The back is a complex structure made up of bones, muscles, nerves and joints (the spine). Back pain can, therefore, be due to problems of different structures and, in general, it is not serious situations such as muscle tension or alterations of the vertebrae or by an "inflammation of the nerves. This can make it difficult to identify the exact cause of the pain: Back pain is usually not caused by severe damage.



Back pain can be caused by a variety of triggers, including performing daily or repetitive activities performed at home or at work.

Possible causes of back pain are:

  • uncoordinated push-ups of the torso
  • lifting, carrying, pushing and pulling of heavy objects
  • incorrect sitting position or sitting for long periods
  • incorrect torsion of the torso
  • overexertion
  • curved position while driving
  • excessive strain on the muscles during physical activity or repetitive execution of the same movement (overwork syndrome of the arms and upper back)

Back pain usually occurs suddenly, for no apparent reason. For example, it can appear in the morning when you wake up without an obvious cause.

Factors that favor the onset of back pain

Some conditions can increase the chance of developing back pain:

  • overweight, excess weight puts pressure on the spine; to assess whether it is appropriate to lose weight, you can calculate your body mass index (BMI) which relates weight to height
  • smoke, tissue damage in the back area can result from smoking or a tendency to lead an unhealthy lifestyle
  • pregnancy and postpartum, excess load can generate additional strain in the back
  • long-term use of medications that lead to weakening of the bones, for example corticosteroids
  • state of stress or depression


In some cases, the ailments (symptoms) caused by back pain can be determined by a specific disease or condition such as:

  • pain in the lower back, associated with numbness or tingling that extends to the entire leg; may be a symptom of inflammation of the sciatic nerve (sciatica), slipping of a vertebra or prolapse of an intervertebral disc
  • joint pain (including the back), due to inflammation of the joints (arthritis) which can cause stiffness or pain upon awakening. family
  • shoulder pain and stiffness that make dressing difficult, driving or sleeping and which could be symptoms of frozen shoulder
  • pain and stiffness in the neck, headache and back pain following a car accident can be symptoms of whiplash

Rarely, back pain can be a sign of a serious illness such as a fracture or "spine infection or cancer."



Most cases of back pain do not require medical attention and can be resolved by using over-the-counter pain relievers and self-care.

However, in the presence of pain that is difficult to contain or that causes concern, you should consult your doctor.

Contact your family doctor

The doctor will evaluate the symptoms and examine the back. Usually, he will test the ability to sit or stand, to walk, and to bend the legs. In addition, the doctor will ascertain the degree of looseness in the back and ask for information on any illnesses or trauma that have occurred, the type of work performed and the lifestyle observed. Some questions the doctor might ask the person with back pain are:

  • when did back pain start?
  • where is the pain present?
  • have you suffered from back problems in the past?
  • can you describe what kind of pain you feel?
  • what makes the pain sensation better or worse?

If your doctor sees fit, they may ask you to do additional tests, such as an X-ray or MRI. Otherwise, he will prescribe the treatments to follow to alleviate the pain and speed up recovery, and will advise on what to do to avoid until the pain is gone.



Treatment for back pain varies according to the duration of the pain, its intensity and the needs or preferences of each person.

Temporary back pain

Back pain is initially treated by taking over-the-counter pain relievers (meaning they do not require a prescription) and with treatments to follow at home. In the majority of cases, appreciable improvements in symptoms are noted within six weeks.


In the past it was believed that bed rest was helpful in recovering from bad back pain but, now, it is recognized that people who remain active are more likely to recover in a short time. If the pain is severe, moving can be difficult but it is advisable to do it gradually every day, increasing the duration more and more. The exercise to be performed may simply consist of walking near or inside the house enduring some discomfort but stopping if the pain becomes intense. To resume work, you do not need to wait for the pain to stop completely; returning to work allows you to resume normal lifestyle and distracts from the thought of pain.

Pain relievers

Paracetamol is one of the drugs recommended as a first treatment for back pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be recommended. A powerful pain reliever, such as codeine, may be an alternative to acetaminophen and, in some cases, may be added to it. Before taking medicines, it is advisable to consult with the treating doctor who, knowing the health status of the people he cares for, will be able to indicate the most suitable medicine for each case. Painkillers, like all medicines, can cause unwanted effects (side effects), even serious ones, can be addictive, can interact negatively with other drugs taken at the same time and can be contraindicated in some diseases.

If over-the-counter pain relievers fail to relieve pain, your GP may prescribe other medicines such as muscle relaxants that reduce back muscle contractions.

