Back pain: causes, treatment and when to see a doctor


Back pain is a very common condition, although it is experienced unambiguously. From dull or throbbing pains with osteoarthritis of the spine to shooting pains, sharp pain with ruptured intervertebral disc, back pain can also come and go, be persistent, worsen with exercise or prolonged sitting and / or be associated with neurological symptoms such as numbness. , etc. tingle.

While back pain can be frustrating and debilitating, on the bright side, most back pain episodes improve or resolve with minimal care, usually within a few weeks.

Illustration by Alexandra Gordon, Get Meds Info

Common causes

There are several potential causes of back pain. These are some of the most common reasons, although this is not an exhaustive list.

Muscle tension / strain

Muscle sprains and strains are perhaps the most common causes of back pain, especially in the lower back. A sprain refers to a tear in a muscle or tendon (the fibrous tissue that connects a muscle to a bone) and a sprain refers to a tear. ligaments (fibrous tissue that connects two bones).

These tears, which are the result of trauma such as lifting the sofa or gradually straining it, cause inflammation, pain and, in some cases, muscle spasms.

The pain caused by stretching a muscle or stretching the back can range from mild to debilitating and is often described as "widespread pain" that reaches the buttocks, worsens with movement, and calms down with rest. Along with pain, muscle stiffness and limited range of motion are often seen with sprains and strains.

Swollen and broken disc

The spinal discs lie between the adjacent vertebrae and serve as shock-absorbing cushions. For various reasons, including the natural aging process, spinal injuries, weight gain, smoking, and repetitive stress on the spine (such as prolonged sitting or heavy lifting), discs begin to deteriorate. over time, making them more prone to bulging or sticking out (called a bulging or slipping disc) .

Over time, a bulging disc (without treatment) can rupture over time. When the disc ruptures, its internal contents ( nucleus pulposus ) are released, compressing nearby nerve roots or the spinal cord itself. A ruptured disc is called a ruptured disc or herniated disc .

A ruptured disc in the lower back causes severe back pain that can progress to the buttocks, groin, and / or one leg. Also, a ruptured disc in the neck can cause pain that runs down the arm. In addition to pain, a herniated disc can cause neurological symptoms such as muscle weakness, numbness, and tingling.

Spinal osteoarthritis

Osteoarthritis can affect any joint in the body, including the small joints in the spine (called vertebral or facet joints). Spinal osteoarthritis occurs as a result of the "wear and tear" of the cartilage located between the joints of the spine.

As the cartilage wears down, a dull, aching, or throbbing pain may develop, increasing with movement. An unpleasant crepitus sensation (cotton sensation) can occur when the cartilage is completely worn down and the joints begin to rub against each other. Joint stiffness and limited range of motion can also occur with osteoarthritis of the spine.

As osteoarthritis of the spine progresses, new bone growths form in the body that stabilize the joint. These bone spurs can end up compressing nearby spinal nerve roots, causing numbness and tingling sensations, similar to a ruptured disc .

In addition to the natural aging process, obesity can contribute to the development of osteoarthritis of the spine, as excess weight puts additional pressure on the vertebral joints.


Sciatica is a compression or pinch of the sciatic nerve, often caused by a herniated disc or bone spur. Injuries or injuries to the pelvis, buttocks, or thighs, diabetes, prolonged sitting, and piriformis syndrome , in which a small muscle in the buttocks spasms and irritates the sciatic nerve, can also cause sciatica .

Since the sciatic nerve is the longest nerve in the body (it runs from the base of the spine down in both legs), compression can cause low back pain that spreads to the buttocks and down the legs to the soles (usually in a side). In addition to burning and / or cramping pain, patients may experience tingling, numbness, and muscle weakness.

Spinal stenosis

Spinal stenosis causes back pain in an aging population. As you age, the spinal canal gradually narrows or narrows, in part due to osteoarthritis and thickening of the tissues in the spine. If the spinal canal becomes too narrow, the nerve roots can become compressed, causing neurological symptoms such as weakness, numbness, and tingling.

In addition to age and arthritis, other conditions that can lead to spinal stenosis include scoliosis and Paget's disease, a condition in which the growth and destruction of bones is impaired .

Traumatic injuries, such as those caused by a car accident, can also lead to spinal stenosis (due to sudden swelling and inflammation in the spinal canal).

