What Is Back Pain?

Overview

Have you ever experienced back pain? If you have, you are not alone. Back pain is very common, with 4 out of 5 people experiencing back pain at some point in their life.⁷ It is one of the most common reasons why people miss work or seek medical care.¹

Some of the common things you may experience accompanying back pain are pain, stiffness and restricted mobility. Back pain has many different causes, and although back pain is not usually due to a serious cause, sometimes it can be a symptom of far more serious conditions, which can lead to permanent disability if they are not treated.²

Fortunately, most back pain can improve after several weeks with such interventions as taking painkillers, physiotherapy, osteopathy, chiropractic, and refraining from certain causative actions that sustain the condition.⁶ There are different treatments for more serious cases of back pain, which depend upon the underlying cause. Surgery for back pain is only very rarely necessary. 

Causes of back pain

The human back provides your body with support, stability and the ability to move. It consists of several key components such as:

• Muscles 
• Vertebrae (the bones of the spine)
• Pelvic and shoulder girdles ( which join the limbs to the spinal column) and ribs 
• Intervertebral discs (shock-absorbing pads that lie between the vertebrae) 
• Ligaments (bands of connective tissue that join together the bones of the spine, pelvis etc.) 
• Spinal cord and nerve roots and nerves (enabling communication between the brain and the rest of the body)

Damage and dysfunction of any of these parts of the back can result in back pain.⁴

Usually, when we refer to back pain, we are referring to lower back pain, which is pain in the region of the bottom five vertebrae of the spinal column (the lumbar spine). This part of your spine carries a lot of weight and experiences a lot of stress and movement. This makes it at risk of injuries and wear and tear. 

However, pain can also occur in the mid and upper back.

There are multiple causes of back pain, which could be due to structural problems in the back, inflammation, or other health conditions. In some cases, the cause of back pain is unknown and this is referred to as non-specific back pain. 

Biomechanical causes of back pain

This is when back pain is a result of damage to any of the structures in the back, such as the muscles, ligaments, discs or joints, which results in dysfunction and pain.² Causes of mechanical back pain include: 

• Strains and sprains: these are the most common causes of back pain. They occur due to injuries to the muscles or ligaments of the back as a result of such causes as heavy or improper lifting or strain developing gradually over time from repetitive movements, improper movements or inappropriate posture
• Bone fractures: fractures in the vertebrae of the spine due to an accident such as a vehicle crash or a fall. Certain conditions like osteoporosis (a disease that leads to weaker bones) can increase the likelihood of bone fractures
• Herniated or ruptured discs: this is when the structure of the disc is compromised by tears in the outer fibrous layer, which then allows the gel-like shock-absorbing centre to bulge through the side wall to increasing degrees and to potentially eventually even rupture the disc wall and extrude material into the surrounding space which sets up a massive inflammatory reaction. This developing condition can press on nearby nerve roots or cause them to become inflamed and irritated, resulting in  back pain 
• Degenerative disc disease: this disease is a result of ageing, causing the discs between the vertebrae to desiccate and break down 
• Spondylolisthesis: is when a spinal vertebra moves out of place due to a fracture in vertebral components, which normally maintain the position and limit  the  extent of movement of vertebrae relative to each other 
• Spinal stenosis: is when the spinal column narrows due to various causes and puts pressure on the spinal column and nerve roots
• Scoliosis: is the abnormal curvature of the spine, often from birth.¹

Inflammatory causes of back pain 

• Osteoarthritis: a common type of arthritis (damage to the joints) that can result in back pain
• Ankylosing spondylitis: a specific type of arthritis of the spine leading to pain, stiffness and eventual fusion of the vertebrae, ribs and pelvic joints with loss of spinal and associated joint movement¹

Other medical conditions that cause back pain

• Infections: the bones and discs of the spine get infected, for example by tuberculosis (TB) 
• Tumours: in rare cases, you can get tumours in your back. Usually, they are often from a cancer that has spread from another part of the body (a metastasis) 
• Pain from other organs: problems in organs such as the kidneys, pancreas, stomach, gall bladder, lungs, and heart can cause pain that refers into the back 
• Pregnancy: the weight of pregnancy can put a strain on your back and alter its postural mechanics. Also softening of pelvic ligaments can produce intransigent chronic lower back pain.¹

