Back pain is one of the most common reasons people go to the doctor and a leading cause of disability around the world. Furthermore, back pain is the leading cause of disability in people ages 19 to 45, though it can strike at any age, and is significantly more common among adults between the ages of 35 and 55.
As for low back pain specifically, 60%-80% of people will experience this condition at some point in life, with a high percentage of them experiencing low back and leg pain caused by a herniated disc, according to the American Academy of Orthopaedic Surgeons.
Although the answer to this question seems obvious, back pain can be much more than just a pain in the back or spine.
The back is an intricately complex set of bones, muscles, ligaments, joints, and nerves. The nerves in the back not only supply sensations, but power the muscles in the arms, hands, legs, and feet. Also, lower back muscles control flexing and rotation of the hips that enable walking and running. Therefore, a back injury may cause pain in other parts of the body.
Most back pain is the result of an injury to a muscle or another component of the back and spine. The body reacts to injury with an inflammatory healing response, which can cause severe pain. In addition to injury, as the body ages, the structures of the back begin to wear and tear, meaning that the spine’s joints, discs, and vertebrae deteriorate over time.
Back pain that lasts a few days to a few weeks is acute. It usually resolves on its own, and there is no loss of function. Chronic back pain persists for 12 weeks or longer, and typically requires treatment from a physician to relieve symptoms; however, in some cases, pain may persist despite medical treatment.
What Causes Back Pain?
The cause of back pain can be complex because the back is a complex system of bones, joints, ligaments, and muscles.
Sometimes a simple movement, like picking up a pencil from the floor, can produce painful results. Often, though, back pain is the result of an accident, muscle strain, or a sports injury. Back pain can also develop without a specific or readily apparent cause.
Common Causes of Back Pain
Some of the more common causes of back pain include:
Whiplash is an injury to the neck caused by a rapid, forcible back-and-forth movement.
Degenerated discs. Intervertebral discs act as pads or shock absorbers for vertebra as the spine moves (bends, flexes, and twists). Degenerated discs do not provide the shock absorbing cushion between vertebra, which results in pain.
Herniated or ruptured discs. Normal discs are rubbery. When they become squeezed, a portion of the disc bulges out between the vertebrae and presses on a nerve, which can cause severe pain.
Osteoporosis is a condition that causes bones to become weak and brittle, which can result in spinal compression fractures.
Radiculopathy is compression or irritation of a nerve as it exits the spinal column. If the nerve is in the lower (lumbar) portion of the spine, the pain can radiate down into the legs. If the nerve is in the neck (cervical radiculopathy), the pain can spread to the arms, neck, chest, and shoulders.
Sciatica is a type of radiculopathy affecting the sciatic nerve that runs from the buttocks down the back of the legs. Inflammation of the sciatic nerve causes burning or pain, like an electrical shock that can radiate down to the feet.
Skeletal irregularities. If the spine curves in an abnormal way, back pain can occur. Scoliosis is one such condition in which the spine curves to the side.
Spinal stenosis is a type of arthritis that narrows the spinal column over time and places pressure on the nerves. It can also make the legs feel weak and numb.
Spondylolisthesis is a condition in which a vertebra slips out of place and pinches spinal nerves, most common at the very bottom of the lumbar vertebra (L5). Spondylolysis is the most common cause of spondylolisthesis. The reason for the vertebra slippage can be a birth defect, trauma, infection, or disease.
Less Common Causes of Back Pain
While considerably less common, back pain can also be a sign of a serious underlying condition that requires immediate attention. Some of the less common causes of back pain include:
Abdominalaortic aneurysm, an enlarged area in the lower part of the aorta, the major blood vessel that supplies blood to the body.
Autoimmune disease. Back pain is a possible symptom of an autoimmune condition, such as ankylosing spondylitis, rheumatoid arthritis, lupus, Crohn’s disease, fibromyalgia, and others.
Infection. A spinal infection (osteomyelitis) is rare but can cause severe pain, and can be life threatening if untreated.
Kidney stones. This common medical problem causes lower back pain that is usually just on one side.
Tumor. Most spinal tumors begin in another part of the body and metastasize (spread) to the spine. The most common tumors that may spread to the spine begin as cancer in the breast, prostate, kidney, thyroid, or lung.
Back pain can also be the result of an everyday activity or poor posture. Examples include:
Adopting a very hunched sitting position when using a computer or driving.
Straining the neck forward.
Long driving sessions without a break (even if not hunched over).
Pushing or pulling something.
Carrying or lifting something.
Standing for long periods.
Bending down for long periods.
Twisting or over-stretching.
Coughing or sneezing.
Several risk factors increase the likelihood of developing back pain, particularly low back pain. These factors include:
A mentally stressful job.
Strenuous physical work.
Vigorous physical exercise (especially if not done properly).