Spondylolysis and spondylolisthesis

Spondylolysis is a stress fracture of one of the vertebrae. This condition is more common in children and adolescents who play sports such as gymnastics or soccer, which cause repetitive stress in the lower back .

Spondylolysis can also result from spinal trauma or degenerative changes in aging that cause the loss of normal stabilizing structures in the spine.

If a stress fracture weakens the vertebrae too much, the vertebra becomes unstable and begins to "slide," a condition called spondylolisthesis . Symptoms of spondylolisthesis include pain and stiffness where the vertebra is displaced.

Also, if a slipped vertebra pinches nearby nerve roots, it can lead to radiating pain (such as pain that shoots up in the hands and fingers) and neurological symptoms such as tingling, numbness, and weakness .


Osteoporosis is a weakening of the bones that makes them more prone to fracture. Back pain due to osteoporosis is most commonly associated with a compression fracture of the vertebra. Often with a compression fracture, the person does not report a history of trauma, but instead experiences sudden back pain after a simple action, such as bending over or sneezing. …

Compression fracture pain is often felt in the lower back or the middle of the back (where the fracture occurred). In rare cases, the pain spreads to other parts of the body, such as the abdomen or legs. Generally speaking, the pain of a compression fracture often increases with movement, decreases at rest or while lying down, and its quality ranges from sharp to dull.


Scoliosis is a condition in which the spine bends and twists, like the letter "S" or the letter "C". It usually develops during childhood or adolescence. In most cases, the cause of scoliosis is unknown, although it may be related to trauma or a birth defect. In some cases, multiple family members will have scoliosis, indicating a potential genetic component.

Due to the curvature and twisting of the spine with scoliosis, a person can develop neck and back discomfort and, if strong enough, respiratory problems.

Rare causes

Less commonly, back pain is due to a general (systemic) medical condition, such as ankylosing spondylitis , or something more alarming, such as a tumor or infection .

Ankylosing spondylitis (AS)

AD is a chronic inflammatory disease of the joints of the spine (vertebrae) that causes pain and stiffness in the lower back, usually beginning before the age of 40. Back pain with AD tends to improve with exercise and is worse at night.


A spinal tumor can occur on its own (called a primary spinal tumor) or as a result of cancer in another part of the body (called metastatic cancer). In addition to stabbing back pain, which is often worse at night and can radiate to the shoulders and neck, the person may experience unexplained weight loss and unusual fatigue.


An infection of the spine called vertebral discitis or osteomyelitis causes severe and persistent pain. Surprisingly, despite having an infection, a person may not have a fever. A history of previous back surgery may indicate the presence of an infection .

Cauda equina syndrome

Cauda equina syndrome is a rare syndrome that occurs when a bundle of nerves located in the lower part of the spinal cord becomes damaged or irritated. In addition to low back pain, a person may experience numbness or tingling in one or both legs, ' drop feet ', sexual dysfunction, and problems with bladder and bowel control .

Illustration by Alexandra Gordon, Get Meds Info

When to contact a healthcare provider

Most episodes of back pain last for several days and resolve completely within a few weeks. If you develop new back pain, you should see your doctor to see if you need more tests. There are also several warning signs that may indicate a problem that requires immediate evaluation:

  • The back pain does not go away for several days.
  • Your back pain wakes you up at night
  • Difficulty controlling the bowels or bladder.
  • You have a fever, chills, sweat, or other signs of infection.
  • Any other unusual symptoms


A detailed medical history and physical examination underlie the diagnosis of back pain, followed by imaging and laboratory tests if a person has warning symptoms, such as fever, indicating a possible infection, or unexplained weight loss, which suggests cancer or inflammatory arthritis such as AD.

History of the disease

Before examining your back, your healthcare provider will ask you a few questions about your back pain, such as when it started, what makes it worse and better, and if you have any accompanying symptoms, such as numbness or tingling. To speed up this process, it may be helpful to come to your appointment with a written description of your pain (to the best of your ability).

Physical exam

During the physical exam, your healthcare professional will carefully examine and apply pressure to the structures in your spine, as well as the muscles corresponding to the area of pain.

It's also important to do a complete neurological exam, including checking your feet for strength, sensitivity, and reflexes, to determine the source of your pain.

Sometimes certain techniques can help your healthcare provider make an accurate diagnosis. For example, your healthcare provider may do a straight leg test in which he raises your leg while you lie on your back.

