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What Causes Back Pain?

Causes of Back Pain

The first step is determining the cause of your back pain. The causes are many and varied:

  • Bone and joint disorders
  • Overuse or sedentary lifestyle
  • Injury
  • Inflammation
  • Age-related wear and tear
  • Family history

Inflammation involving the spine can often cause back pain, and inflammation of the spinal nerves can cause nerve symptoms in the limbs.

Not all spinal conditions cause inflammation, and not all abnormalities in the spine cause pain.

Low Back Pain

Low back pain occurs in the lumbar spine. There are many different sources of back pain, but ultimately all pain is due to inflammation, compression, and/or abnormal mechanics.

Neuropathic pain is caused by pressure or irritation to the spinal cord or nerves leaving the spine.

Mechanical pain refers to pain that occurs when the 'mechanics' of the spine are strained such as occurs with disc or joint conditions.

Spinal conditions that can cause back pain include:

  • Acute strains of muscle and soft tissues
  • Chronic strain of soft tissues such as from poor posture
  • Arthritis
  • Disc degeneration
  • Bulging disc
  • Herniated disc
  • Facet joint pain
  • Sacroiliac joint pain
  • Pinched nerve without nerve damage (Radicular pain or Radiculitis)
  • Pinched nerve with nerve damage (Radiculopathy)
  • Spinal Stenosis
  • Segmental instability
  • Spondylolisthesis
  • Vertebral fractures
  • Osteomyelitis
  • Spinal tumors

Symptoms of Back Pain

Your symptoms of back pain will vary depending on where in your spine the pain is located, the severity of the pain, and the timing of your symptoms.

Back pain can be acute (less than 3 weeks), subacute (3 weeks to 3 months), or chronic (more than 3 months).

The quality of the back pain can be described as dull, pressure, tightness, burning sharp, stabbing, etc.

Pain that radiates into a limb can also be described these ways, or also include radiating pain, numbness, tingling, pins and needles, and weakness.

It's important for you and your doctor to discuss when your symptoms are present and what positions or activities make it better or worse. Identifying these factors is very important for your provider to best treat your back pain, and to individualize treatment for you.

Consider the following scenarios:

  • Perhaps your low back pain travels into your buttocks and legs?
  • Is your pain constant or does it let up occasionally?
  • Does your pain get worse with sitting, standing and/or walking?
  • Does your pain lead to numbness and tingling?
  • Do you have neck pain that radiates into your head or causes headaches?
  • Does the neck pain run down your arms or into your chest?

Tips for Managing Back Pain

The expert staff at the EvergreenHealth Neuroscience, Spine & Orthopedic Institute offers these tips to help manage and alleviate the back pain you may be experiencing.

  • Remain active (under the supervision of your physician) including appropriate exercise for your age and health status.
  • Warm up before exercising or other physical activities, especially after prolonged sitting.
  • Avoid prolonged inactivity or bed rest.
  • Maintain proper posture.
  • If you work in an office, make sure that you have an ergonomic working environment, and minimize prolonged sitting.
  • Always lift with your legs rather than with your back. Keep the object you're lifting close to your body, and don't twist when lifting.
  • Wear comfortable, low-heeled shoes.
  • Maintain a healthy diet
  • Quit smoking

Mechanisms of Spine Pain

There are several different mechanisms that can cause pain.

Irritation of the nerves coming out of the spine (spinal nerves) can cause radiating pain down the leg or arm. The medical terms used to describe an irritated spinal nerve are radicular pain, radiculitis, and radiculopathy. A common layman's term for pain radiating down the leg is “sciatica”. A great majority of cases of sciatica are due to a pinched nerve in the lumbar spine.

Pain due to a pinched spinal nerve is often felt in a specific nerve distribution. Some people feel pain straight down the back of their leg, while others feel it down the outer side of their leg, or wrapping around from the side to the front. Some people feel it radiate to the top of the foot, while others feel it on the outer or inner side of the foot. A pinched nerve in the neck can cause pain radiating into the shoulder blade region and down the arm, and often into the hand.

Pain also can be caused by compression or inflammation involving the spinal cord. Pain will often be felt in the region of the body supplied by that area of the spinal cord.

Pain can occur when a peripheral nerve is inflamed or entrapped. Common examples of this include the median nerve at the wrist (aka carpal tunnel syndrome) and ulnar nerve at the elbow. Pain and nerve symptoms most often occur below the area of nerve entrapment.

Direct muscle injury can cause pain. Although trauma is a common cause, there are also non-traumatic causes of muscle inflammation. An example of this is polymyalgia rheumatica, a condition in which pain is felt around both sides of the hips and shoulders.

Other sources of back pain include the bones, joints, ligaments, and tendons of the spine.

Although hip joint pain is often felt primarily in the groin, it's common to feel a lesser degree of pain in the low back and buttock.

Shoulder conditions can similarly cause pain and tension into the lower neck and shoulder blade area.

Many joint problems in the legs or arms can also cause radiating symptoms that feel similar to conditions originating in the back.

Your physician will thoroughly collect information about your symptoms, and perform a complete physical examination, in order to determine the exact source of your pain. If there is more than one pain source, your physician will help you understand what symptoms are due to which source, so that treatment can be properly focused and prioritized.

Several other medical conditions that can cause pain include systemic inflammation from a rheumatologic condition (e.g. autoimmune disorders), generalized nerve inflammation (e.g. neuropathy), vascular conditions, internal organ disorders, infection, or cancer.

Learn more about diagnosing your pain.