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Lower back pain: Causes, symptoms, and Treatment

Lower back pain: Causes, symptoms, and Treatment

Suffering from back pain is ubiquitous and is recognized as one of the greatest public health issues worldwide. Most people have experienced lower back pain at some point in their life. According to a report by BMJ Medical Journal, back pain is one of the leading causes of occupational setbacks in the world [1]. It is also a recurring cause of missed workdays at most offices. This condition is unlikely to change as our lives advance towards a sedentary and monotonous lifestyle. Thus, this blog aims to identify the causes, symptoms, and treatments for back pain to help you move toward a pain-free life. 

What is lower back pain?

Lower back pain occurs in the lumbar region, beginning from the rib cage. This section of the body supports the upper body and also supports daily movements. The occurrence of lower back pain may stem from several factors. Such pain usually ranges from mild to severe. However, such conditions can be improved with the right diagnosis and treatment in conjunction with rest and physical therapy. 

How common is lower back pain?

It is estimated that four of every five people experience body pain at some point in their lives. The Health Policy Institute identifies back pain as the sixth costliest condition in the USA, with approximately 16 million people suffering from chronic pain [2].  The chances of occurrence of back pain in people are not similar. Some of the risk factors for encountering back pain in people are-


How-common-is-lower-back-pain
 
  • Bodyweight: As the lumbar region supports the upper body, obese people are more likely to experience such discomfort.

  • Mental health: Emotional distress or mental health issues and back pain are correlated. Suffering from depression and anxiety are two of the most common causes of back pain.

  • Age: As a person ages, the muscle fibers in the body become less dense and more prone to incurring soreness and injury. According to Dr. Tingan, a Penn Medicine physician, most people experience back pain between the ages of 40 to 60 years [3].

  • Lifestyle and occupation: People with jobs involving lifting heavy objects or bending are more prone to back pain.

  • Disorders: People with a family history of cancer, osteoarthritis, and other health disorders are more susceptible to facing back pain.

Lower back pain causes: Male

The frequency and causes of back pain may largely vary in males and females. A study by riverside pain physicians indicates the female body has a more intense natural response to pain [4]. They have a greater nerve density, thus making females experience intense pain compared to males. However, there are severe back pain causes that can occur in people irrespective of gender, such as

  • Fractures- Injury in the bone-forming spinal cord may result in excruciating and severe lower back pain. 

  • Ruptured Disc- Intervertebral discs are present between the spine and bones. These discs can wear off over time due to several factors, such as smoking, trauma, obesity, reparative stress, and aging. This can thus cause sharp pain in the back. 

  • Strains and sprains- Suffering injury in the muscle, ligament, and tendon can result in muscle strain. 

  • Arthritis- Osteoarthritis in the spine is a condition that causes wear and tear of cartilage between the bones of the spinal cord. This causes throbbing pain that can worsen with movement. With time, such patients may also develop bony growths, resulting in numbness. 

  • Diseases- several health disorders, such as infections, cancer, and spine tumors, can generate back pain. Kidney stones and abdominal aortic aneurysms also contribute to causing severe lower pain in patients. 

Lower back pain with fever

Having a tender back with a fever could be a sign of infection of the spine. Apart from these, the other medical conditions that can contribute to this condition are kidney infection, bladder infection, or pelvic inflammatory disease. These conditions may worsen with time if not treated at the right time. Even if the severity of back pain is low, it requires immediate medical attention if it is integrated with fever and chills. 

How-common-is-lower-back-pain

Lower back pain causes: Female

Certain risk factors of body pain are more specific to females due to their anatomic difference from males on a cellular level. CDC states that 21.7% of females experience body pain in comparison to men, which is about 19% in the USA [5]. 

 

Lower back pain causes: Female

 

 

Some causes of back pain that are more specific to women include- 

  • Spinal disc degeneration- this condition accelerates in women post-menopause due to declining estrogen levels.

  • Fibromyalgia- This is a condition that is characterized by musculoskeletal pain. People suffering from this condition suffer from long-term back pain in addition to numerous other symptoms. 

  • Endometriosis- This is a chronic condition resulting in back pain in women [6]. Endometriosis is a disorder where the tissue acts like endometrial tissue growing outside of the uterus. This can thus cause severe lower back pain in the patient. 