During this maneuver, pain radiating below the knee indicates pain in the L4-S1 nerve roots, meaning that these nerve roots are compressed or irritated, often due to a herniated disc or bone spur from arthritis.


Depending on your doctor's suspicion of a particular diagnosis, he or she may order different blood tests. For example, if your healthcare provider is concerned about infection or cancer, they may order a complete blood count and markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) .


Imaging tests are generally not necessary for acute low back pain, unless there are symptoms or signs of cancer, infection, fracture, or cauda equina syndrome. If imaging is required, magnetic resonance imaging (MRI) is generally chosen, computed tomography (CT) is an alternative.

Differential diagnosis

When your healthcare provider evaluates your back pain, they will consider other health conditions that are causing your back pain. For example, some gastrointestinal conditions can indicate back pain, such as pancreatitis, gallbladder disease, and peptic ulcer disease. However, there are usually other symptoms that indicate a digestive problem (as opposed to a musculoskeletal problem), such as abdominal discomfort or nausea and vomiting.

Also, shingles (shingles) can cause back pain; Interestingly, the pain often occurs before the rash appears.

Even more alarming, an abdominal aortic aneurysm (AAA) can indicate back pain, usually in the middle and lower portions. A person with an abdominal aortic aneurysm may also experience abdominal discomfort along with a throbbing sensation in the abdomen.

Other conditions that may indicate back pain include:

If your healthcare provider suspects a specific source of back pain , pelvic or abdominal exams and various blood or urine tests may be performed.

Watch out

The most frustrating aspect of back pain treatment is that the symptoms often go away. Most people make a full recovery simply by avoiding back strain. However, keep in mind that this does not mean prolonged bed rest. Instead, slow to moderate physical activity can shorten recovery time.

Self service

Patients often find that strategies such as rest, ice, and heat can ease their pain and possibly speed up the healing process.


If basic back pain treatments don't relieve your symptoms, the next step is to see your doctor. Depending on the symptoms and duration of the problem, your healthcare provider can design a treatment regimen that may include one or more medications. The two most common medications used to treat low back pain are non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants .

Spinal epidural injections , in which a steroid (cortisone) is injected into the epidural space around the spine, is sometimes used to relieve symptoms of sciatica and spondylolisthesis. For osteoarthritis of the spine, it is sometimes recommended to inject a steroid into the affected facet joint to relieve pain.


Your healthcare provider may recommend physical therapy to strengthen and stretch your back muscles, improve mobility and function, and relieve pain. Additionally, a low-intensity exercise regimen, such as walking, swimming, or cycling, can help improve range of motion and flexibility in conditions such as spondylolisthesis, spinal osteoarthritis, or sciatica.

Alternative and complementary medicine

Some examples of potentially calming complementary therapies include:

Supplements like magnesium or vitamin D can also help ease back pain. However, be sure to speak with your doctor before taking vitamins, herbs, or supplements to make sure they are suitable and safe for you.

Colunm surgery

Spine surgery is generally intended to treat back pain that does not go away with simple steps. However, there are some conditions under which surgery may be required. Your healthcare provider can help you determine when surgery might be the right treatment for your condition.


Back pain is one of the most common and unpleasant ailments. On the positive side, there are several strategies you can take to prevent the onset and / or progression of back pain.

Some strategies include :

  • keep a healthy weight
  • Participate in an exercise program that strengthens your core muscles and is gentle and light (such as swimming, walking, yoga, or Pilates).
  • Practice correct posture and body mechanics (such as lifting by bending at the knees instead of at the waist)
  • Sleep in a bed that supports your spine well
  • Avoid bad habits like smoking

Get the word of drug information

While getting information about your back pain is proactive, be sure to review it to optimize your recovery. You deserve to feel better again and enjoy life as soon as possible.

Frequently asked questions

  • Start with a hard mattress ; one that is too soft and crushing will not support your spine. The best sleeping position for low back pain is on your side, with your knees slightly bent. You may find that a small pad between your knees helps to relieve tension in your lower back. If you can only sleep on your back, put pillows under your knees and a small pillow under your lower back.

  • Start by not sitting for long periods of time – get up every 15 minutes or so to move. When sitting, adjust the chair so that your knees and hips are bent at a right angle and both feet are on the floor. Place a small pillow or rolled towel between your lower back and the back of your chair to maintain the natural curve of your lumbar spine .

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