Back Pain Symptoms, Causes, Diagnosis and Treatment

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The Universal Guide to Back Pain: Everything you ever wanted to know, straight from the experts.

In This Article: Parts of the Spine   |   Tissue   |   Who Gets Back Pain?   |   Types of Back Pain   |   Risk Factors   |   Conditions That Cause Back Pain   |   Other Symptoms   |   Diagnosis   |   Treatment Team   |   Nonoperative Treatments   |   Surgery    |   Sources

Back pain is one of the most common reasons people self-treat and seek medical care. It will affect approximately three in four adults during their lifetime.

It’s caused, directly or incidentally, by a huge number of health conditions, which may make teasing out the root cause of back pain exceedingly difficult. Sometimes the cause is obvious and sometimes not even a team of doctors can figure out why your back hurts. Many cases go away on their own, but some stick around for months or even years.


Back pain concept, man touching on virtual screen.Back pain is a big topic because between the upper back and tailbone, there are 17 vertebral bodies, many joints, the sacrum and tailbone. Photo Source: 123RF.com.

Yes, uncertainty abounds when dealing with back pain, but SpineUniverse is here to help. Below is your guide to everything back pain: Its causes, its complications, how it’s diagnosed, how it’s treated, how to live with it, mitigate it and prevent it. Read on.

What Are the Parts of the Spine?

Learning about spine anatomy can help you understand your back pain on a deeper level.

Reginald Q. Knight, MD, an orthopedic surgeon and Director of the Bassett Spine Care Institute in Cooperstown, NY, breaks down the regions of the spine.

“The cervical spine is a highly mobile segment of the spine prone to degenerative changes,” says Dr. Knight. As you age, pain is more likely to take place in what’s called the “transitional zone” between the flexible cervical vertebrae and the more rigid thoracic portion of the spine.

The thoracic spine is associated with the chest and connects to your ribs. Dr. Knight says that particularly, the elderly can experience compression fractures in this region, a result of losing bone mass.

The lumbar spine is generally known as the lower back. “This is the most common region for back pain,” Dr. Knight says. “Younger patients are more prone to discogenic back pain, whereas older patients are more prone to facet joint issues.” Discogenic pain means one or more intervertebral discs cause pain while facet joint issues originate from the top and bottom of each vertebra.

Finally, the sacral region is the very bottom of the spine. It consists of the flat, triangle-shaped sacrum bone that connects to the hips, and the coccyx, also known as the tailbone, an evolutionary leftover. Dr. Knight mentions that degeneration of this area tends to occur in older patients. You can also fracture your sacrum or tailbone by falling hard on your rear.

Back pain spine illustrationUnderstanding the spine--its parts and in whole--can help you understand your back pain.

What Muscles, Bones and Other Tissue Make Up the Spine?

Back pain is a big topic. Between the upper back and tailbone, there are 17 vertebral bodies, many joints, the sacrum and tailbone, plus fibrous and muscular supporting structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but here’s what you need to know about those parts.

Before discussing the muscles, we need to talk about vertebrae. Vertebrae are a series of small bones that make up the backbone to which the muscles attach. A spine typically consists of 33 vertebrae, each separated by an intervertebral disc.

Every vertebra is made up of two parts: an anterior vertebral body that protects the spinal cord and nerve roots and a posterior vertebral arch which accommodates the canal and also safeguards the spinal cord.

Back muscles fall into three groups:

  • Intermediate muscles make up something called the erector spinae, which includes the longissimus, iliocostalis, and spinalis muscles. These muscles allow the ribs to move as needed.
  • Intrinsic muscles stabilize the vertebral column and are located underneath the erector spinae; also known as the “deep” muscles of the back and control the movement and posture of the vertebral column.
  • Superficial muscles are directly underneath the skin and attach to the bones of the shoulder, aiding in neck and shoulder movements along with controlling upper limb movements.

