place a support pillow or rolled towel against the lower curve of your back while you sit. If you smoke, you should try to quit. Smoking may reduce blood flow to the discs in your back and cause premature breakdown. For backache, you may take aspirin or other over-the-counter pain relievers such as Tylenol. These medications decrease the production of prostaglandins that cause pain. Take the medicines with food to prevent stomach upset. If you are overweight, you need to lose weight to reduce the stress on your back. Keep your weight down by reducing fats, cholesterol and sugar.

A day or two of rest may offer some relief but more rest may delay your recovery. Sleep on a firm mattress or hard floor. The most comfortable position is usually lying on your side with knees bent. You may find additional relief by using one pillow to support your head and putting another between your legs. Avoid lying flat. Whether on your back or on your stomach, lying flat puts too much stress on your lower back. If you must lie on your back, have your knees propped up by a pillow. Take pain relievers, such as aspirin or Tylenol. Take herbal supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts . These contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. If you have been injured, apply ice packs two or three times a day for one or two days. Exercises to strengthen your back muscles are very important and can be done at home (see below). If your back pain is not due to a recent injury, your doctor may give you deep heat treatment with ultrasound or diathermy machines. Deep heat allows the tissues to heal faster and reduces the pain and muscle spasm. Your doctor may prescribe medications such as muscle relaxants to ease the tension in your back muscles. A good relaxant is Lioresal or Zanaflex (Tizanidine). Both of these medications are very effective and specific muscle relaxants and do not make you as drowsy as the other relaxants e.g. Robaxin, Soma, Flexeril. Zanaflex also has anti-inflammatory properties. If you have sciatica (nerve pain running down your leg), your doctor may also prescribe antidepressant medication like Elavil or Lexapro or Vivactil. St. John's Wort, a herbal antidepressant is also effective. These medications have been found not only to help with depression but also to relieve sciatica and other types of nerve pain. Other drugs that help control sciatic nerve inflammation and symptoms of numbness and tingling include a subcutaneous injection of the biologic drug Kineret as well as an intravenous (IV) or intramuscular (IM) injection of cortisone, plus an IV infusion of the anti-seizure drug Depacon combined with IV infusion of magnesium sulfate and IV mini bolus doses of Ketamine. To ease the pressure and stress on your back, you may use a back brace to support yourself until you exercise and strengthen your back and abdominal muscles. A strong but gentle anti-inflammatory medication is Tolmetin sodium. It is 10 times stronger than Motrin and very effective if some of the pain is due to arthritis of the spine. Strong short acting pain medications such as Vicodin ES or Norco 10 may be given. If you have chronic low back pain, you may need a long acting narcotic medication like Oxycontin which is taken twice daily. The short acting pain medications are then used in between for relief of breakthrough pain. These pain killer drugs should be used carefully so that they do not produce drug dependency. If you have had backache for less than six weeks duration, your doctor may not prescribe X rays. This is because most backaches are caused by soft tissue such as muscles, ligaments or discs that don't show up on X rays. However your doctor may order X-rays, CT scans, bone scans or MRI if your backache does not get better or if he or she suspects a specific problem with your back such as degenerating discs, spinal curvature, arthritis of the back joints (facet joints), cancer or fracture. With chronic backache, you may sometimes get relief from electrical stimulation devices (such as TENS units) which transmit short electrical impulses that trigger the release of the body's natural pain killing hormones. Acupuncture can reduce inflammation and swelling and is effective in many people. Acupuncture involves treatment of pain by inserting tiny solid needles at various points and depths in the skin. These needles may be manipulated by hand or electrically stimulated. The pattern of needle placement is governed by a series of body points described in ancient Chinese texts. Each body point represents an internal body part. The actual placement of the needles is based on the practitioner's interpretation of the distribution of the yin (cold or low function) and yang (heat or high function) in a particular body part. Spinal manipulation is another effective treatment that is often done by a chiropractor. Treatments typically consist of short level thrusts to the spine. Lumbar traction or can also be done by your doctor or chiropractor. These can be quite helpful and may be combined with massage, traction, ultra sound or muscle stimulation. You can also purchase some home traction units. Your doctor may use biofeedback or meditation to help you learn to relax. In some instances, your doctor may perform an epidural or facet injection of steroids and anesthetics such as Lidocaine. These medications are injected into your back and decrease inflammation and nerve pain from bulging discs, or degenerative back joints (facet joints). In severe cases of back pain, a little tube may be implanted in the back (epidural or spinal catheter) to allow continuous or intermittent delivery of pain medication to the nerves coming out of the spine. Prolotherapy is another type of treatment with injections of highly concentrated Dextrose and Lidocaine to strengthen the ligaments of the back. Surgery is sometimes necessary if there is weakness in the legs, bladder or bowel problems or severe back pain which does not get better with medical treatment. Always do the least surgery that is needed to treat your pain such as a discectomy. You should only undertake fusion or artificial disc replacement surgery as a last resort as it has a higher incidence of complications.