Back Pain

The back is a complex structure of bones, joints, ligaments, and muscles. Your spine consists of 33 vertebrae separated by spongy discs that act as shock absorbers. This intricate system supports your body, protects your spinal cord, and allows flexible movement. When any component is injured or strained, back pain can result.

Back pain can range from a dull, constant ache to sudden, sharp pain that makes movement difficult. It may stay in one place or radiate to other areas, such as the buttocks, legs, or abdomen. The pain might worsen with specific movements, like bending or lifting, or improve with rest.

Most back pain is mechanical, meaning it's related to the way your spine moves or the way you feel when your spine moves in certain ways. Only rarely is back pain caused by serious medical conditions, though these must be ruled out when pain is severe, persistent, or accompanied by other symptoms.

Mechanical Causes

• Muscle or ligament strain: Heavy lifting, sudden movements, poor posture
• Herniated disc: Disc material presses on nerves
• Degenerative disc disease: Age-related wear and tear
• Spinal stenosis: Narrowing of spinal canal
• Spondylolisthesis: Vertebra slips forward
• Facet joint dysfunction: Joint inflammation or wear
• Sacroiliac joint dysfunction: SI joint problems

Skeletal Conditions

• Osteoporosis: Weakened bones prone to fractures
• Osteoarthritis: Joint degeneration
• Ankylosing spondylitis: Inflammatory arthritis of spine
• Scoliosis: Abnormal spine curvature
• Compression fractures: Often from osteoporosis
• Spinal fractures: From trauma or weakened bones

Nerve-Related Causes

• Sciatica: Compression of sciatic nerve
• Radiculopathy: Pinched nerve root
• Cauda equina syndrome: Emergency condition
• Peripheral neuropathy: Nerve damage
• Spinal cord compression: Various causes

Systemic Conditions

• Fibromyalgia: Widespread pain condition
• Kidney stones: Can cause severe back pain
• Kidney infections: Pyelonephritis
• Endometriosis: In women, can cause back pain
• Aortic aneurysm: Can present as back pain
• Pancreatitis: Can radiate to back

Cancer-Related

• Spinal tumors: Primary or metastatic
• Multiple myeloma: Bone marrow cancer
• Metastatic cancer: Spread from other organs

Lifestyle Factors

• Poor posture: Prolonged sitting or standing
• Obesity: Extra weight stresses spine
• Sedentary lifestyle: Weak core muscles
• Improper lifting: Using back instead of legs
• Smoking: Reduces blood flow to spine
• Stress: Muscle tension and pain perception

Back pain may be accompanied by other symptoms that help identify the cause:

• Leg pain (sciatica): Shooting pain down leg
• Numbness or tingling: In back, buttocks, or legs
• Muscle spasms: Involuntary contractions
• Stiffness: Especially in morning
• Limited range of motion: Difficulty bending or twisting
• Weakness: In legs or feet
• Pain with specific movements: Bending, lifting, sitting
• Fatigue: From chronic pain
• Sleep disturbances: Pain interfering with rest
• Mood changes: Depression or anxiety from chronic pain

Medical History

• Pain onset and duration
• Location and radiation pattern
• Pain quality and severity
• Aggravating and relieving factors
• Previous episodes and treatments
• Work and activity levels
• Red flag symptoms

Physical Examination

• Posture and gait assessment
• Range of motion testing
• Muscle strength evaluation
• Neurological examination
• Straight leg raise test
• Palpation for tenderness
• Reflex testing

Imaging Tests

• X-rays: Show bone problems, alignment
• MRI: Detailed images of soft tissues
• CT scan: Cross-sectional bone images
• Bone scan: Detect fractures or tumors
• Electromyography (EMG): Nerve function

Note: Most acute back pain doesn't require imaging unless red flags are present.

Surgical Options

Surgery is rarely needed but may be considered for:

• Severe nerve compression
• Progressive neurological deficits
• Cauda equina syndrome
• Failed conservative treatment
• Structural instability

Gentle Stretches

• Knee to chest: Relieves lower back tension
• Cat-cow stretch: Improves spine flexibility
• Child's pose: Stretches entire back
• Piriformis stretch: Helps with sciatica
• Hamstring stretches: Reduces back strain

Strengthening Exercises

• Partial crunches: Strengthen core safely
• Bird dog: Core and back stability
• Bridges: Strengthen glutes and core
• Wall sits: Build endurance
• Planks: Core strengthening

Important: Start slowly and stop if pain worsens. Consider working with a physical therapist.

• Exercise regularly: Focus on core strength and flexibility
• Maintain healthy weight: Reduce spine stress
• Practice good posture: Sitting, standing, sleeping
• Lift properly: Bend knees, keep load close
• Ergonomic workspace: Proper chair, desk height
• Take breaks: Avoid prolonged sitting
• Quit smoking: Improves spine health
• Manage stress: Reduces muscle tension
• Sleep position: Support spine alignment
• Wear supportive shoes: Good arch support
• Stay hydrated: Maintains disc health

Schedule an Appointment If:

• Pain persists beyond 2 weeks
• Pain is severe or worsening
• Pain radiates down legs
• Numbness or weakness in legs
• Pain after a fall or injury
• Pain worse at night or at rest
• Unable to work or perform daily activities
• Previous cancer history
• Unexplained weight loss
• Over age 50 with new back pain

For those with chronic back pain, a comprehensive approach is essential:

• Pain management program: Multidisciplinary approach
• Regular exercise: As tolerated
• Psychological support: Cope with chronic pain
• Activity modification: Not elimination
• Support groups: Connect with others
• Work accommodations: Ergonomic adjustments
• Sleep hygiene: Quality rest despite pain
• Stress management: Reduce pain perception