What Causes Pain in the Lower Right Part of Your Back?

Woman holding back in pain
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Dealing with any type of back pain can be tough because while the pain may be excruciating, in reality, the problem is not that bad. In other words, the cause may not be as serious as it seems while you're in the midst of the pain.

Because the pain can be such a bear, some medical providers may be a little too thorough when diagnosing and treating it. Along with the standard medical history and physical exam, your doctor may order a complete battery of diagnostic imaging tests.

But experts have, in recent years, recommended against films at first — unless you’ve been involved in an accident, fall, have sustained other trauma to your spine, or you have neurological symptoms. Neurological symptoms include things like pins and needles, pain, weakness, numbness and/or electrical sensations that travel down one leg. (You may be more familiar with them by their non-medical name, sciatica.)

An overzealous doctor might also prescribe narcotic pain medication, aka, opioids, as a first line treatment, even before physical therapy and home exercise. But this may be unnecessary.

Opioids are some very strong drugs, and they come with the risk for addiction. Think about it for a moment: Is your back pain really so bad that you need the strongest acting medication around?

Working with a physical therapist on a home exercise program often makes an excellent adjunct and/or alternative to strong medication. In fact, it often restores spine patients to their former condition without the help of narcotics at all.

And finally, because back pain can be unbearable, some doctors may pre-maturely steer you toward surgery. Again, giving a course of physical therapy the chance to work (and this means doing your exercises daily) before writing it off as ineffective may be instrumental in "avoiding the knife."

All this to say that back pain — even when you can barely tolerate it — is more often than not “non-specific,” meaning tests and exams can’t or don't reveal a cause. Reasons for non-specific back pain can range from soft tissue damage or muscle imbalances to pain that’s referred from other areas, including trigger points in nearby (and faraway) muscles. But it's generally not due to serious diseases that can be identified by testing or serious spine issues such as herniated disc that presses on a spinal nerve root.

Right Side Back Pain

And things can become more worrisome should you notice your pain is limited to one side or the other. Again, the cause may be serious, so if the pain keeps you up at night, lasts longer than a week or if this is a recurrence rather than a first time experience of the symptoms, it's best to consult with your doctor. The same is true if you’ve had an injury or cancer. Note that these are just a few of the signs that your back needs medical attention; there are a number of others, as well.

Serious underlying health problems sometimes cause right side back pain, although this is rare.

In such cases, even though you feel it in your back, the problem that actually needs the treatment will likely be located elsewhere in your body. For this reason, it’s working with your doctor, and possibly a specialist as well, is key. Going to see a chiropractor, taking pain meds and waiting for the pain to go away and/or trying exercise may not fully resolve the issue, especially if the pain is due to a systemic health issue or problems with an organ.

Below is a list of common systemic and/or serious underlying causes of right side back pain.

Cysts and Tumors

Two potentially very serious causes of right side back pain are cysts and tumors. Although they are different from one another medically, one thing they do share in common is that they can press on your spine.

Cysts are related to degenerative changes in the spine. They can press on the spinal nerve root, which may result in radiculopathy symptoms. Radiculopathy is suggested when pain, weakness, numbness, tingling, electrical sensations and/or pins and needles that go down one leg.

Other symptoms of a spinal cyst may include neurogenic claudication, which is cramping and discomfort in your legs, especially when you walk for anything other than short distances. Neurogenic claudication is related to posture and tends to accompany spinal stenosis.

Symptoms of cauda equina, while rare, may also be caused by a cyst that presses on your spine. Cauda equina may result in bowel or bladder dysfunction, progressive weakness in your legs as well as other symptoms. Generally, immediate surgery is recommended in cases of cauda equina.

It’s important to seek medical attention as soon as you can and immediately for cauda equina symptoms for any and all of the items discussed above.

Tumors, on the other hand, may press on your spinal cord, which is different than your spinal nerve root. Whether or not it does, as well as the type of symptoms you’ll experience, depend on the location of the mass.

Symptoms include back pain that may radiate to other areas, difficulty walking, loss of sensation, decreased sensitivity to pain, disrupted bowel or bladder functioning, muscle weakness and more.

Tumors in the spine may be non-cancerous or cancerous. Regardless, speaking with your doctor as soon as you can is your best course of action if you have the symptoms listed above or you otherwise find out you have a spinal tumor.

Kidney Stones

Kidney stones — mineralized material, often calcium, that form in the kidney — are a common cause of non-spine related back pain. Small ones may pass through the urine, and can be very painful. Small kidney stones may also be passed without causing symptoms at all.

Due to the location of the organ, which is in the upper abdominal area, adjacent to back muscles, pain from kidney stones may be felt in the left or right side of your back. 

If your kidney stones give you pain, it will likely feel sharp and be localized to the area described above. You may feel abdominal discomfort and/or pain during urination, as well as other symptoms. In these cases, it's best to work with your doctor to resolve the problem.