Lower back pain in pregnancy

Experiencing backache during the early stages of pregnancy is common. During this period, the ligament in the body becomes softer and stretches to prepare for labor. Thus, this exhibits a strain in the joints of the pelvis and lower back, resulting in pain. Some of the major factors contributing to severe lower back pain during pregnancy include-


Lower back pain in pregnancy
 
  • Bodyweight changes- A woman gains approximately 25 to 35 pounds during a healthy pregnancy. The spine and lower back supporting this weight experience intense pressure, resulting in pain. In addition, the growing baby's weight also exerts pressure on the pelvic nerves and blood vessels.  

  • Hormonal changes- The body produces a hormone called relaxin during pregnancy, which causes relaxation of the pelvic area and joints. The same hormone also loosens the ligaments that support the human spinal cord, thus resulting in lower back pain. 

  • Muscle separation- in this condition, as the uterus expands, muscle running from the rib cage to the lower hop region separates from the center seam. This thus results in causing back pain. 

Causes of severe lower back pain during period

Suffering from pain during a period is medically termed dysmenorrheal. During the cycle, the endometrial cells in the uterus produce prostaglandins that result in cramps and lower back pain. Dysmenorrhea is classified as primary and secondary. However, both these categories are associated with lower back pain.

  • Primary dysmenorrheal- this occurs from uterine contractions resulting in cramps and back pain.

  • Secondary dysmenorrheal- this condition occurs later in life. Discomfort from secondary dysmenorrheal is usually associated with pelvic inflammatory disease and endometriosis

Age-related lower back pain in older adults

Lower back pain is one of the major health disorders in older people. Elderly people, especially those above 50 years of age, are susceptible to suffering from lower back pain. According to a paper published in NCBI, about 65 to 85 percent of the total elderly population have reported suffering from musculoskeletal pain. In addition to it, 36 to 76 % of the total percentage have reported suffering from lower back pain[7].

 

Age-related lower back pain in older adults

The above graphical representation of the data published by the CDC displays the percentage of adults aged 18 and above with chronic pain. The study shows that the percentage of occurrence of body pain exponentially rises with age. Experiencing low back pain is one of the most common health issues in elderly people, resulting in pain and disability.

Numerous causes can be the reason to trigger lower back pain in elderly people. The most common among them have been mentioned below:

  • Sprain and strain of the muscle and ligaments: This is a prevalent reason for lower back pain, which can be due to twitching or overstretching of the muscle and ligaments.

  • Degenerative diseases or changes in the joints and discs: Aging leads to loss of moisture and wears down the discs. This makes the spine unable to provide resilience, causing lower back pain.

  • Spinal stenosis occurs when the area of the spinal cord through which it passes narrows down, imposing pressure on the spinal cord and nerves.

  • Sciatica or Radiculopathy occurs due to a herniated lumbar disc that compresses the nerve roots. This produces pain that radiates from the lower back, passing through the hips and down the legs.

  • Scoliosis: Scoliosis refers to the deformation of the curvature of the spine.

  • Spondylolisthesis or facet joint pain occurs when a vertebra slips onto the vertebra beneath. Pain due to this condition localizes the lower back to the thigh muscles.

  • Osteoarthritis: Osteoarthritis occurs due to the wearing of the cartilage and the disc attributes.  

  • Vertebral Compression Fracture or VCF: It is a type of fracture occurring especially in the lower part of the spine resulting from the collapsing of the vertebral body present in the spine.

  • Rheumatoid Arthritis: It is an autoimmune and inflammatory disease that affects the body's healthy cells by mistake and results in pain.

  • Herniated disc: It is one of the most common reasons for back pain as it localizes in the lumbar region. A herniated disc occurs when the nucleus of the spinal disc ruptures or pushes out of the annulus[8]. 

Back pain in athletes 

Athletes are at a higher risk of experiencing lower back pain or lower spine injury due to their intense physical activity. The strenuous activity from all the different sports puts a strain on the back of the person. Approximately 5 to 10 percent of the injuries incurred by athletes are related to the lumbar region.   

 

Causes of lower back pain when running

Running is one of the most core engaging physical activities. Incurring sprain in the lower back and ligament while running is common. This aerobic activity can cause prolonged stress over the weeks or happen suddenly to cause soft tissue injuries in the lower back. Athletes and joggers can minimize the risk of injury by incorporating minor changes to warm up the body before the actual run. 


