Back pain: Causes, symptoms, and treatments

Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and debilitating.

It can result from injury, activity and some medical conditions. Back pain can affect people of any age, for different reasons. As people get older, the chance of developing lower back pain increases, due to factors such as previous occupation and degenerative disk disease.

Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.

Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.

Causes

A man with visible spine holds his back.
Problems with the spine such as osteoporosis can lead to back pain.

The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones, which work together to support the body and enable us to move around.

The segments of the spine are cushioned with cartilage-like pads called disks.

Problems with any of these components can lead to back pain. In some cases of back pain, its cause remains unclear.

Damage can result from strain, medical conditions, and poor posture, among others.

Strain

Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:

strained muscles or ligaments

a muscle spasm

muscle tension

damaged disks

injuries, fractures, or falls

Activities that can lead to strains or spasms include:

lifting something improperly

lifting something that is too heavy

making an abrupt and awkward movement

Structural problems

A number of structural problems may also result in back pain.

Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.

Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.

Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.

Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.

Abnormal curvature of the spine: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.

Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.

Kidney problems: Kidney stones or kidney infection can cause back pain.

Movement and posture

Back pain can also result from some everyday activities or poor posture.

Examples include:

Example of poor posture when using a computer
Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.

twisting

coughing or sneezing

muscle tension

over-stretching

bending awkwardly or for long periods

pushing, pulling, lifting, or carrying something

standing or sitting for long periods

straining the neck forward, such as when driving or using a computer

long driving sessions without a break, even when not hunched

sleeping on a mattress that does not support the body and keep the spine straight

Other causes

Some medical conditions can lead to back pain.

Cauda equina syndrome: The cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. There are sometimes bowel and bladder function disturbances.

Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain.

Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.

Other infections: Pelvic inflammatory disease, bladder, or kidney infections may also lead to back pain.

Sleep disorders: Individuals with sleep disorders are more likely to experience back pain, compared with others.

Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves are affected.

A chiropractor works on the back of a patient
A chiropractor manipulates and adjusts the back of a patient.

A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.

An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.

A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.

Chronic or acute pain?

Back pain is categorized into two types:

Acute pain starts suddenly and lasts for up to 6 weeks.

Chronic or long-term pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.

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