What Is Back Pain? What Causes Back
Back pain is a very common complaint.
According to the Mayo Clinic, USA,
approximately 80% of all Americans will
have low back pain at least once in their
lives. Back pain is a common reason for
absence from work, or visiting the
According to the NHS (National Health
Service), UK, back pain is the largest
cause of work-related absence in the
United Kingdom. Although back pain may
be painful and uncomfortable, it is not
Even though back pain can affect people
of any age, it is significantly more
common among adults aged between 35
and 55 years.
Experts say that back pain is associated
with the way our bones, muscles and
ligaments in our backs work together.
Pain in the lower back 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, abdomen 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.
What are the risk factors for back pain?
A risk factor is something which
increases the likelihood of developing a
condition or disease. For example,
obesity significantly raises the risk of
developing diabetes type 2. Therefore,
obesity is a risk factor for diabetes type
2. The following factors are linked to a
higher risk of developing low back pain:
A mentally stressful job
Pregnancy - pregnant women are much
more likely to get back pain
A sedentary lifestyle
Age - older adults are more susceptible
than young adults or children
Gender - back pain is more common
among females than males
Strenuous physical exercise (especially if
not done properly)
Strenuous physical work
What are the signs and symptoms of
A symptom is something the patient feels
and reports, while a sign is something
other people, such as the doctor detect.
For example, pain may be a symptom
while a rash may be a sign.
The main symptom of back pain is, as the
name suggests, an ache or pain anywhere
on the back, and sometimes all the way
down to the buttocks and legs. In most
cases signs and symptoms clear up on
their own within a short period.
If any of the following signs or symptoms
accompanies a back pain your should see
Elevated body temperature (fever)
Inflammation (swelling) on the back
Persistent back pain - lying down or
resting does not help
Pain down the legs
Pain reaches below the knees
A recent injury, blow or trauma to your
Urinary incontinence - you pee
unintentionally (even small amounts)
Difficulty urinating - passing urine is
Fecal incontinence - you lose your bowel
control (you poo unintentionally)
Numbness around the genitals
Numbness around the anus
Numbness around the buttocks
According to the National Health Service
(NHS), UK, the following groups of
people should seek medical advice if they
experience back pain:
People aged less than 20 and more than
Patients who have been taking steroids
for a few months
Patients with cancer
Patients who have had cancer
Patients with low immune systems
What are the causes of back pain?
The human back is composed of a
complex structure of muscles, ligaments,
tendons, disks and bones - the segments
of our spine are cushioned with
cartilage-like pads. Problems with any of
these components can lead to back pain.
In some cases of back pain, its cause is
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Strain - the most common causes of back
Lifting something improperly
Lifting something that is too heavy
The result of an abrupt and awkward
A muscle spasm
Structural problems - the following
structural problems may also result in
Ruptured disks - each vertebra in our
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 that
travels through the buttock and down
the back of the leg, caused by a bulging
or herniated disk pressing on a nerve.
Arthritis - patients with osteoarthritis
commonly experience problems with the
joints in the hips, lower back, knees and
hands. In some cases spinal stenosis can
develop - the space around the spinal
Abnormal curvature of the spine - if the
spine curves in an unusual way the
patient is more likely to experience back
pain. An example is scoliosis, when the
spine curves to the side.
Osteoporosis - bones, including the
vertebrae of the spine, become brittle
and porous, making compression
fractures more likely.
Below are some other causes of back
Cauda equina syndrome - the cauda
equine is a bundle of spinal nerve roots
that arise from the lower end of the
spinal cord. People with cauda equine
syndrome feel a dull pain in the lower
back and upper buttocks, as well as
analgesia (lack of feeling) in the
buttocks, genitalia and thigh. There are
sometimes bowel and bladder function
Cancer of the spine - a tumor located on
the spine may press against a nerve,
resulting in back pain.
Infection of the spine - if the patient has
an elevated body temperature (fever) as
well as a tender warm area on the back,
it could be caused by an infection of the
Other infections - pelvic inflammatory
disease (females), bladder or kidney
Sleep disorders - individuals with sleep
disorders are more likely to experience
back pain, compared to others.
Shingles - an infection that can affect the
Bad mattress - if a mattress does not
support specific parts of the body and
keep the spine straight, there is a greater
risk of developing back pain.
Everyday activities or poor posture
Back pain can also be the result of some
everyday activity or poor posture.
Standing for long periods
Bending down for long periods
Sitting in a hunched position for long
periods (e.g. when driving)
Long driving sessions without a break
(even when not hunched)
Diagnosing back pain
Most GPs (general practitioners, primary
care physicians) will be able to diagnose
back pain after carrying out a physical
examination, and interviewing the
patient. In the majority of cases imaging
scans are not required.