Causes of lower back pain when running

Lower back pain while running or jogging occurs due to the following factors-

  • Lack of strength in the muscle surrounding the lower back may cause a failure to face the running load.

  • Overloading the lower back by running too fast and too soon. 

What are the symptoms of lower back pain?

The appearance of symptoms of lower back pain can be gradual or may appear suddenly. This condition may incorporate various symptoms. Depending on the cause of the pain, the symptoms of the condition may vary. Some of the common symptoms of pain and discomfort in the lower back are-

  • Pain that may worsen with prolonged standing or sitting

  • Discomfort that is contained to the lower back section of the body

  • Difficulty in walking, standing, or moving from a sitting position to standing

  • Tightness in the lower back, hips, and pelvis

  • Muscle spasms

When to consult a doctor?

Exercise, home remedies, and over-the-counter pain medications may gradually improve lower back pain. However, under the following conditions, it is advisable to consult a doctor-

  • Causes weight loss

  • The condition doesn’t improve with rest

  • Spreads or travels to the other parts of the body

  • Causes weakness in both legs.

Correlation between Covid and lower back pain

The CDC does not list back pain as a symptom of Covid. However, most physicians include muscle and back pain as a sign of the infection. Based on a survey by Indiana University’s School of Medicine, people post-recovery from Covid claim to experience severe lower back pain [9]. The World Health Organization (WHO) analyzed about 56,000 Covid cases in China. This survey reported that 15 percent of the patients encountered back and muscle pain. Another study conducted in the year 2020 found about 69 percent in a group of 210 people suffering from body pain [10]. The scientific reason for experiencing back pain during COVID-19 infection is the immune response of the body. The muscle pain is a result of cells of the immune system fighting against the COVID-19 viruses. 

Best way to sit with lower back pain at work

Long hours of desk work at work can result in back pain. Inactivity and body movement can largely be responsible for causing discomfort in the body. When at work, practicing the following sitting habits will prevent the occurrence of lower back pain.


Best way to sit with lower back pain at work
  
  • Supporting your spine by choosing the right chair. Bend the knee at a 90-degree angle to support your back. 

  • Avoid slouching forward when working on a desktop. Try to sit straight with your ears directly above your shoulder. Also, ensure to adjust the monitor so one can see the top third of the screen without bending. 

  • Practice good posture by keeping your back against the backrest of the chair, keeping your head and neck aligned, keeping your feet flat on the ground, and not crossing your feet. 

  • Wear comfortable and supportive shoes. 

  • Take short breaks to relax and wind down. This will help you free your muscles and further prevent lower back pain. 

Exercises for lower back pain

Research indicates that exercise helps in increasing the flow of blood in the body. This thus helps reduce the stiffness and lower the intensity of the pain in the body. Regular exercises also strengthen the core, arm muscles, and legs, thus preventing back pain. Common exercises to prevent and manage lower back pain are-


Exercises for lower back pain
 

Bridges

This exercise works on the muscle gluteus maximus in the lower back. Keeping it strong will support your back and ensure lower chances of back pain. 

To perform this exercise- 

First, lie on the ground, bend your knees, and place your feet flat on the floor. Now press the feet on the floor and keep your arms on the sides. Following this, rise your hip until the body forms a straight line from the shoulder to the knee. 

 

Lower back rotational stretches

Performing this exercise will help relieve tension from the trunk and lower back region. Rotating the lower back is also effective in improving the stability of the person.

To perform this activity-

First, lie on the floor and bend your knees. Keep the shoulder firm on the ground and roll bent knees on one side. Hold this position for 5 to 10 seconds and return to the starting position.  

 

Pelvic tilts

Performing pelvic tilt exercises helps in loosening the tight back muscles and keeping them flexible.

To perform this exercise-

Begin by lying on your back with your knees bent. Then, arch the lower back and push the stomach out. Hold this position for 5 seconds and then relax. 

 

Superman position

To maintain a good posture, it is important to have strong back extensors. These are muscle that runs along the sides of the human spine.

To perform this exercise-

First, begin by lying on the ground and stretching out both your arms. Keep your legs stretched and flat on the ground. Gradually raise both the hands and feet and create a gap of about 6 inches between your feet and the floor. Then, lift your core off the floor and keep the head straight. While performing this exercise, ensure to look at the floor to avoid neck injury.   

