Causes of Back Pain and Treatment Options

Everything you need to know about back pain

woman with back pain
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Back pain is a very common condition, albeit a uniquely experienced one. Ranging from the dull or throbbing aches of spine osteoarthritis to the shooting, sharp pain of a ruptured disc, back pain can also come and go, be constant, worsen with exercise or prolonged sitting, and/or be associated with neurological symptoms like numbness and tingling. While back pain can be frustrating and debilitating, the upside is that the majority of episodes of back pain improve or resolve with minimal care, and usually within a few weeks.

Common Causes 

There are multiple potential causes for back pain. Here are some of the more common causes, although this is not an exhaustive list.

Muscle Strain/Sprain

Muscle strains and sprains are perhaps the most common causes of back pain, especially in the lower back. A strain refers to tearing of a muscle or a tendon (a fibrous tissue that connects muscle to bone), while a sprain refers to tearing of a ligament (a fibrous tissue that connects two bones together). With these tears—which result from an injury like lifting a couch or gradual overuse)—inflammation occurs, causing pain and, in some cases, muscle spasms.

The pain of a muscle strain or sprain in the back can range from mild to debilitating and is often described as an "all over pain" that moves into the buttocks and is worse with movement and soothed with rest. Along with pain, muscle stiffness and a restricted range of motion are often reported with muscle strains and sprains of the back.

Bulging and Ruptured Disc

Your spinal discs are located between adjacent vertebrae and serve as shock-absorbing cushions. For a combination of reasons—including the natural process of aging, trauma to the spine, weight gain, smoking, and repetitive stress to the spine (for example, sitting for prolonged periods of time or lifting heavy objects)—the discs begin to deteriorate over time, making them more prone to bulging or protruding outward (called a bulging or slipped disc).

Over time, the bulging disc (without treatment) can eventually tear. When a disc tears, its inner content (nucleus pulposus) is released, which compresses nearby nerve roots or the spinal cord itself. A torn disc is called a ruptured disc or a herniated disc.

A ruptured disc in the lower back causes sharp back pain that may move down into the buttocks, groin, and/ or down one leg. Likewise, a ruptured disc in the neck may cause pain that moves down an arm. Besides pain, a herniated disc may cause neurological symptoms like muscle weakness, numbness, and tingling.

Spine Osteoarthritis

Osteoarthritis can affect any joint in the body, including the small joints of the spine (called vertebral or facet joints).

Spine osteoarthritis occurs as a result of "wear and tear" of the cartilage located between the spine's joints. As the cartilage wears away, a dull, aching, or throbbing pain that is worse with movement may develop. An unpleasant feeling of crepitus (a popping sensation) may be felt as the cartilage wears away completely and the joints begin rubbing against each other. Joint stiffness and a limited range of motion may also occur with spinal osteoarthritis.

As spine osteoarthritis progresses, the body makes new bony growths to stabilize the joint. These bone spurs can eventually compress nearby spinal nerve roots, causing numbness and tingling, similar to that of a ruptured disc.

Besides the natural process of aging, obesity may contribute to the development of spine osteoarthritis, as the excess weight places additional stress on the vertebral joints.

Sciatica

Sciatica refers to compression or pinching of the sciatic nerve, often caused by a herniated disc or bone spur. An injury or trauma to the pelvis, buttocks, or thigh, diabetes, prolonged sitting, and piriformis syndrome—when a small muscle in the buttocks spasms and irritates the sciatic nerve—may also cause sciatica.

Because your sciatic nerve is the longest nerve in the body (running from the base of the spine down both legs), compression of it may lead to lower back pain that spreads into the buttocks, and down the legs into the soles of the feet (usually on one side). In addition to burning and/or cramping pain, patients may experience tingling, numbness, and muscle weakness.

Spinal Stenosis

Spinal stenosis causes back pain in the aging population. As you get older, the spinal canal gradually becomes constricted or narrowed, due in part to osteoarthritis and the thickening of tissues in your spine. If the spinal canal becomes too tight, nerve roots may become compressed, causing neurological symptoms like weakness, numbness, and tingling.

Besides age and arthritis, other conditions that can lead to the development of spinal stenosis include scoliosis (see below) and Paget's disease—a condition in which there is a defect in how bones grow and break down.

A traumatic injury, like from a car accident, may also lead to spinal stenosis (due to the sudden swelling and inflammation within the spinal canal).