Muscles that support the spine are structured in layers, says Dr. Knight. Some muscles extend from the base of a person’s skull to their pelvis. Other muscle groups cover shorter distances depending on the segment of the spine: cervical, thoracic, or lumbar. He adds, “These muscle groups function as primary stabilizers of the bony and ligamentous structures. Strains of these muscles affect all age groups.”

There are several other parts of the spine worth considering when you are identifying your back pain. These include:

  • Ligaments and tendons. While tendons are part of the muscular structure attaching a muscle to bone, ligaments attach bone to bone with no intervening muscle. Both ligaments and tendons contain elastic fibers. 
  • Intervertebral discs, which actas miniature shock absorbers that sit between vertebrae and prevent bone-on-bone friction. Discs can naturally degenerate over time.
     
  • Hinge-like facet joints, which connect each of the vertebra to the one above it and the one below it. They provide the optimal combo of mobility and stability: Each vertebra can move independently, but since they’re all connected the spine can act as a whole. There are four facet joints per vertebra—two on top and two on the bottom.

Back pain vertebra illustrationThe vertebrae, or backbones, can be more complicated than they first seem. Learn about how they work to understand how they can hurt.Who Gets Back Pain?

Well, it depends on where it hurts. Chronic upper back pain affects 15 to 19% of people globally. Those suffering tend to fall into certain age groups. For instance, one study found that postmenopausal women are at greater risk, likely due to the risk of osteoporosis and vertebral compression fractures.

Your career choice may also lead to upper back pain. Those who have to hunch for long periods, such as dentists and eye doctors, report higher incidences of upper back pain. Office workers frequently have upper back pain due to poor ergonomics.

So, what about pain in the mid-back—low in the thoracic spine and even the top of the lumbar? Adolescents get it a lot. According to a 2016 study, between 13% and 45% of children and adolescents will have mid-back pain in a given four-year period.” A Danish report, which studied overall spinal pain in 11 and 13-year-olds, reported increased mid-back pain if the kids were more physically active than most. Mid-back pain is also a common result of car accidents.

You’ll often get mid-back pain from pushing your body too hard, but lower back pain can come from not pushing it hard enough. A sedentary lifestyle is a big contributor to low back pain. One study says that reporting of chronic low back pain has gone from 3.9% in 1992 to 10.2% in 2006. While reasons are unclear for this increase, a couple possible factors include higher rates of obesity and depression.

What Are Some Different Types of Back Pain?

The first thing you should probably know about back pain is that it can last anywhere from a few days to years, and that timeline makes a big difference in how your pain is diagnosed and treated.

Acute back pain is defined as severe but lasting a short time, usually 7 to 10 days. Subacute pain can last from two to six weeks. Chronic back pain usually occurs every day and sticks around for longer than six to eight weeks. It can be severe and last months or even years, but may be characterized as mild, deep, achy, burning, or electric-like.

Beyond the when, there’s also the where. Mechanical pain means that the source of your pain may lie in the facet joints, discs, soft tissues, or vertebrae. Back pain that travels into another part of the body, such as the leg, may be consider radicular pain (because it radiates; get it?), particularly when it radiates below the knee. This scenario is commonly called a lumbar radiculopathy (eg, sciatica). Fortunately, not all occurrences of back pain include leg pain.

Perhaps you’ve heard of inflammatory pain. While it sounds like it could be a separate type of pain from mechanical and radicular pain, it’s actually an element of both. Dr. Knight explains, “Symptoms of pain, whether mechanical or radicular, share a component of inflammation.” Simply put, inflammation is when your body knows something isn’t right and “flares up” as a result.

What Are Some of the Risk Factors for Back Pain?

There are myriad health conditions that can lead to back pain. Dr. Knight points out that other than these specific conditions, there are overarching factors as well.

