Causes of Back Pain and Treatment Options

There are a wide range of back pain causes. They include acute conditions like a common muscle strain or chronic, more serious issues like scoliosis or even cancer. Getting back pain relief starts with figuring out which cause is at play so treatment can be tailored accordingly.

Many back pain causes resolve in a few days or weeks with rest, over-the-counter medication, and other relatively simple measures. More severe causes may require ongoing care and treatment, including surgery for conditions including sciatica.

This article discusses possible causes of back pain, as well as how they are diagnosed and treated. It will help you to know if back pain is serious and when to see a healthcare provider.

Common Back Pain Causes

There are many possible causes of back pain. Here are some of the more common ones.

Strain or Sprain

Strains and sprains are the most common causes of back pain, especially in the lower back.

A strain refers to the tearing of a muscle or tendon (which connects muscles to bones), while a sprain refers to the tearing of a ligament (which connects bones in a joint).

A torn tendon or ligament may result from a fall or sports injury, or from overuse of a joint, known as a repetitive stress injury.

The pain can range from mild to severe and is often described as an "all over pain" that moves into the buttocks. The pain tends to worsen with movement and improve with rest.

Along with pain, common symptoms of strains and sprains include:

• Muscle stiffness
• Muscle spasms
• Reduced range of motion (limited mobility)

Bulging or Ruptured Disc

Intervertebral discs are located between the bones of the spine and serve as shock-absorbing cushions. The discs can break down over time, typically due to risk factors including:

• Age and aging
• Trauma or injury
• Stress due to obesity
• Repetitive stress injury
• Smoking

When this happens, a disc can start to protrude outward, which is known as a bulging or slipped disc.

The disc can also tear, resulting in a ruptured (herniated) disc. When this happens, the inner part of the disc (called the nucleus pulposus) will push out and compress nearby nerves, triggering nerve pain.

A ruptured disc in the low back can cause sharp back pain that may move down into the buttocks, groin, and leg. A ruptured disc in the neck can cause pain that moves down an arm. It may also cause muscle weakness, numbness, and tingling.

Osteoarthritis

Spine osteoarthritis is a form of arthritis that is caused by the wear and tear of cartilage between the spinal bones. As the cartilage wears away, you can experience a dull, aching, or throbbing back pain that worsens with movement.

You can feel a popping sensation known as crepitus, joint stiffness, and a reduced range of motion.

As the disease progresses, bony growths can develop. These bone spurs can compress nearby nerve roots, causing numbness and tingling sensations similar to that of a ruptured disc.

Sciatica

Sciatica refers to a feeling of nerve pain that goes down the leg. The term is a misnomer since the sciatic nerve (a large nerve in the leg that's formed by nerve roots that come off of the lumbar spine) isn't specifically irritated in this condition. Irritation of the lumbar nerve roots causes sciatica.

Sciatica can be caused by a ruptured disc, bone spur, or an injury to the pelvis, buttock, or thigh. Diabetes, pregnancy, and prolonged sitting are also risk factors.

A condition called piriformis syndrome can also cause sciatica when the nearby piriformis muscle goes into spasm.

Sciatica causes shooting, burning, or cramping pain that extends from the lower back into a buttock and sometimes down the leg and into the sole of the foot. Tingling, numbness, and muscle weakness are common.

Spinal Stenosis

As you get older, the spinal canal, which contains the spinal cord, can begin to narrow. This is referred to as spinal stenosis.Spinal arthritis can also cause overgrowth of bone within the canal.

If your spinal canal becomes too tight and compresses nerves, you can feel shooting pains in your lower back and buttock, muscle weakness, numbness, and tingling.

Other causes of spinal stenosis include scoliosis, Paget's disease of the bone, and spinal trauma.

Spondylolysis and Spondylolisthesis

Spondylolysis is a stress fracture in one of the bones of the spine. It is most common in children who play sports that put repeated stress on the lower back (such as gymnastics or football). Spondylolysis can also be due to a spinal injury or aging-related weakness of the spine.