Yoga for lower back pain

Practicing yoga is a great way to manage body pain. According to a study published in the Annals of Internal Medicine, yoga can help in lowering the need for pain medication. However, yoga is not recommended for people with severe pain. It works best in people with occasional pain and body soreness. Some of the effective yoga positions that one can perform to potentially lower back pain are-

Yoga for lower back pain
 

Downward-Facing Dog

This is considered to be one of the most classic yoga positions. It stretches the body and targets the back extensors. One can begin with this position by placing the hands in front of your shoulder. Now, by pressing the back, raise the knees away from the floor and lift your tailbone. Hold this position for 5 to 10 seconds. 

Child's Pose

This is considered to be an active stretch that helps in elongating the back. Performing this exercise before bed can help to de-stress. Begin by sitting down on your arms and legs. Then, follow by sitting on your feet, but do not completely touch your heels. Hold this position for 5 to 10 seconds and repeat. 

Pigeon Pose

This pose is not recommended for beginners. One can start in a downward-facing position with your feet together. Now, bring the left knee forward and bend it. Keep your back leg straight behind you. Hold this position for 5 to 10 seconds. 

Triangle Pose

This pose effectively strengthens the back, torso, legs, and muscles. Begin by standing strength. Then, spread your legs apart from each other. Then, turn your chest to the sides and open up the pose by stretching the right arm towards your feet and the left arm towards the ceiling. 

How is lower back pain diagnosed?

Back pain may arise from several causes and thus requires a proper diagnosis. The medical practitioner suggests diagnostic imaging options to look for broken bones and other disorders. Some of the common diagnoses prescribed by doctors for back pain are-

  • Spine X-rays – this uses radiation to produce images of the bone

  • The CT scan uses radiation and a computer to make 3D images of the soft tissues and bones.

  • MRI is a diagnostic technique that uses a magnet and radio waves to form images of the muscle, tendon, and bones of the lower back.

  • Electromyography (EMG) is a technique to test the muscular and neuropathy damage in the body, including the back.

Based on the cause of the pain, the physician will recommend one of the examinations mentioned here, along with urine and blood tests. 

Clinically-proven lower back pain treatment

Using analgesics is one of the best and quickest solutions to managing lower back pain. Practicing exercise and yoga can induce pain relief, but it is a comparatively much slower process. Lower back pain from muscle tension can be potentially helped using muscle relaxers such as the Soma pill. On the other hand, for severe and chronic back pain, physicians currently prescribe Tapentadol 100 mg for its tolerance and efficacy. 

 

Soma muscle relaxer- 

It is a skeletal muscle relaxer and the brand name of Carisoprodol. With the onset of action within 30 minutes, the use of the Soma pill is very effective for short-term acute pain. The Carisoprodol muscle relaxer is available in two doses- Soma 350mg and Soma 500mg, with the former being recommended for beginners. The Soma pill price at Healthnaturo is approximately $0.74 per pill, making it a widely chosen solution for body pain. With a long half-life, the action of the analgesic is seen to last for 5 to 6 hours in the user. 

A comparative study between Soma vs. Robaxin shows that Carisoprodol is a better treatment option for lower back pain than other muscle relaxers such as Robaxin.

Key features to choosing Carisoprodol for acute pain-

  • Fast-acting formulation

  • Highly tolerant with fewer side effects 

  • Manges mild to moderate pain

  • Long hours of action

  • Multiple administration in a day is permissible 

Tapentadol 100mg- 

 

Tapentadol is your friend in need for those stubborn, severe back pain. It is also commonly known as Nucynta and Aspadol and is an effective opioid pain medication.

The dual mode of action that Tapentadol makes it a much more potent analgesic drug in the market. It is a highly tolerant medication with fewer chances of side effects. This contributes to the rise in the number of people getting Tapentadol online without a prescription.

The Aspadol doses are available in two formulations- extended-release and Immediate-release. Buy Aspadol 100 mg for quicker relief of pain in 30 minutes.

 

Key features to choosing Tapentadol for chronic pain-

  • It is considered one of the safest opioid pain medication

  • The onset of action within 30 minutes

  • High level of tolerance with a lower scope of occurrence of side effects 

  • It is a prescription drug for treating both acute and chronic body pain 

  • Physicians recommend the administration of multiple doses of the analgesic. 