He says, “The main medical conditions [and behaviors] associated with back pain are obesity and smoking. The impact of excessive weight and its effect on spinal anatomy is significant. Smoking and the adverse impact on the vascular system—macro and micro—is associated with increased severity and frequency of back pain.” Smoking impairs the delivery of nutrients to structures in the back, and can also make healing from back injuries or surgery more difficult and less effective.

Back pain risk factor smokingPlease just quit. Do you really need yet another reason? Other elements that can come into play include fitness level, genetics, psychological factors, and career choice.

What Conditions Can Cause Back Pain?

Among all the different areas of back pain—neck pain, upper back pain, lower back pain, and tailbone pain—there’s a host of conditions that can bring it on.

There are several diseases, disorders, and illnesses that can cause back pain. Some of the more common causes include:

  • Compression and Wedge Fractures: a vertebral body, almost always due to weak bones from osteoporosis, collapses under the weight of the spinal column
  • Herniated Disc: when the pads between vertebrae move out of position and press on the nerves; this can take place in the lumbar region, producing sciatica
  • Spinal Stenosis: when the spinal canal narrows, usually due to a herniated disc but sometimes caused by bone spurs from osteoarthritis or by injury; the structure causing the narrowing frequently compresses a nerve root or the spinal cord itself (myelopathy)
  • Pregnancy: 50 to 80% of pregnant women experience back pain
  • Cervical Sports Injuries: also called a “stinger,” these injuries occur when the head or neck is hit to one side
  • Whiplash: neck sprain or strain from hyperextension and hyperflexion
  • Scoliosis: an abnormal curvature of the spine that can also be experienced in childhood; it can be painful when it causes degenerative changes in adults
  • Kyphosis: abnormal curvature that causes a hunchback or slouching posture
  • Spondylolisthesis: when one vertebra slips forward over the vertebra below it

Less common causes of back pain can include:

  • Depression: depression can bring about back pain, or, depression can come about as a result of chronic pain
  • Stress: daily pressures can exacerbate back pain

What Other Symptoms Can Appear with Back Pain?

Sometimes, back pain isn’t just back pain. Other symptoms can appear along with it, and there are some that can be concerning. While pain radiating in the legs is a fairly common symptom that accompanies back pain, there are others that should alert you to call your doctor. They include:

  • Bowel or bladder issues
  • Fever
  • A recent injury
  • Sudden and unexplained weight loss
  • Weakness, numbness, or tingling in legs

These can all indicate medical emergencies. At the very least, call your doctor right away, but be prepared to head to the ER. 

How Can You Get a Back Pain Diagnosis?

Whether you back pain falls into the “seek urgent medical care” list above, or you are following your gut reaction that says, “Go see your doctor,” below is what you can expect.

  • A review of your medical history, including immediate family members who have back problems. Some back problems (e.g., scoliosis, osteoporosis) have a genetic potential.
  • Discuss when back pain started, what you were doing when pain began, current pain severity and characteristics (e.g., stabbing, burning), how pain may have changed since it began, and other questions. Your doctor wants to learn as much about your pain and symptoms before he examines you—while the exam may provoke pain, your doctor doesn’t want to make the process intolerable!
  • Physical examination evaluates your vital signs (eg, heart rate). It is not unusual for your blood pressure to be elevated as a result of pain. The doctor examines your spine, feeling for abnormalities and areas of tenderness.
  • Neurological examination involves assessing sensation and function. The doctor may employ the pin prick test to determine if feeling is the same on both sides of particular parts of the body (eg, legs). Function, flexibility and range of motion are assessed while you walk, bend forward and backward (if able to), and during other movements. The doctor tests your reflexes too.

After a thorough review, your doctor probably has come to one or two conclusions as to what is causing your back pain and other symptoms. To obtain more information about your back problem, and to help confirm the diagnosis, the doctor may order an X-ray, CT scan, or MRI. Sometimes lab tests are ordered too. Keep in mind that an accurate diagnosis is essential to a well-developed treatment plan.