If the doctor and/or patient suspect
some injury to the back, tests may be
ordered. Also, if the doctor suspects the
back pain might be due to an underlying
cause, or if the pain persists for too long,
further tests may be recommended.
Suspected disc, nerve, tendon, and other
problems - X-rays or some other imaging
scan, such as a CT (computerized
tomography) or MRI (magnetic
resonance imaging) scan may be used to
get a better view of the state of the soft
tissues in the patient's back.
X-rays can show the alignment of the
bones and whether the patient has
arthritis or broken bones. They are not
ideal for detecting problems with
muscles, the spinal cord, nerves or disks.
MRI or CT scans - these are good for
revealing herniated disks or problems
with tissue, tendons, nerves, ligaments,
blood vessels, muscles and bones.
Bone scan - a bone scan may be used for
detecting bone tumors or compression
fractures caused by brittle bones
(osteoporosis). The patient receives an
injection of a tracer (a radioactive
substance) into a vein. The tracer collects
in the bones and helps the doctor detect
bone problems with the aid of a special
Electromyography or EMG - the electrical
impulses produced by nerves in
response to muscles is measured. This
study can confirm nerve compression
which may occur with a herniated disk
or spinal stenosis (narrowing of the
The doctor may also order a blood test if
infection is suspected.
Chiropractic, Osteopathy and Physical
Therapy (UK: Physiotherapy)
A chiropractor - the chiropractor will
diagnose by touching (palpitation) and a
visual inspection. Chiropractic is known
as a direct approach, with a strong focus
on the adjustments of the spinal joints.
Most good chiropractors will also want
to see imaging scan results, as well as
blood and urine tests.
An osteopath - the osteopathic approach
also diagnoses by touching and a visual
inspection. Osteopathy involves slow and
rhythmic stretching (mobilization),
pressure or indirect techniques and
manipulations on joints and muscles.
A physical therapist (UK:
physiotherapist) - a physical therapist's
training focuses on diagnosing problems
in the joints and soft tissues of the body.
What are the treatment options for back
In the vast majority of cases back pain
resolves itself without medical help - just
with careful attention and home
treatment. Pain can usually be addressed
with OTC (over-the-counter, no
prescription required) painkillers.
Resting is helpful, but should not usually
last more than a couple of days - too
much rest may actually be
Usually back pain is categorized into two
Acute - back pain comes on suddenly and
persists for a maximum of three months.
Chronic - the pain gradually develops
over a longer period, lasts for over three
months, and causes long-term problems.
A considerable percentage of patients
with back pain experience both
occasional bouts of more intense pain as
well as more-or-less continuous mild
back pain, making it harder for the
doctor to determine whether they have
acute or chronic back pain.
If home treatments do not give the
desired results, a doctor may recommend
Medication - back pain that does not
respond well to OTC painkillers may
require a prescription NSAID
(nonsteroidal anti-inflammatory drug).
Codeine or hydrocodone - narcotics -
may also be prescribed for short periods;
they require close monitoring by the
Some tricyclic antidepressants, such as
amitriptyline, have been shown to
alleviate the symptoms of back pain,
regardless of whether or not the patient
Physical Therapy (UK: physiotherapy) -
the application of heat, ice, ultrasound
and electrical stimulation, as well as
some muscle-release techniques to the
back muscles and soft tissues may help
alleviate pain. As the pain subsides the
physical therapist may introduce some
flexibility and strength exercises for the
back and abdominal muscles. Techniques
on improving posture may also help. The
patient will be encouraged to practice
the techniques regularly, even after the
pain has gone, to prevent back pain
Cortisone injections - if the above-
mentioned therapies are not effective
enough, or if the pain reaches down to
the patient's legs, cortisone may be
injected into the epidural space (space
around the spinal cord). Cortisone is an
anti-inflammatory drug; it helps reduce
inflammation around the nerve roots.
According to The Mayo Clinic, USA, the
pain-relief effect will wear off after less
than six weeks.
Injections may also be used to numb
areas thought to be causing the pain.
Botox (botulism toxin), according to
some early studies, are thought to reduce
pain by paralyzing sprained muscles in
spasm. These injections are effective for
about three to four months.
Surgery - surgery for back pain is very
rare. If a patient has a herniated disk
surgery may be an option, especially if
there is persistent pain and nerve
compression which can lead to muscle
weakness. Examples of surgical
Fusion - two vertebrae are joined
together, with a gone graft inserted
between them. The vertebrae are
splinted together with metal plates,
screws or cages. There is a significantly
greater risk for arthritis to subsequently
develop in the adjoining vertebrae.
Artificial disk - an artificial disk is
inserted; it replaces the cushion between
Discectomy (partially removing a disk) -
a portion of a disk may be removed if it is
irritating or pressing against a nerve.