Spondylolysis and Spondylolisthesis

Spondylolysis refers to a stress fracture in one of the vertebrae of the spine. This condition is most common in children and adolescent who play sports, such as gymnastics or football, that place repeated stress on the lower back. Spondylolysis can also occur as a result of trauma to the spine or from the degenerative changes of aging, which cause loss of the normal stabilizing structures of the spinal column.

If a stress fracture weakens the vertebrae too much, the vertebra becomes unstable and begins to "slip"—this condition is called spondylolisthesis.

Symptoms of spondylolisthesis include pain and stiffness at the site of the slipped vertebra. Furthermore, if the slipped vertebra pinches nearby nerve roots, radiating pain (for example, pain that shoots down the arms into the hands and finger) and neurological symptoms like tingling, numbness, and weakness may occur.

Osteoporosis

Osteoporosis is a weakening of the bones that can make them more prone to breaking. Back pain from osteoporosis is most commonly related to a compression fracture of the vertebra. Often times, with a compression fracture, a person does not report a history of trauma but rather notes sudden back pain after a simple activity like bending over or sneezing.

The pain of a vertebral compression fracture is often felt in the lower back or in the middle of the back (where the fracture occurred). Rarely, pain radiates to other areas of the body like the abdomen or legs. Generally speaking, pain from a compression fracture often worsens with motion, is eased with rest or lying down, and ranges in quality from sharp to dull.

Scoliosis

Scoliosis is a condition in which the spine curves and twists, like the letter "S" or letter "C." It usually develops in childhood or during adolescence. In most cases, the cause of scoliosis is unknown, although it may be related to an injury or birth defect. In some instances, multiple family members will have scoliosis, suggesting a potential genetic component.

Due to the curving and twisting of the spine, a person may develop neck back discomfort, and if severe enough, trouble with breathing.

Rare Causes

Less commonly, back pain is due to a whole-body (systemic) illness, such as ankylosing spondylitis, or something more alarming, like a tumor or infection.

Ankylosing Spondylitis (AS)

AS is a chronic inflammatory disease of the spine joints (vertebrae) that causes low back pain and stiffness, typically starting before the age of 40. The back pain of AS tends to improve with exercise and worsen at night.

Cancer

A tumor in the spine may arise on its own (called primary spinal tumor) or from cancer elsewhere in the body (called metastatic cancer). In addition to gnawing back pain that is often worse at night and may radiate to the shoulders and neck, a person may experience unexplained weight loss and unusual fatigue.

Infection

An infection in the spine, called vertebral diskitis or osteomyelitis, causes severe, constant pain. Surprisingly, despite an infection being present, a person may not have a fever. A history of a prior back surgery may provide a clue that an infection is present.

Cauda Equina Syndrome

Cauda equina syndrome is a rare syndrome that occurs when the bundle of nerves located at the bottom of your spinal cord becomes damaged or irritated. Besides pain in the lower back, a person may experience numbness or tingling that spreads down one or both legs, "foot drop," sexual dysfunction, and problems with bladder and bowel control.

When to See a Doctor

Most episodes of back pain last a few days and have completely resolved within a few weeks. If you have new back pain, you should contact your doctor to see if you need further evaluation. There are also a few warning signs that may indicate a problem that needs immediate evaluation:

  • Your back pain persists beyond a few days
  • Your back pain awakens you at night
  • You have difficulty controlling your bowels or bladder
  • You have a fever, chills, sweats, or other signs of infection
  • Any other unusual symptoms

Diagnosis

A detailed medical history and physical examination lay at the crux of diagnosing back pain, followed by imaging and labs if a person has "red flag" symptoms, like a fever, suggestive of a possible infection, or unexplained weight loss, suggestive of cancer or inflammatory arthritis like AS.

Medical History

Before examining your back, your doctor will ask you several questions about your back pain, like when it started, what makes it worse and better, and whether you have any associated symptoms like numbness or tingling. In order to speed up this process, it may be helpful to come to your appointment with a written description of your pain (as best as you can).

Physical Examination

During the physical examination, your doctor will closely inspect and press on your spine structures, as well as the muscles correlating to the area of pain.

A thorough neurological examination, which includes testing the legs for strength, sensation, and reflexes, is also important for determining the source of your pain.