Gender. Back pain is more common among females than males.
Pregnancy. A pregnant woman is much more likely to experience back pain.
A sedentary lifestyle.
Age. Older adults are more susceptible than young adults or children.
Obesity and being overweight.
What are the Symptoms of Back Pain?
Most people will experience back pain at some point in life. The pain can range from a dull, constant ache to a sudden, sharp pain making movement difficult. It can be mild and annoying, or it can be severe and debilitating. The pain may start suddenly, or it can start slowly. It may come and go, and gradually get worse over time.
Symptoms of back pain include:
Persistent aching or stiffness anywhere along the spine, from the base of the neck to the tail bone.
Sharp, localized pain, especially after lifting heavy objects or engaging in other strenuous activity. (This type of pain in the upper back can also be a sign of a heart attack or another life-threatening condition.)
Pain that spreads into the arm, neck, chest, or shoulders.
Muscle weakness and possibly numbness or tingling in the fingers or hands.
A lack of coordination, especially in the hands.
A description of the symptoms of back pain typically includes how they begin and their duration:
Acute back pain usually comes on suddenly and lasts a few days or weeks. It is a normal response of the body to injury or tissue damage. The pain gradually subsides as the body heals itself.
Chronic back pain is defined as lasting more than 3 months. This type of pain is usually severe and does not respond to initial treatments. The pain likely requires a thorough medical workup to determine the exact source of the pain.
How is Back Pain Diagnosed?
To diagnose back pain, a doctor will begin with a complete medical history and perform a physical exam. The doctor will carefully examine the back and assess the patient’s ability to sit, stand, walk, and lift the arms and legs. The doctor may also inquire about how well the patient can perform daily tasks with the pain. These assessments help determine the location of the pain, at what point the pain begins, and whether there are muscle spasms. These tests also help rule out more serious causes of back pain.
X-ray. Images that provide a clear detail of the bone structures in the spine, showing the alignment of the bones and to check for instability. An X-ray can help determine if the pain is from arthritis or broken bones. X-rays alone do not show problems with the spinal cord, muscles, nerves, or discs.
CT scan. An image that can help identify certain conditions, such as a herniated disc or spinal stenosis.
MRI scan. These images can provide details about the back, discs, and nerve roots. MRI scans are most commonly used for pre-surgical planning.
Blood test. A standard test to help determine if an infection or other condition is present in the body that might be causing the pain.
Bone scan. In rare cases, a bone scan is used to look for bone tumors or compression fractures caused by brittle bones (osteoporosis).
Nerve study (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of the muscles. This test can confirm nerve compression from a herniated disc or narrowing of the spinal canal (spinal stenosis).
Medical tests may not always show the cause of back pain. There are many cases in which the cause of back pain is never known. In some cases, back pain can get better even when the cause is unknown.
How is Back Pain Treated?
Treatment for back pain depends on the type of pain. Acute back pain usually gets better without any treatment. The use of over-the-counter pain relievers (acetaminophen, aspirin, or ibuprofen) may help ease the pain while the back heals. In some cases, the application of heat or cold packs to the painful area may help relieve the pain.
If possible, it is important not to treat back pain with bed rest. A Japanese study found that patients treating acute low back with bed rest were more likely to have recurring or chronic back pain than those remaining active. Therefore, back pain sufferers should try to continue daily light activities, such as walking, while stopping any activity that increases pain.
If after several weeks, home treatments do not help, stronger medications or other therapies may be necessary.
Depending on the type of back pain, over-the-counter (OTC) pain relievers may help. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might relieve acute back pain. Take these medications only as directed, because overuse can cause serious side effects.
If OTC pain relievers don’t relieve the pain, other options include:
Muscle relaxants. If mild to moderate back pain doesn’t improve with OTC pain relievers, a muscle relaxant may work for some types of pain. However, muscle relaxants can cause dizziness and sleepiness.
Topical pain relievers include creams, salves, and ointments that are massaged into the skin at the site of the pain.
Narcotics. Certain drugs (codeine or hydrocodone) may help, but only for a short time with close supervision by a doctor.
Antidepressants. Low doses of certain types of antidepressants (particularly tricyclic antidepressants, such as amitriptyline) have been shown to relieve some types of chronic back pain, independent of their effect on depression.
Injections. If other measures don’t ease the pain, an injection of cortisone (an anti-inflammatory medication), or other numbing medication, into the space around the spinal cord may help. A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.
Physical Therapy and Exercise
Physical therapy is a cornerstone of back pain treatment. A physical therapist has a variety of treatments available, such as heat, ultrasound, electrical stimulation, gentle cervical traction, mobilization, and muscle-release techniques for back muscles and soft tissues to help reduce pain.
