Low Back Pain

Low back pain happens in the area known as the lumbar spine. The lumbar region includes bones (vertebrae) and disks made of cartilage and a gel-like substance that help cushion your bones.

Ligaments keep the bones of your low back in alignment, while tendons attach muscles to your spine. A network of nerves relays electrical impulses between the spinal cord and your brain. These electrical impulses help you move and may send signals that your brain interprets as pain.

There are a lot of reasons you might feel pain. It can develop when injury, a condition you’re born with (congenital) or degenerative disorders affect the lumbar region. Low back pain can be:

• Acute: Acute lower back pain is pain you feel for a short time. It typically goes away on its own with care at home.
• Chronic: Chronic pain is pain that persists (usually for three months or more). It may make it difficult to do the activities you want to do and create emotional suffering as a result.

Anyone can develop acute or chronic low back pain. Your pain may go along with other conditions, including:

• Adult scoliosis.
• Herniated disk (slipped, ruptured or bulging disk).
• Degenerative disk disease.
• Obesity.
• Osteoarthritis.
• Spinal stenosis.
• Spondylolisthesis.

Low back pain can be stressful. Feelings of fear or frustration from your pain are understandable. But they can also make your physical pain worse.

Conditions affecting the lower back can cause pain in other parts of your body too. If you have sciatica, nerves that begin in the lumbar region may cause pain in your leg.

Our medical and surgical spine and pain experts work with you to see what type of care will be a good fit for you. We talk with you about your daily activities and what you hope to get out of treatment.

We start with a physical exam. Our experts look at your posture and range of motion.

We may recommend imaging tests to rule out physical causes of low back pain, including:

• CT scan.
• MRI.
• Myelogram.
• X-ray.

You may have an electromyogram (EMG) to see how muscles and nerves in your low back are working. Our experts may also recommend neurological testing to look at your:

• Balance.
• Gait.
• Muscle strength and reflexes.
• Perception of pain.

Low Back Pain Treatment at Cleveland Clinic

Our experts use a range of therapies to treat and help you manage low back pain. Depending on your specific symptoms and diagnosis, our specialists might use:

Physical therapy for low back pain

Physical therapy specialists design specific exercise programs to relieve low back pain. You may do these exercises with our therapists and at home on your own. Our experts may also use nonsurgical spinal decompression therapy to stretch and align the muscles and bones of your spine.

Medications for low back pain

Our specialists may use pain medications to relieve your low back pain and reduce swelling (inflammation) in the lumbar region. We may recommend:

• Anticonvulsants: Medications to help reduce nerve response.
• Antidepressants: Depression medications to help change how your brain experiences pain signals.
• Muscle relaxants: Medications to loosen knotted muscle tissue.
• Pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.
• Topical medications: Creams or patches applied to your skin to relieve pain.

Interventional spine treatments

Cleveland Clinic spine experts use injections to loosen muscle knots known as trigger points. We may also use epidural injections to relieve pain. We may inject:

• Local anesthetic (medications that relieve pain).
• Corticosteroid injections (medications that reduce inflammation).

Surgery for low back pain

When low back pain causes loss of function or pain that won’t go away in your hips or legs, surgery may help. Our spinal surgeons use minimally invasive spine surgery to provide relief with faster recovery. A few examples of the sophisticated tools and techniques we use include:

• Exoscopic surgery: Surgeons use a high-definition video monitoring system (exoscope) that provides detailed magnified views of your spine. Using an exoscope and miniature instruments, surgeons remove bone and repair damage to the spine.
• Expandable cages: After removing the cushioning disc between two vertebrae, surgeons implant a plastic or metal cage between the vertebrae. This cage supports your spine, increases space in the spinal column and promotes bone growth between the vertebrae.

We may do spine surgery to:

• Decompress your spine and spinal nerves (laminectomy).
• Remove damaged or herniated disks (diskectomy).
• Remove the disk between two vertebrae and close the space (spinal fusion).
• Repair fractures (vertebroplasty).
• Replace damaged disks with artificial disks (disk replacement).

Behavioral strategies

We teach you mind-body strategies to help manage chronic low back pain. You meet with our behavioral pain specialists to learn ways to decrease your pain and how much it affects your daily activities and sleep. We teach you mindfulness techniques like meditation to manage your response to pain.

Managing Chronic Low Back Pain at Cleveland Clinic

When low back pain is chronic, we may refer you to our comprehensive pain recovery experts. Our specialists use an integrated approach that empowers you to manage back pain.

We call it our Back on TREK (Transform Restore Empower Knowledge) program. This 10-week program is a good option if you have low back pain that hasn’t responded to conservative treatments or physical therapy. You’ll have:

• Behavioral medicine sessions led by behavioral pain specialists.
• Sessions with a physical therapist specially trained in relieving spine pain.

We also offer a Trek for Success class. This single session is focused on developing pain management skills. If you have spine surgery at Cleveland Clinic, take this class to help you prepare for surgery.

Taking the Next Step

Sitting, standing, sleeping all become so much harder when you’re living with low back pain. No matter what’s causing it or how long it’s been bothering you, it may be time to connect with one of our experts. We will guide you through the entire treatment process, creating a plan that fits your goals. Low back pain doesn’t need to be a part of your daily life. Our experts are there to help you find relief.