Who Might Be On Your Back Pain Treatment Team?

When experiencing back pain, whether it’s acute, subacute, or chronic, you’ll be glad to know that several professionals can help you.

  • Orthopedic Surgeon: a surgeon who specializes in bone, joint, tendon, ligament, muscle, and nerve disorders
  • Neurosurgeon: a surgeon who specializes in the central and peripheral nervous system
  • Neurologist: a medical professional who specializes in disorders of the brain and nervous system; “Neurologists often evaluate patients with radicular symptoms or more unusual complaints,” Dr. Knight adds.
  • Physical Therapist: a movement expert who specializes in specific exercises and provides “the mainstay of care for most patients presenting with mechanical symptoms,” Dr. Knight says.
  • Chiropractor: a professional who specializes in spinal manipulation and alternative therapies; Dr. Knight states, “Chiropractors have a longstanding role in evaluation and treatment of mechanical symptoms.”
  • Acupuncturist: Dr. Knight notes that an acupuncturist, a professional who specializes in inserting thin needles into specific points of the body, is “another modality in managing difficult mechanical symptoms.”

What Are Some Nonoperative Treatments for Back Pain?

It can be comforting to know that you don’t always—or even usually—have to go the surgery route when addressing back pain. In addition to traditional nonoperative therapies like pain medications, both over the counter and prescribed, muscle relaxants, and topical pain relief, Dr. Knight says various physical activities and forms of complementary and alternative medicine can help your back pain, such as:

Additional nonoperative treatments can include the following:

  • Medication: Dr. Knight explains, “First line medications in my practice are NSAID’s (non-steroidal anti-inflammatory drugs). Then there’s the occasional use of muscle relaxants, and rarely narcotics are indicated. Nerve pain may be aided by membrane-stabilizing medications, such as gabapentin or Lyrica. And depending on the specialty of the physician, other medications in the anti-depressant category may be used to augment treatment.”
  • Corticosteroid Injections: Also known as a cortisone shot, these injections act as an epidural to alleviate pain. “In my opinion, corticosteroid injections are most appropriate in treatment of radicular symptoms refractory to other medications listed above,” Dr. Knight says.
  • Physical Therapy: This type of therapy is effective in helping people return to a normal, active range of motion. Dr. Knight also notes that since physical therapy can lessen pain, it may reduce or eliminate the need to take opioids.

What Back Pain Surgery Options Are Available?

If you’ve tried everything or you have a condition that requires surgical attention, these are some of the main back surgery options currently available.  

  • Microdiscectomy: Discectomy is the removal of portions of a herniated disc that are compressing nerve roots. It’s the main surgical method of addressing herniated discs.  It can be accomplished via traditional open (just called a discectomy).

    However, it’s much more likely you’ll have a microdiscectomy. In a microdiscectomy, the surgeon uses minimally invasive techniques and special magnifying glasses called loupes. The loupes act as microscopes, hence the term ‘microdiscectomy.’

Back pain treatment microdiscectomy loupesSpecial glasses called loupes help surgeons perform microdiscectomies.

A surgery like this is recommended if a person is experiencing radicular symptoms, has a visually-confirmed disc herniation, and has failed to experience symptom improvement following a therapy program.

  • Laminectomy: This is a procedure that removes a portion of the vertebral bone, also called the lamina. It’s advised when back or neck pain persists after treatment or there are symptoms of nerve damage—these can include numbness in the arms or legs.

    Recovery time has a wide range, from a few days with a mild laminectomy to a few months when it’s coupled with a spinal fusion. A laminectomy can also occur during a discectomy. Dr. Knight says, “A partial laminotomy is typically part of the discectomy procedure.”
     
  • Vertebroplasty and kyphoplasty: These surgeries are performed when the spine has a compression fracture, which can result from trauma or osteoporosis. They use bone cement injected into the vertebral body to restore its height and shape.

