The human spine is a complex engineering marvel. It provides the scaffolding for the entire body and a protective housing for the thick bundle of nerves that forms the spinal cord. But things can go awry in any part of this well-tuned machine and that can lead to back pain and other difficulties.

Although catastrophic spinal cord injuries, like the one that paralyzed actor Christopher Reeve, are rare, thousands of people seek care in emergency rooms every year because of back pains and injuries. “Oftentimes they’re in excruciating pain and convinced it’s something grave, but it’s usually just the result of overdoing it with unused muscles, such as shoveling snow in the winter or doing a new sport,” says Edward Benzel, MD, chair of the Department of Neurosurgery at the Cleveland Clinic Foundation in Ohio.

Here’s a rundown of the most common back complaints, what to expect in the ER, and what you can do to feel better and prevent the pain from coming back.

Four Common Back Problems

NECK AND SHOULDER PAIN
(Cervical Spine)
Common Cause: Although the cervical spine is quite flexible, it’s also very much at risk from strong, sudden movement, which happens in whiplash-type injuries. The high likelihood of injury is because of the limited muscle support that exists in the cervical area and the fact that this part of the spine has to support the weight of the head.

Diagnosis and Treatment: The doctor will do a physical exam, which includes feeling the curvature of the spine, checking vertebral alignment, and probing muscles or other tender points for pain. And the doctor will assess your range of motion, muscle strength, and your ability to sit, stand, walk, and lift your legs. Your reflexes might be tested to help determine where the pain is coming from.

If there are no red flags, little is to be gained by doing an X-ray for back pain. But if the cause of pain is not evident by history and examination, says Dr. Benzel, the emergency physician may then order an X-ray, which can determine if bones are fractured.

The first choice for pain relief is over-the- counter (OTC) analgesics, such as acetaminophen, aspirin, ibuprofen, and naproxen. Gentle stretching can also ease the pain. In severe cases, muscle relaxants or a cervical collar may be prescribed.

Preventing Future Injury: Ask the ER doctor to recommend neck exercises, which can restore function and increase strength and endurance. To prevent recurrences, improve your posture at work and take frequent breaks to reduce neck strain.

CRAMPING, PAIN, NUMBNESS, OR LOSS OF FEELING IN YOUR SPINE OR EXTREMITIES
Common cause: Spinal stenosis, which occurs when one or more areas in your spine narrow. The main cause of this deterioration is arthritis, a condition in which the cartilage that cushions the bones in your joints wears down. When trying to repair itself, your body may produce growths called bone spurs. When these form at joints, they narrow the spinal canal and pinch the spinal cord or nerves, causing pain in the neck or down the arms.

Diagnosis and Treatment: If an emergency physician suspects you have spinal stenosis on the basis of your symptoms, the doctor will likely order an X-ray to check for arthritis. Many people with spinal stenosis can effectively be treated with conservative measures, such as using OTC and prescription medications to reduce inflammation and pain.

If tests reveal you have stenosis, you might be referred to a specialist — a neurosurgeon or orthopedic surgeon. Initially, you may work with a physical therapist. Epidural steroid injections can dampen inflammation, especially if pain radiates down the back of your leg. But in more severe cases you may need surgery.

Preventing Future Injury: Maintain a healthy weight with regular exercise, which helps maintain strength and flexibility. Combine aerobic activities, such as walking and biking, with weight training and stretching.

LOWER BACK PAIN (Lumbar Spine)
Common Cause: Overuse or misuse of the muscles in the lower back. Because the lumbar spine is connected to your pelvis, this is where most of your weight bearing and body movements take place. Typically, this is where people tend to place too much pressure, such as with lifting, twisting, or carrying a heavy load, and can strain or sprain muscles or ligaments in the back. Repetitive stress injuries, such as poor posture or sitting at a computer screen for hours on end, which cramps muscles, can also lead to damage.

Diagnosis and Treatment: Here again, the emergency physician will do a physical exam and take your medical history to determine the source of the pain. Depending on what the doctor suspects is wrong, he or she might also perform an abdominal, pelvic, or rectal examination to identify whether you have an illness or infection that could be the culprit. For a person who is in extreme lower back pain, the emergency physician might order an X-ray to detect broken bones and other skeletal defects and might then refer the patient to an orthopedist or a physical therapist.

The first line of defense for treatment is OTC pain relievers, including nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen. They are taken to reduce stiffness, swelling, and inflammation, and to ease mild to moderate lower back pain. Exercise may be the most effective way to speed recovery from lower back pain and help strengthen back and abdominal muscles. The ER doctor can recommend exercises to work aching muscles.

Preventing Future Injury: Regular exercise can restore muscle strength. Swimming, walking, strength training to build abdominal muscles, and movement therapies, like yoga, are examples of effective exercises. Maintaining correct posture and learning to lift heavy objects properly can help prevent injuries. The use of ergonomically designed products and workstations might also help reduce these kinds of injuries.

BACK PAIN OR SCIATICA (Shooting Pain Down the Legs)
Common cause: Herniated, ruptured, or slipped discs. As we get older, the outer covering of the disc deteriorates and becomes brittle, causing the jelly-like substance in the center to bulge or seep out (rupture). When this occurs, the nerves from the spinal cord may become compressed, causing back pain and sciatica (when the sciatic nerve is pinched). Herniated discs occur more frequently in the lower (lumbar) region of the spine.
Diagnosis and Treatment: Patients with sciatica, which can indicate that discs are pressing against nerves, will sometimes be referred to a specialist. In the meantime, pain medications, heat or cold packs, braces, stretching, and aerobic exercise can usually improve disc problems and allow your body to heal itself.

If you have persistent back spasms, the doctor might prescribe muscle relaxants. Neuropathic pain medications can ease painful nerve conditions. Steroids, either orally or by injection, dampen inflammation and swelling.
Preventing Future Injury: Kick the habit — smoking reduces blood flow to the lower spine and causes discs to degenerate. Once your back improves, you can embark on an exercise program to strengthen and stabilize your back. This could include stretching, lumbar stabilization exercises to correct posture and strengthen back muscles, and aerobic exercises to help control pain.