Causes of back pain
Involved in almost every movement of your body, your back is made up of interconnected components, and they can each be injured in different ways. You have moving vertebrae (small bones that make up the spine), shock-absorbing disks between the vertebrae, large supporting muscles, tendons, and ligaments, and a network of nerves.
Back pain is most common in people 45 and older. An estimated 80% of Americans will experience low back pain in their lifetime, with nearly 30% reporting it in any given year.
The causes are as varied as the pain itself. Muscle or ligament strains can ache, pull on vertebrae, squeeze nerves, and trigger muscle spasms. Ruptured (herniated) disks can press on nerves, causing shooting pain, while worn-down disks can cause bone-on-bone friction.
Arthritis causes pain through inflammation, and other conditions cause pain by compressing (pinching) nerves in the spinal cord.
Treatments can range from rest, ice, and heat to spinal surgery, depending on what is causing the pain.
1. Low back strain
- Dull achy pain in the lower back
- Pain that is worse when bending and getting up from sitting
- Sudden muscle cramping or spasm
Low back strain is a twisting, pulling, or tearing of a muscle in the lower back. Strains can happen suddenly or be chronic. Low back strain is usually caused by overuse, lifting of heavy objects, or sports.
Treatment for low back strain usually includes:
- Applying ice or heat
- Taking a pain reliever like an NSAID (such as Advil or Motrin)
- Wearing a support belt to brace the area if you have to do heavy lifting
Your doctor may also suggest seeing a physical therapist, a chiropractor, an acupuncturist, or a massage therapist.
- Radiating pain into the buttocks and down the back of one leg
- Pain can be aching, burning, or feel like an electrical shock
- You may feel numbness of the skin on the leg or some weakness
Sciatica is a general term describing any shooting pain that begins at the spine and travels down the leg. It is caused by something pressing on the sciatic nerve, which starts in the back and goes through the buttocks and down your leg.
A physical therapist can suggest a routine of stretches and exercises to treat the pain. At-home remedies like heat, ice, NSAIDs, and a few days of rest can also help. You can also see a chiropractor or an acupuncturist to treat sciatica, and your doctor may prescribe more powerful painkillers, cortisone injections, or muscle relaxants.
3. Herniated (slipped or bulging) disk in the lower back
Sometimes slipped disks can cause pain in the center of the low back. However, it is not uncommon to only have leg pain and not back pain with slipped disks. So even though the problem is in the back, the pain is in the leg! —Dr. Benjamin Schwartz
- Low back pain
- Back pain that shoots down the leg
- Back pain that is worse when sitting
- Weakness in the leg or foot
- Numbness or burning in the leg or foot
In between your vertebrae are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep them in place. When you have a herniated disk, the outer shell of the disk tears, and the jelly-like substance bulges out. That bulge can press on nerves, causing pain and other symptoms.
Treatment for a herniated disk usually begins with rest, physical therapy, anti-inflammatories, and modifying your exercise routine. If symptoms fail to improve, your doctor may recommend cortisone injections into the spine. In rare cases, surgery may be necessary to remove pieces of bulging disk.
4. Spinal stenosis
- Pain and/or stiffness in your lower back or back of the hip
- Burning pain or ache that shoots down the leg or to the butt (often affecting both legs at the same time)
- Numbness, weakness, cramping, or pain in your legs or feet
- Heaviness or easy fatigue in the legs when walking distances
Your spine is a column of hollow bones that protects your spinal cord, which runs inside the spine. Spinal stenosis is a narrowing of the spaces within your spine. That narrowing puts pressure on the nerves that travel through the spine or directly on the spinal cord itself.
Treatment for spinal stenosis can include:
- Physical therapy
- Steroid injections to reduce swelling and inflammation
- A decompression procedure to take pressure off the spinal cord
- Spinal fusion surgery
How your doctor treats spinal stenosis will depend on how severe it is and whether or not your symptoms improve with non-surgical treatment.
5. Cauda equina syndrome
- Back pain
- Numbness or tingling in the buttocks and legs
- “Saddle anesthesia” numbness in the inner thighs
- Loss of bowel or bladder control
- Difficulty walking
Cauda equina syndrome is a rare but serious condition where extreme pressure on the spinal cord causes sudden, severe back pain with numbness and weakness in the legs. This can happen from spine tumors, large disk herniations, bleeding or infection around the spinal cord, or trauma to the spine. Some patients also lose control of their bowels or bladder.
Cauda equina syndrome is a medical emergency and has to be treated with surgery to prevent permanent damage to the nerves.
Other possible causes
Back pain can also be caused by:
- Iliolumbar syndrome—stretching or tearing of ligaments in the lower back.
- Upper back (thoracic) disk herniation—pain that shoots along the ribs.
- Referred pain—pain felt in the back that comes from another source, such as kidney stones or gallstones.
- Fibromyalgia—pain in several pressure points in the body, including the back.
- Pregnancy—can put pressure on the lower back.
- Compression fracture—a fracture of the vertebrae as a result of severe osteoporosis (weakening of the bones)
- Discitis—infection of a spinal disk as a result of:
- Kidney stones
- A kidney infection
- An aortic aneurysm
When to call the doctor
Back pain is a very common problem, and you can usually treat it at home. But consider calling your doctor if you have any of the following:
- Severe pain, numbness, or weakness that makes it hard to walk.
- Worsening pain, numbness, or weakness.
- Symptoms that do not improve after at least 3 weeks of home treatment.
MRI scans are rarely needed and, in fact, may lead to overtreatment or unnecessary anxiety. Studies have shown that even people without back symptoms tend to have abnormal MRI findings that do not require treatment. —Dr. Schwartz
Should I go to the ER for back pain?
If you have chest pain or pressure, pain in your shoulder or jaw, shortness of breath, lightheadedness, or nausea in addition to back pain, you may be having a heart attack. Call 911 or go to an emergency room immediately.
You should also go to the emergency room if you have any of these other symptoms along with back pain, since they can be signs of serious medical conditions:
- Loss of bowel or bladder control
- Numbness or weakness in your legs
- Weight loss
- Inability to move
Back pain treatments
Back pain can be frustrating and limiting, but the majority of cases get better over time. The key to treatment is patience, patience, patience! —Dr. Schwartz
- A short period of rest (24 to 72 hours) immediately after the injury can help to relax your back muscles.
- Ice for 2 to 3 days to reduce inflammation, then use heat to relax muscles.
- Take over-the-counter pain relievers like NSAIDs (such as Advil or Motrin) as needed.
- Gradually return to your activities, avoiding bending or lifting until the pain is gone.
- Do gentle stretching exercises as pain allows.
Other treatment options
- Your doctor may prescribe more powerful medications such as stronger anti-inflammatories or muscle relaxants.
- Nonsurgical treatments may include physical therapy, chiropractic, acupuncture, and massage.
- You may need cortisone injections in the spine to relieve pain, depending on the diagnosis.
- In some cases, surgery may be recommended.
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