Gallstones and Back Pain

Gallstones are similar to kidney stones. The main difference between the two is that gallstones consist of hardened digestive fluids that form in the gall bladder rather than minerals in the kidney. The gall bladder lives under the liver, and both organs are located on the right side of the body only.

Similar to kidney stones, gallstones are hard crystallized pieces that form in the organ and may cause problems. When gallstone symptoms make themselves known, they can include, among other things, pain under your right shoulder blade. 

Gall stones are likely related to a high fat diet, so one way to avoid this type of right side back (and abdominal) pain may be to change the way you eat.

And as with kidney stones, it’s best to work with your doctor to address gall stones.

Orthopedic and Neurological Reasons for Right Side Back Pain

Right side back pain can come from the spine. Here's a non-exhaustive list of what could happen there.

Herniated Disc

Herniated disc occurs when the tough outer covering of the shock-absorbing cushion that's located in between two adjacent spinal bones frays or ruptures. In many cases the soft, liquid-like substance on the inside escapes to the outside of the disc structure. In and of itself, that's not so bad, but should the escaped substance contact a nearby spinal nerve root, this may cause pain. In fact, it often does.

As you can imagine the spinal nerve root is very sensitive; anything it comes into contact with will likely irritate it and cause radiculopathy symptoms. Remember from above, radiculopathy symptoms include pain, weakness, numbness, electrical sensations and similar things that go down one leg.

These symptoms are, by nature, one-sided; herniated discs are generally "posteriolateral" meaning their direction of exit for the soft substance that escapes is a combination of back and side. (Posterior means back; lateral means side.)

While many people have microdiscectomy surgery for their herniated disc, trying a six week course of physical therapy first is generally recommended. This may abate symptoms and help you avoid a more invasive procedure. But if the pain, weakness, numbness and/or electrical feelings persist, surgery may make a good option for you.

Facet Joint Pain and Spinal Arthritis

Facet joints are interconnecting joints located at the back of the spine; collectively, they give the spine its integrity by limiting excessive movement. Each spinal level has a right and left facet joint.

Facet joints are often the site where bone spurs and other arthritic changes occur. Such changes tend to be related to wear and tear, and at any given level, may occur on one facet joint, but not the others. So when they develop on the right side, they may cause right side back pain. Other symptoms include numbness, tingling, electrical sensations and/or weakness that travel down one extremity. 

Facet joints are also known as zygapophysial joints.

Sacroiliac Joint Dysfunction

Similar to spinal discs, the sacroiliac joint has two areas — right and left — that may become misaligned and/or be the site of pain.

Unlike herniated disc, though, the two sides are often related; in other words, if you have excess movement or locking on one side, you may feel it there, but you might also feel something the other side.

Another type of sacroiliac pain, caused by inflammation, is an arthritic condition known as ankylosing spondylitis. Ankylosing spondylitis is a progressive, debilitating disease that over time can result in the fusion of the entire spine. That said, the inflammation starts at the sacroiliac joints. Symptoms include stiffness, pain and immobility. If you experience them, it's a good idea to try for a diagnosis as soon as possible; an early diagnosis may make this serious disease easier to manage in the long term.

Scoliosis

Scoliosis is a deformity in which one or more areas of the spine deviate from the midline; the result is a side to side "S" or "C" curve when viewing the body from the back. Additionally, one side of the back, where the curve is, becomes convex, with the backbone in closer proximity to the outside of the body; the other side becomes concave. The curves are created by vertebrae that rotate.

Scoliosis may also lead to muscle imbalance. 

On the concave side, muscles may get tight and painful, while on the convex side of the curve, they may become overstretched and weak. Overstretched muscles tend to get taut, which also causes pain.

For adults, not engaging in a scoliosis specific exercise program may help worsen the deformity.

Muscle Imbalances and Trigger Points

To help you sit, stand, walk, run and otherwise be active, the muscles, bones and joints of the body have an uncanny way of "robbing from Peter to pay Paul," so to speak.

It's all in the name of keeping you balanced and moving. But for whatever reason (and there are many potential ones) the balance that's established is often not the most ideal, leading to some muscles getting very tight, and others becoming overstretched and taut. In this case, you may develop painful spasms or trigger points on one side of the body or the other.

Muscles commonly affected include your quadratus lumborum which is your flank muscle and your gluteus medius which is located at the side of your hip, and plays a key role in keeping you from excessive side to side movement. Both can lead to pain on the right (or left) side of your back, depending on the nature of the imbalance.

A Word From Verywell

In sum, pain on the right side of the back is usually not serious. That said, it pays to be astute, as well as to check with your doctor about symptoms that linger, bother you or perplex you. If a serious problem does happen to underlie your right side back pain, it's best to get a diagnosis and start treatment as soon as you can.

 

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