  • The time of action of the Tapentadol ER and IR differs. The Extended-Release formula of the analgesic lasts for 12 hours, whereas the Immediate-Release works for 5 to 6 hours.  


FAQ's

Lower back pain can be categorized into 3 categories concerning the persisting time. However, the periods might differ from person to person.

  • Acute:  Acute back pain persists for a few days to 4 weeks.

  • Moderate or sub-acute: Moderate or sub-acute back pains are in-between acute and chronic pain that usually lasts for 4 to 12 weeks.

  • Chronic: This category of back pain lasts for a longer period of 12 weeks or more.

If the back pain does not alleviate within 72 hours[11] and tends to be more severe followed by other symptoms then it can be a matter of concern. Seek medical help when you experience the following symptoms:

  • Pain persists for over a week

  • Constant high fever

  • Bowels or urination problem, painful and often contains blood

  • Nausea or vomiting

  • Weakness in the lower body or limbs (numbness or tingling)

  • Pain radiates to other parts of the body

Sudden lower back pain should be treated as early as possible to avoid major health risks. Some methods to treat common lower back pains are mentioned below:

  • Stay hydrated

  • Move your muscles by doing light exercises and stretches 

  • Maintain a good or correct posture

  • Maintain a healthy weight 

  • Apply hot or cold compression

  • Take food rich in mineral and vitamin supplements

  • OTC medications and spray or ointments can help to relieve the pain

  • One can also use Carisoprodol (Soma pills) and Tapentadol. These prescribed medications help to provide relief from the excruciating pain within 30 minutes of ingesting the pills.

According to research conducted in 2020, it has been reported that back pain is the most common early symptom of Covid. The report shows that 69.3 percent of 210 people diagnosed with COVID, reported pain as their symptom. Of which 46.6 percent of the total percent reported pain as the major symptom and 43.6 percent reported back pain. Other reports also show that 10 percent of the people diagnosed with COVID had back pain as one of the symptoms.[10]
However, suffering from lower back pain does not always confirm that you have COVID. It can be the result of injury, posture, or other underlying health issues.

We often feel a sudden and sharp lower back pain. This can be due to several reasons such as injury of the muscles or ligaments, muscle spasms, or strain or tear in the muscle or ligaments of the body. If the pain lasts for a longer period, do not panic and do consult a health expert.

Lower back pain can be due to muscle sprain or strain. Such pain as a sign of cancer is rare but we cannot deny that it can also be a possible reason indicating cancer. Cancers related to spinal cancer, colorectal cancer, ovarian cancer, or tumor in the surrounding area of the back can result in lower back pain.
Some symptoms of lower back pain that could indicate cancer are mentioned below:

  • Back pain is not sensitive or related to movement

  • Back pain that occurs at night time or morning hour and alleviates during the daytime

  • Pain that lasts even after taking medical treatments or therapies

  • Unexplained weight loss

  • Tiredness or fatigue

  • Bowel and urination issues that cause pain or contain blood

  • Weakness or numbness of the limbs 

One can know if the back pain is kidney-related by closely monitoring the exact location of the pain. Back pain usually occurs in the lower part of the back whereas kidney-related pain occurs in the higher up part of the back under the ribs. Back pain can be the most common symptom of muscle sprain or spams which is different from kidney-related back pain which occurs due to infection of the kidneys or pyelonephritis or other kidney-related problems. Moreover, the symptoms related to both the pain are different. Some kidney-related pain symptoms are:

  • High fever

  • Frequent need to urinate

  • Pain or burning sensation while urinating

  • Chills or trembling

  • Nausea or vomiting

  • Change in the smell or color than regular urine

Organs that are present near the lower back area are kidneys, pancreas, colons, and uterus. However, the back pain caused due to these organs is experienced near the area where the organ is present. Therefore we cannot confirm that organs are the sole reason for lower back pain. Taking a note of the exact location of the pain can indicate the reason or the cause of the back pain which will in turn help in getting the right treatment.

A herniated disc is a condition related to the protective cushion that lies between the vertebrae and that prevents the spinal bones from colliding or coming together. It can occur in any part of the spine but usually occurs in the lower back. When bulging and herniated disc occurs it can cause excruciating pain. However, a person can also be asymptotic to this condition showing no signs of pain in the back or leg.