As pain improves, the therapy may include exercises to help increase flexibility, while also strengthening the back and abdominal muscles. Techniques for improving posture may also help. Regular use of these techniques, even after the pain is gone, can help prevent a recurrence of back pain. Proper exercise can also help ease chronic pain, but should not be used for acute back pain – only a doctor or physical therapist can determine the best types of exercise, depending on the cause of the back pain.
Complementary and Alternative Medical Treatments
When back pain becomes chronic, or if other treatments do not relieve it, complementary and alternative therapies may help. The most common forms of these treatments are:
Manipulation. A professional (chiropractor) treats joint, muscle, and bone problems using their hands to adjust or massage the spine and nearby tissues.
Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver mild electrical impulses that help to relieve pain by blocking pain signals sent to the brain. This treatment is not recommended for people with epilepsy, a pacemaker, a history of heart disease, or pregnant women.
Acupuncture. This Chinese practice uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as part of a comprehensive treatment plan for low back pain. Practitioners say acupuncture may help the body release natural painkillers (endorphins) as well as stimulate nerve and muscle tissue.
Acupressure. A therapist applies pressure to certain places in the body to relieve pain. However, there are few studies on the effect of acupressure on back pain.
Shiatsu. A type of finger pressure therapy that massages and applies pressure along energy lines in the body. The shiatsu therapist applies pressure with their fingers, thumbs, and elbows.
Yoga. Specific poses, movements, and breathing exercises. Some forms of yoga may help strengthen the back muscles and improve posture while stretching muscles contributing to the pain.
Cognitive Behavioral Therapy (CBT). Patients learn to perceive less pain. The therapy works on how the person feels and reacts to pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude.
High-Frequency Spinal Cord Stimulation. A study in the journal Anesthesiology found that spinal cord stimulation therapy can deliver effective pain relief without any unwanted side effects for patients suffering from chronic back pain.
Few people need surgery for back pain. However, if there is unrelenting pain, along with radiating leg pain or progressive muscle weakness, surgery may provide relief. Normally, surgery is only for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disc, that have not responded to other therapy.
How to Avoid Back Pain
It may be possible to avoid back pain or prevent its recurrence, by improving physical conditioning and practicing proper body mechanics. Some ways to maintain a healthy and strong back include:
Exercise. Regular low-impact aerobic activities (those that do not strain or jolt the back) can increase strength and endurance in the back, and allow muscles to function better. Walking and swimming are good choices.
Build muscle strength and flexibility. Core-strengthening exercises help condition both abdominal and back muscles to better work together. Flexibility in the hips and upper legs helps align the pelvic bones to improve body mechanics.
Maintain a healthy weight. Excess pounds place excess stress on back muscles. The amount of weight, as well as its location on the body, affects the risk of developing back pain.
Stop Smoking. A significantly higher percentage of smokers have back pain when compared by age, height, and weight to non-smokers.
Many back problems develop between the ages of 30 and 50, and become worse with age. Most of the problems are because of wear and tear on the body. Therefore, proper body mechanics can help support a healthy back:
Work. Jobs requiring lifting, pushing, pulling, and twisting are at risk for producing more back pain. However, sedimentary jobs come with their own unique problems. Therefore, proper body mechanics should be addressed with all jobs.
Moving objects. It is better to push objects using leg strength, rather than pulling them.
Sit smart. At work, choose a chair with back support, armrests, and a swivel base. Consider placing a pillow or rolled towel in the small of the back to help maintain its normal curve. Keep knees and hips level. Change your sitting position at least every half-hour. Office workers who sit at a computer all day may be more likely to experience back pain, especially if they have poor posture.
Stand smart. If it is necessary to stand for long periods, place one foot on a low stool to help take some of the load off the lower back, and alternate feet. Good posture helps reduce stress on back muscles.
Lift smart. If possible, avoid heavy lifting. When it is necessary to lift something heavy, let the legs do most of the work. Keep the back straight without twisting. Bend only at the knees – never bend at the waist to pick up something. Hold the load close to your body when carrying it. Get help if the object is heavy or is awkward to handle.
A heavy backpack. Heavy backpacks place unnecessary strain on the back. If a backpack weighs more than 20% of the weight of the carrier, it’s too heavy and could cause muscle strain and back pain. It is of particular importance to ensure a child’s backpack is not too heavy.
Shoes. Flat footwear places less strain on the back.
Having proper back support while driving is important. Position side mirrors to avoid twisting to view. Foot pedals should be squarely in front of your feet. If on a long journey, plan for “stretching breaks” to get out of the car and walk around.
It is best to sleep on a mattress that keeps the spine straight, while also supporting the shoulders and buttocks. Use a pillow that does not force the neck into a steep angle. There doesn’t appear to be one type of mattress that’s best for people with back pain. Sleep on the bed that feels most comfortable.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating back pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.