If the fracture weakens the spine too much, the vertebra may start to "slip," leading to a condition called spondylolisthesis. Symptoms of spondylolisthesis include pain and stiffness. If the slipped bone pinches a nerve, it can cause shooting pain, tingling, numbness, and weakness. The vertebrae may slip forward (anterolisthesis) or backward (retrolisthesis).

Osteoporosis

Osteoporosis is the thinning and weakening of the bones. Back pain associated with osteoporosis is most often due to a compression fracture in the spinal column. The break can occur without warning, often after doing something as simple as sneezing or bending over.

The back pain can range from dull to sharp. It is often felt in the lower or middle back and tends to get worse with movement. In rare cases, the pain may radiate to the legs or abdomen.

Scoliosis

Scoliosis is a condition in which the spine curves or twists like the letter "S" or "C." It usually develops in childhood.

In most cases, the cause of scoliosis is unknown, although it is linked to conditions like cerebral palsy and muscular dystrophy. It can also result from a birth defect or family genetics (as multiple family members are sometimes affected).

Scoliosis can cause chronic back or neck pain, as well as a reduced range of motion. In severe cases, a person may begin to have trouble breathing.

Rare Back Pain Causes

Less commonly, back pain is caused by a systemic (whole-body) disease. Examples include:

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disease that causes the small bones of the spine to fuse together.

This leads to lower back pain, spinal stiffness, and a hunched posture, often before the age of 40. The back pain tends to improve with exercise and worsen at night.

Cancer

A cancerous tumor in the spine may arise on its own (called a primary tumor) or can be caused by the spread of cancer from other parts of the body (called metastasis).

The pain is often described as gnawing and tends to worsen at night. It may radiate to the shoulders or neck. It can also be accompanied by unexplained weight loss and chronic fatigue.

Osteomyelitis

An infection in the spine, called osteomyelitis, causes severe, constant pain.

It can occur due to recent spinal surgery or when a local infection (such as a staph infection) enters the bloodstream.

Unlike most infections, fever is not common.

Cauda Equina Syndrome

Cauda equina syndrome is a rare disorder that is caused by severe compression of spinal nerve roots in the lower spine.

Besides lower back pain, it can cause numbness or tingling that spreads down one or both legs.

Other symptoms include foot drop (difficulty lifting the front of a foot) and problems with bladder or bowel control.

When to See a Healthcare Provider

Most cases of back pain last for a few days and resolve completely within a few weeks. If you have sudden, new back pain, contact your healthcare provider.

There are a few warning signs that immediate care is needed:

• The pain persists for more than a few days or is worsening.
• The pain wakes you up at night.
  
• You have a fever, chills, or other signs of infection.
• You have problems with bladder or bowel control.
• There are other symptoms you cannot explain.

Diagnosis

The diagnosis of back pain starts with a review of your medical history and a physical exam. You will be asked when the pain started, what it feels like, what makes the pain better or worse, and what other symptoms you have (such as numbness or swelling).

Based on the findings, your healthcare provider will order lab and imaging tests to explore the suspected causes.

Physical Exam

During your exam, your healthcare provider will gently press on muscles and parts of the spine, on or near the site of your pain. You will be asked to describe the location and type of pain.

You will have a neurological exam to assess your nerve and motor responses. The aim of the exam is to identify any areas of sensory changes, muscle weakness, or reflex changes.

One example is the straight leg test in which the healthcare provider lifts your leg while you lie flat on your back. If the movement causes pain below the knee, it suggests that nerves are being pinched at a specific part of the spine.

Lab Tests

Your healthcare provider may order lab tests, such as:

• A complete blood count (CBC), including a white blood cell count (WBC) to detect signs of infection
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to detect signs of inflammation
• HLA-B27 test to detect genetic signs of ankylosing spondylitis
• Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) tests to help detect certain types of bone cancer

Imaging Tests

Imaging tests are generally not needed for a flare-up of back pain unless there are signs of cancer, infection, a fracture, or cauda equina syndrome. They are typically done if pain persists for several weeks or if muscle weakness is getting worse.