Partially removing a vertebra - a small
section of a vertebra may be removed if it
is pinching the spinal cord or nerves.
CBT (Cognitive Behavioral Therapy) -
according to some studies, CBT can help
patients manage chronic back pain. The
therapy is based on the principle that the
way a person feels is, in part, dependent
on the way they think about things.
People who can be taught to train
themselves to react in a different way to
pain may experience less perceived pain.
CBT may use relaxation techniques as
well as strategies to maintain a positive
attitude. Studies have found that patients
with CBT tend to become more active
and do exercise, resulting in a lower risk
of back pain recurrence.
A large number of patients opt for
complementary therapies, as well as
conventional treatments; some opt just
for complementary therapies.
According to the National Health Service
(NHS), UK, chiropractic, osteopathy,
shiatsu and acupuncture may help
relieve back pain, as well as encouraging
the patient to feel relaxed.
An osteopath specializes in treating the
skeleton and muscles.
A chiropractor treats joint, muscle and
bone problems - the main focus being the
Shiatsu, also known as finger pressure
therapy, is a type of massage where
pressure is applied along energy lines in
the body. The shiatsu therapist applies
pressure with his/her fingers, thumbs
Acupuncture, which originates from
China, consists of inserting fine needles
and specific points in the body.
Acupuncture can help the body release
its natural painkillers - endorphins - as
well as stimulating nerve and muscle
Studies on complementary therapies are
have given mixed results. Some people
have experienced significant benefit,
while others have not. It is important,
when considering alternative therapies,
to use a well qualified and registered
TENS (transcutaneous electrical nerve
stimulation) - a popular therapy for
patients with chronic (long-term) back
pain. The TENS machine delivers small
electric pulses into the body through
electrodes that are place on the skin.
Experts believe TENS encourages the
body to produce endorphins, and may
possibly block pain signals returning to
the brain. Studies on TENS have provided
mixed results; some revealed no benefits,
while others indicated that it could be
helpful for some patients.
A TENS machine should be used under
the direction of a doctor or health care
Pregnant women, people with epilepsy,
people with a pacemaker, and patients
with a history of heart disease should
not use a TENS machine.
Prevention of back pain
Steps to lower the risk of developing
back pain consist mainly of addressing
some of the risk factors.
Exercise - regular exercise helps build
strength as well as keeping your body
weight down. Experts say that low-
impact aerobic activities are best;
activities that do not strain or jerk the
back. Before starting any exercise
program, talk to a health care
Core-strengthening exercises; exercises
that work the abdominal and back
muscles, help strengthen muscles which
protect your back.
Flexibility - exercises aimed at improving
flexibility in your hips and upper legs
may help too.
Smoking - a significantly higher
percentage of smokers have back pain
incidences compared to non-smokers of
the same age, height and weight.
Body weight - the fatter you are the
greater your risk of developing back
pain. The difference in back pain risk
between obese and normal-weight
individuals is considerable.
Posture when standing - make sure you
have a neutral pelvic position. Stand
upright, head facing forward, back
straight, and balance your weight evenly
on both feet - keep your legs straight.
Posture when sitting - a good seat should
have good back support, arm rests and a
swivel base (for working). When sitting
try to keep your knees and hips level and
keep your feet flat on the floor - if you
can't, use a footstool. You should ideally
be able to sit upright with support in the
small of your back. If you are using a
keyboard, make sure your elbows are at
right-angles and that your forearms are
Lifting things - the secret for protecting
your back when lifting things is to think
"legs not back". In other words, use your
legs to do the lifting, more than your
back. Keep your back as straight as you
can, keep your feet apart with one leg
slightly forward so you can maintain
balance, bend only at the knees, hold the
weight close to your body, and straighten
the legs while changing the position of
your back as little as possible. Bending
your back initially is unavoidable, when
you bend your back try not to stoop or
squat, tighten your stomach muscles so
that your pelvis is pulled in. Most
important, do not straighten your legs
before lifting; otherwise you will be
using your back for most of the work.
Do not lift and twist at the same time. If
something is particularly heavy, see if
you can lift it with someone else. While
you are lifting keep looking straight
ahead, not up nor down, so that the back
of your neck is like a continuous straight
line from your spine.
Moving things - remember that it is
better for your back to push things
across the floor, rather than pulling them.
Shoes - flat shoes place less of a strain on
Driving - it is important to have proper
support for your back. Make sure the
wing mirrors are properly positioned so
you do not need to twist. The pedals
should be squarely in front of your feet.
If you are on a long journey, have plenty
of breaks - get out of the car and walk
Your bed - you should have a mattress
that keeps you spine straight, while at
the same time supporting the weight of
your shoulders and buttocks. Use a
pillow, but not one that forces your neck
into a steep angle.