    “Both procedures are typically used to treat osteoporotic compression fractures,” Dr. Knight says. “The difference between these procedures relates to the consistency of cement used and preparation of the vertebra. In vertebroplasty, the cement is injected under higher pressures, thinner consistency, and without coring out or other preparation of the vertebral body. In kyphoplasty, the cement is injected under lower pressures, thicker consistency, and following preparation of the vertebral body to accept the cement.”

    Most patients report a reduction of pain either immediately or within 24 to 48 hours.
     
  • Spinal Fusion: A spinal fusion is the use of a bone graft to bring two opposing bony surfaces together, usually in the case of a spinal deformity like scoliosis. A full recovery requires physical therapy and a time period of three to six months.

We know that’s a lot of information to take in—the back is a complex structure. That’s why we’ve created an entire website dedicated to the spine! But, knowledge really is power, and this information can aid you as you seek out a diagnosis for your back pain or wish to learn more about a condition you already know you have.

To learn even more about back pain and its accompanying disorders and conditions, we recommend visiting a spine specialist near you who can help.

Sources

Interesting Back Pain Stats: BMC Musculoskeletal Disorders. (June 2009) “Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review” https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-10-77

Interesting Back Pain Stats: PLOS.org. (July 2019) “Upper back pain in postmenopausal women and associated physical characteristics” https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220452

Interesting Back Pain Stats: European Spine Journal. (July 2019) “Back pain prevalence, intensity and associated factors in French dentists: a national study among 1004 professionals” https://link.springer.com/article/10.1007/s00586-019-06080-4

Interesting Back Pain Stats: Occupational Medicine. (December 2015) “Neck and upper back pain among eye care professionals” https://academic.oup.com/occmed/article/65/9/753/1442878

Interesting Back Pain Stats: South African Journal of Physiotherapy. (November 2015) “The effect of a workstation chair and computer screen height adjustment on neck and upper back musculoskeletal pain and sitting comfort in office workers” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093093/

Interesting Back Pain Stats: Complementary Therapies in Medicine. (October 2016) “Short-term effects of traditional Thai massage on electromyogram, muscle tension and pain among patients with upper back pain associated with myofascial trigger points” https://www.sciencedirect.com/science/article/abs/pii/S096522991630084X

Interesting Back Pain Stats: European Journal of Pain. (May 2016) “Incidence and prognosis of mid‐back pain in the general population: A systematic review” https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.884

Interesting Back Pain Stats: BMJ Open Sport & Exercise Medicine. (May 2016) “The most physically active Danish adolescents are at increased risk for developing spinal pain: a two-year prospective cohort study” https://bmjopensem.bmj.com/content/2/1/e000097?cpetoc=&utm_source=trendmd&utm_medium=cpc&utm_campaign=bmjosem&utm_content=consumer&utm_term=1-A

Interesting Back Pain Stats: European Journal of Pain. (February 2015) “A population‐based, incidence cohort study of mid‐back pain after traffic collisions: Factors associated with global recovery” https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.681

Interesting Back Pain Stats: Journal of Physical Therapy Science. (2015) “Effect of an exercise program for posture correction on musculoskeletal pain” https://www.jstage.jst.go.jp/article/jpts/27/6/27_jpts-2015-023/_article/-char/ja/

Interesting Back Pain Stats: Archives of Internal Medicine. (February 2015) “The Rising Prevalence of Chronic Low Back Pain” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339077/

Interesting Back Pain Stats: Annals of Internal Medicine. (April 2017) “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians” https://www.acpjournals.org/doi/full/10.7326/M16-2367

Interesting Back Pain Stats: Cochrane Systematic Review. (September 2015) “Massage for low‐back pain” https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001929.pub3/abstract

Interesting Back Pain Stats: JAMA. (March 2016) “Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain” https://jamanetwork.com/journals/jama/article-abstract/2504811

Updated on: 09/16/20
Reginald Q. Knight, MD, MHA
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