If needed, magnetic resonance imaging (MRI) is usually the test of choice, with a computed tomography (CT) scan being the alternative.

Differential Diagnoses

As part of your assessment, your healthcare provider will consider other medical conditions that can cause back pain. The differential diagnosis will be based on your medical history and your risk factors for certain diseases.

A differential diagnosis is part of the process that will help you to tell the difference between muscle pain and kidney pain, for example. In the end, your back pain may be a part of a condition that doesn't directly involve the back muscles or spine.

Examples include:

• Abdominal aortic aneurysm
• Endometriosis
• Gallbladder disease
• Kidney infection
• Pancreatitis
• Pelvic inflammatory disease (PID)
• Peptic ulcer disease
• Prostatitis
  
• Shingles

Back Pain Treatment

The treatment of back pain often takes time. Most people recover by resting and avoiding activities that stress the lower back. Other treatments may be used to ease pain and restore the function of the spine or back muscles.

Self-Care

Rest, along with ice application or heat application, is among the fastest ways to relieve back pain. This treatment may speed the healing process because ice can help reduce swelling. Heat is good for back pain because it promotes blood flow and helps to relax tissues.

Keep in mind, though, that rest doesn't necessarily mean prolonged bed rest. Low-intensity physical activity is important to help shorten your recovery time.

Medications

If rest and ice/heat application are not enough to ease your pain, medications may be prescribed.

Over-the-counter nonsteroidal anti-inflammatories (NSAIDs) and prescription muscle relaxants are good painkillers for back pain, and among the most commonly used back pain relief products.

Epidural spinal injections, in which steroids are injected into the space around your spine, may be used to treat sciatica and spondylolisthesis.

For spine osteoarthritis, a steroid injection into the spinal joint can be used if the pain is severe.

Physical Therapy

Your healthcare provider may also advise physical therapy to help strengthen and stretch your back muscles, improve mobility, and ease back pain.

Walking is good for lower back pain, as are other low-impact exercises like swimming and biking that can help to improve your range of motion and flexibility.

You may find even more motivation if you use a wearable activity tracking device. A 2019 study of wearables used by people with chronic back pain found that they did significantly more walking and other exercise than people in a control group. It's possible this may lead to reductions in the use of other back pain therapies, but more research is needed.

Complementary and Alternative Medicine

Some examples of complementary therapies used to ease back pain include:

• Massage therapy
• Acupuncture
• Tai chi
• Yoga
• Chiropractic care

Be certain to speak with your healthcare provider before taking any vitamins, herbs, or supplements to ensure they are right and safe for you.

Spinal Surgery

Spinal surgery is reserved for people who don't get adequate symptom relief with non-operative treatment, and when the cause of pain is well-explained by the imaging studies.

There are some conditions for which surgery may be beneficial, such as conditions that undermine the stability of the spine.

A spine surgeon can help you to determine if surgery is the right option for you and what risks are involved.

Prevention

Back pain is one of the most common ailments affecting people of all ages. There are ways to reduce your risk factors for back pain and prevent it from worsening.

Some of the more useful prevention tips include:

• Maintaining a healthy weight
• Exercising regularly with low-impact activities to strengthen core muscles
• Practicing good posture and body mechanics (e.g., lifting with the knees)
• Sleeping on a bed that supports the spine
• Quitting cigarettes (chemicals in tobacco smoke promote the deterioration of spinal disks)
  

Summary

The causes of back pain are many. While strains, sprains, ruptured disks, sciatica, and spinal arthritis are common causes, there are others that do not involve the back muscles or the spine at all.

The diagnosis of back pain involves a physical exam and a review of your medical history. Based on the findings, lab and imaging tests will be ordered to help narrow the causes.

Back pain is often treated with rest, ice or heat application, and pain medications. People with persistent back pain or a severe back injury may benefit from physical therapy. Spinal surgery may be used when all other attempts to resolve the pain have failed.