Treatments with heat and cold

Some people find it beneficial to apply heat to the painful area, such as a hot bath or hot water bottle; others find a cold treatment, such as an ice pack or a bag of frozen products, more effective. A variant to reduce pain may consist of "alternating hot and cold packs. However, it should be considered that the application of a hot or cold pack should not be in direct contact with the skin to avoid burns: the pack should be wrapped in a light cloth before applying it to the skin.

Relaxation and positive attitude

Relaxing is crucial to relieving pain as the muscle tension caused by a state of agitation can make the situation worse.

Change your sleeping position

Changing positions during sleep can release tension and relieve back pain. If you are sleeping on your side, it may be helpful to bring your legs slightly towards your chest and place a pillow between your legs. If you sleep on your back, place the pillow under your knees to preserve the normal curvature of your back.

Physical activity and lifestyle

To avoid new attacks of back pain it is advisable to try to recognize the causes that triggered it. The most frequent are overweight, wrong positions and stress. Regular exercise every day helps keep your back strong and healthy. Activities such as walking, swimming, yoga are the most common choices. The important thing is to choose an enjoyable activity that you will benefit from without experiencing pain.

Chronic back pain

If back pain persists beyond six weeks (chronic back pain), your GP may prescribe pain relievers and advise you to:

  • take a gymnastics class taught by qualified instructors to strengthen and stretch (stretch) the muscles, do aerobic activity and improve posture
  • follow a manual therapy with manipulations, mobilizations and massages, usually performed by physiotherapists, chiropractors and osteopaths (although chiropractic and osteopathy are not practices dispensed by the National Health Service in all Regions). It is important to ensure that these treatments are performed by highly specialized personnel
  • undergo acupuncture, a practice that uses thin needles inserted in specific points of the body and which, in some cases, is effective for reducing back pain. It is not always available free of charge by the National Health Service

These treatments have often proved effective when back pain prevents normal daily activities.

Other treatments

Antidepressant drugs

If pain relievers have not been effective, your doctor may prescribe tricyclic antidepressant drugs (TCAs) such as amitriptyline. These are medicines originally intended to treat depression that have also been shown to be effective in persistent pain. , the dose is very small.


Psychotherapy is recommended when common treatments have not worked. In the presence of severe back pain, the perception of one's state of suffering can make the situation worse. Therapies such as cognitive behavioral therapy (CBT) can help manage back pain by changing its perception.

Pain therapy

In case of chronic back pain, a pain therapy specialist may be consulted. There are programs that help manage pain and indicate how to increase your level of physical activity and how to have a better quality of life while living in pain. Such programs may include a combination of group therapy, physical activity, relaxation techniques and training sessions on what pain is and how to deal with it on a psychological level.


Back pain surgery is only envisaged in cases where alternative treatments have failed or when the pain becomes so intense that it prevents you from sleeping or performing normal daily activities. The type of surgery depends on the type of back pain and its causes Two of the techniques that are sometimes applied are:

  • discectomy, consists of removing fragments of the intervertebral discs, in order to stop the pressure they exert on the nerves (a condition known as slipping of a vertebra or prolapse of an intervertebral disc)
  • spinal fusion, consists in the union of two or more vertebrae with a bone graft to stabilize the spine and reduce pain

These surgical techniques can help reduce pain caused by nerve compression but do not always give positive results as complications can occur.In some cases, the nerves near the spine can be damaged and lead to numbness or weakness in one or both legs and, in rare cases, a form of paralysis. Before undergoing surgery, it is necessary to discuss the risks and benefits of the operation with the surgeon and be sure that you have understood them well in order to be aware of the consequences.

Treatments not recommended

There are a number of treatments used, sometimes, to treat chronic back pain but which are not recommended due to the lack of evidence on their effectiveness for treating non-specific back pain (back pain with no known cause):

  • low-frequency laser therapy, consists of directing low-frequency laser energy on the back to reduce inflammation and stimulate tissue reconstruction
  • interference therapy (IFT), consists in passing, through a device, a flow of electric current through the back to accelerate healing, stimulating the production of endorphins (the body's natural painkillers)
  • ultrasound therapy, consists in "directing ultrasounds on the back to accelerate healing and stimulate the reconstruction of the tissue
  • transcutaneous electrical nerve stimulation (TENS), it consists in conveying on the back, through a specific instrumentation, low discharges of electricity through electrodes (small adhesive patches) applied to the skin; the electrical impulses stimulate the production of endorphins and inhibit the transmission of pain from the spine to the brain
  • lumbar support, shock cushions and braces used to support the spine
  • traction, consists in exerting a "force action on the back with an appliance
  • injections, infiltration of a painkiller directly into the back


Keeping your back strong and flexible is the best way to avoid feeling pain again. Exercising, maintaining proper body position, and lifting weights correctly can help prevent this.