Before knowing the symptoms of pain in the lower back it is very important to know the types of pain related to the lower back. Lower back pain is usually of two types:

  • Mechanical pain and

  • Radicular pain 

Mechanical pain is the common cause of lower back pain. It is related to muscles, ligaments, joints, or bones near the spine. Such type of pain is usually experienced in the lower back part, buttocks area, and occasionally on the upper part of the legs. Radicular pain occurs due to inflammation of the spinal nerve which causes sharp and radiating pain.
Some symptoms of lower back pain are

  • Dull or sore pain persistent in the lower back

  • Muscle spasms or stiffness in the lower back, hips, or the pelvis

  • Adverse pain resulting from constant sitting or standing

  • Sharp sciatica

  • Exceedingly onerous in walking or stanging or changing positions from standing to sitting or vice versa 

Lower back pain is a very common medical issue. It occurs in the lower back part of the body called the lumbar region. The lumbar region is the area of the lumbar spine that starts from beneath the ribcage. The lumbar spine interconnects the muscles, nerves, bones, joints, and ligaments. It is responsible for providing strength, support, and flexibility to the body.

es, lower back pain can also cause other symptoms. The pain caused due to lower back can radiate to the other parts of the body resulting in “referred pain”. Referred pain is a term that is used when the pain originates in some other part and the threshold of the pain is felt at another part of the body. Lower back pain can cause disability or difficulty in motor coordination and other related health conditions.

UTI or Urinary Tract Infection is an infection related to the urinary system which comprises the kidneys, bladder, ureters, and urethra. It causes symptoms like pain during urination, frequent urination, or pain in the lower abdomen. When an upper UTI occurs that reaches the kidneys it can cause excruciating lower back pain followed by high fever and vomiting.

Lower back pain differs from person to person concerning the intensity and nature of the pain. Some might experience dull and fluctuating pain others might experience severe and persistent sharp pain. When the lower back pain gets severe and constant medical help and treatment should be sought as early as possible to avoid major health issues and life-threatening risks.

The twist and turn while you sleep can add up to your misery. So, if you are having issues with settling your score with body pain and discomfort it is important to consider a pain-free sleeping position.  Lower back pain can be very excruciating and can be bothersome, especially during the nighttime. Back pain and sleeping issues are interrelated. It can make you uncomfortable and interfere with your sleep pattern resulting in sleep disorders. Some favorable sleeping positions for lower back pain are mentioned below:

  • If you want to lay on your back, lay down in a reclined position

  • Consider using a firm mattress. 

  • Lying on your back by placing a pillow underneath your legs, knees, and lower back can help maintain the natural spinal curve.

  • If you like lying on your stomach place a pillow under the hips and abdomen

  • Lying on the side in a fetal position can help with lower back pain and herniated disc

  • Lay down on your side by placing a pillow between the knees this removes the pressure from the lower back muscles

Lower back pains usually get better on their own. Reports show that about 90 percent of the total people suffering from back pain recover within 4 to 6 weeks[12]. However, this period might be different from person to person depending on the cause and the threshold or severity of the pain. However, if the pain persists for more than 6 to 8 weeks then consult a health expert. Health experts might run a series of tests to know the root cause of the pain thereby suggesting and prescribing treatments and diagnoses accordingly.


References-

  1. Management of low back pain, BMJ medical journal. 

  2. Chronic Back Pain, georgetown.edu

  3. Back and Neck Pain: Is It a Normal Part of Getting Older?, Pennmedicine

  4. Do Women Feel More Pain More Intensely than Men?, Riverside pain physicians. 

  5. Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019, CDC

  6. 7 Lower Back Pain Causes That Affect Women, Spineuniverse

  7. Low back pain in older adults: risk factors, management options, and future directions, National Library of Medicine, NCBI, published April 18, 2017

  8. Herniated disk, Mayoclinic

  9. Why COVID-19 Can Sometimes Cause Back Pain, According to Doctors, prevention. 

  10. Can COVID-19 Cause Back Pain?, Healthline. 

  11. 5 signs your back pain might be an emergency, UT Southwestern, Medical center

  12. What Are The Chances My Back Pain Will Get Better On Its Own Without Treatment?, ABC NEWS