Sometimes, specific maneuvers can help your doctor pinpoint a diagnosis. For example, your doctor may perform the straight leg test, in which he raises your leg up while you lie on your back. During this maneuver, pain that radiates below your knee is suggestive of L4-S1 nerve root pain, meaning those nerve roots are being compressed or irritated, often from a herniated disc or a bone spur from arthritis.

Labs

Depending on your doctor's suspicion for a certain diagnosis, he may order various blood tests. For example, if your doctor is worried about an infection or cancer, he may order a complete blood count and inflammatory markers, like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Imaging

Imaging tests are generally not needed for acute low back pain unless there are symptoms or signs concerning for cancer, infection, a fracture, or cauda equina syndrome. If an imaging test is warranted, magnetic resonance imaging (MRI) is usually the test of choice, with a computed tomography (CT) scan being the alternative.

Differential Diagnoses

When your doctor is evaluating your back pain, he will consider other health conditions that refer pain to your back. For example, a few gastrointestinal conditions can refer pain to the back, including pancreatitis, gallbladder disease, and peptic ulcer disease. Usually, though, other symptoms are present to suggest a digestive problem (versus a musculoskeletal problem), such as abdominal discomfort, or nausea and vomiting.

Likewise, shingles (the herpes zoster rash) may cause back pain—interestingly, often times, the pain arises prior to the rash popping up.

More alarmingly, an abdominal aortic aneurysm (AAA) can refer pain to the back, usually the mid to lower sections. A person with an abdominal aortic aneurysm may also experience belly discomfort along with a pulsating sensation in their abdomen.

Other conditions that may refer pain to the back include:

If your doctor suspects a referred source of back pain, a pelvic or abdominal exam may be performed, as well as various blood or urine tests.

Treatment

The most frustrating aspect of the treatment of back pain is that it often takes time for symptoms to resolve. Most individuals recover completely by simply avoiding stress to the back. Keep in mind, though, that this does not mean prolonged bed rest. Instead, slow and mild physical activity can improve recovery time.

Self-Care

Patients often find that strategies like rest, ice, and heat can soothe their pain and possibly, speed up the healing process.

Medications

If the basic treatments for back pain do not relieve your symptoms, the next step is to seek medical evaluation. Depending on the symptoms and the length of the problem, your physician can create a treatment regimen, which may include taking one or more medications. Two of the most common medications used to treat low back pain include nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants.

Epidural spinal injections, in which a steroid (cortisone) is injected into the epidural space around your spine, are sometimes used to alleviate symptoms of sciatica and spondylolisthesis. For spine osteoarthritis, a steroid injection into the affected facet joint is sometimes recommended for pain relief.

Physical Therapy

Your doctor may recommend physical therapy to help strengthen and stretch your back muscles, improve mobility and function, and help ease your pain. In addition, a low-impact exercise regimen, like walking, swimming, or biking, can help improve your range of motion and flexibility in conditions like spondylolisthesis, spinal osteoarthritis, or sciatica.

Complementary and Alternative Medicine

Some examples of potential back-soothing complementary therapies include:

Supplements, like magnesium or vitamin D, may also help ease your back pain. However, be certain to speak with your doctor before taking any vitamins, herbals, or supplements to ensure they are right and safe for you.

Spine Surgery

Spine surgery is usually reserved for the treatment of back pain that does not resolve with simple steps. However, there are some conditions where surgery may be necessary. Your doctor can help you determine when surgery may be an appropriate treatment for your condition.

Prevention

Back pain is one of the most common and uncomfortable ailments. The upside is that there are several strategies you can undertake to prevent the onset of and/or progression of back pain.

Some of these strategies include:

  • Maintaining a healthy weight
  • Engaging in an exercise program that strengthens your core muscles and is gentle and low impact (for example, swimming, walking, yoga, or Pilates)
  • Practicing good posture and body mechanics (e.g. lifting by bending your knees, rather than your waist)
  • Sleeping on a bed that supports your spine well
  • Avoiding harmful habits like smoking

A Word From Verywell

While it's proactive to gain knowledge about your back pain, remember to get it checked out so you optimize your recovery process. You deserve to get back to feeling your best and enjoying life as soon as possible.

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Article Sources
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  • American Academy of Orthopedic Surgeons. (n.d.). Spondylolysis and Spondylolisthesis. https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis

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