If back pain recurs over time (recurring) it may help:

  • lose weightif overweight, excess weight can put strain on the lower back; to evaluate whether it is appropriate to lose weight, it is possible to calculate your body mass index which relates weight to height
  • wearing flat shoes with cushioned insoles,which can relieve pressure on your back
  • avoid sudden movements,which can cause muscle tension
  • reduce sources of stress, anxiety and tension, possible causes of back pain or its worsening
  • keep activeRegular physical activity, such as walking and swimming, is an excellent way to prevent back pain

Physical activity

Physical activity is an excellent way to prevent back pain and reduce pain. In case of pain that has lasted for 6 weeks or more, you must follow a program developed by your doctor before starting physical activity. Walking or swimming strengthens the muscles that support the back, without exerting tension or straining the back to jerks. Yoga and pilates improve flexibility and strengthen the back muscles. The important thing is to practice these activities under the guidance of a qualified professional.

Some simple exercises can be done at home and repeated several times each day to prevent or ease back pain:

  • pelvic stretches, kneel leaning on the four limbs, with the knees in line with the hips and hands in line with the shoulders. Slowly bring your pelvis back trying to sit on your heels and maintaining the natural curve of the spine. Remain in the stretch position for the time of one deep breath (at least 20 seconds) and return to the starting position. Stop if you feel pain and reduce the stretch. Repeat the exercise 8 to 10 times
  • rotation of the legs, lie down with your stomach up (supine) and rest your head on a flat pad or book. Bend the legs (flexed), keep the feet on the ground, bring the knees together and slowly rotate them to one side towards the floor, keeping the shoulders close to the ground. Maintain the stretch for the time of a deep breath (at least 20 seconds) and return to the starting position. Repeat the exercise 8 to 10 times, alternating sides
  • back extensions, lie down with your stomach on the ground (prone) and lean on your elbows. Arch your back while pushing down with your hands. Breathe in and hold your breath for 5 to 10 seconds. Return to the starting position. Repeat the exercise 8 to 10 times

Stop these exercises right away if the pain gets worse.

Body position (posture)

The way you sit, stand or lie down can have major consequences for your back. The correct body position involves:

Upright position

Stand up straight, with your gaze forward and your back straight. Keep your balance on both feet, keeping your legs aligned.

Sitting position

Make sure you sit upright with a support at kidney height - a small flat pillow or rolled towel to support the kidneys may help. The knees should be in line with the hips and the feet should be completely flat on the floor with "use of a rise if necessary. If you are using the computer keyboard, be sure to keep your forearms horizontal with your elbows at right angles.

Driving position of the car

Make sure your lower back is resting on adequate support. Correctly adjust the side mirrors to avoid twisting with the torso. The pedals must be exactly in front of the feet. When driving long distances, take breaks to do leg stretches.

Position during sleep

The mattress should be firm enough to support the body, supporting the weight of the shoulders and pelvis, in order to keep the spine straight. If the mattress is too soft, insert a hard board underneath (2 cm thick is ideal). The head should be supported by a pillow and the neck should not be in an angled position.

Lift and carry weights

One of the biggest causes of back injuries, particularly in the workplace, is lifting or handling objects improperly. Learning and applying the correct method to perform these activities helps to avoid back pain:

  • before lifting a weight, evaluate if you are able to do so, whether handles can be used and where the object to be lifted must be stored
  • assume a correct position, feet must be spaced apart, with one leg slightly forward to keep balance; when lifting, make sure that the legs are supporting the weight; slightly flex the knees while keeping the back straight without bending it, contract the muscles of the abdomen to pull in the pelvic area; lift the weight by straightening your legs
  • keep the weight close to the waist because the heavier the load, more must be kept close to the body for as long as possible
  • avoid twisting your back or leaning sidewaysespecially when the back is bent. Shoulders should be aligned with the hips; turning around while moving the feet is preferable to twisting the torso
  • keep your head up and gaze forward and not towards the weight
  • know your limits if you are unsure if you can safely lift a weight, get help
  • push rather than pull, if you have to move a heavy object on the floor, it is better to push it than to pull it
  • distribute weight equally on both sides of the body whenfor example, shopping bags or suitcases are carried

Guys who go to school should use a well-thought-out backpack that can be worn on both shoulders. Avoid loading yourself with unnecessary items, in order to minimize the weight of your backpack or bag.

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