Signs and symptoms of back pain

Back pain can vary in its nature, quality and intensity. When experiencing back pain, you may feel anything from a sharp and shooting pain, a burning pain, an electric shock-type pain, toothache-like pain, or a dull, achy pain. You may also experience pain and/or numbness and pins and needles radiating down one or both of your buttocks or legs, which could be due to a condition called sciatica. This occurs when a nerve is irritated or compressed. 

Pain in both buttocks or legs (bilateral) together with numbness around the tops of the inside thighs and anus and perineum should not be ignored as it could be an indicator of a more serious cause known as cauda equina syndrome. 

Therefore if you experience these symptoms, especially with accompanying changes in bladder and/or bowel function, immediately seek emergency medical attention.³

If you have a back problem, you may experience the following symptoms: 

• Stiffness and increased movement restriction when you wake up or have been inactive for a while
• Increasing pain in the back when bending forward or lifting something 
• Pain in the back increasing when at rest, sitting or standing up or with particular triggering movements
• Pain and /or numbness and tingling radiating down your buttocks or legs, which can extend as far as the feet 
• Weakness in the legs and/or twitching of the leg muscles. The legs might feel like they are ‘giving way’⁴

Management and treatment for back pain

The way your back pain is managed and treated depends on what caused it and the nature of the back pain. Back pain can either be acute (pain lasting for less than 4-6 weeks) or chronic (pain lasting for longer than 12 weeks).

 Acute back pain is usually caused by an injury or a muscle strain or sprain, whereas chronic back pain can often be due to a subsequent sensitisation of the nervous system (central sensitisation).⁹ Sometimes, it is due to a more serious underlying condition and requires a more extensive treatment plan.¹

Acute back pain can often get better by itself after 4-6 weeks, but there are things you can do to help speed up your recovery, such as: 

• Keep moving and trying to continue with your daily activities. However, stop activities and movements that worsen your pain, especially lifting, but don’t avoid activity altogether as this may slow your recovery. Long periods of bed rest can quite quickly lead to muscles becoming weaker 
• Taking anti-inflammatory painkillers such as ibuprofen or naproxen can reduce pain and inflammation, but slow overall recovery
• Use an ice pack to reduce pain and swelling
• Use a heat pack to help relax the muscles and reduce pain
• Try some therapeutic exercises and stretches to help relieve lower back pain
• Stay positive as stress can make back pain worse

If your back pain does not resolve after a few weeks, is getting worse over time or is interfering with your daily activities, it is worth seeking help from a registered healthcare professional. You may get treated with medication, physical therapy such as physiotherapy, osteopathy and chiropractic or in severe cases, surgery may be necessary.¹

Medications used for back pain

You may be prescribed the following types of medicine for back pain by your healthcare professional:  

• Pain relief: if over-the-counter painkillers such as ibuprofen or naproxen don’t help, your doctor may prescribe alternate anti-inflammatory medications 
• Muscle relaxants: you might get these if painkillers don’t work or in addition to them
• Topical pain relief: pain relief that you apply locally via your skin, such as creams or ointments
• Opiates: these may be prescribed for a short time for severe back pain
• Antidepressants such as Amitriptyline can act as pain relief for lower back pain

Physical therapy 

You may be referred for physiotherapy for your back pain. Your physiotherapist may provide you with exercises that can help your back pain by strengthening your back muscles, increasing flexibility and improving your posture. You may also get manual ‘hands-on treatment’ from a registered osteopath, chiropractor or physiotherapist that involves massage of the back muscles and/or manipulation of the spine.¹

Other procedures and surgery

• Cognitive behavioural therapy (CBT): Your doctor may suggest CBT to help you cope with the pain and stress that comes with chronic back pain
• Injections: If you have pain that is radiating down your leg (sciatica), you may get an epidural injection – an injection containing a steroid and numbing medication. This can often help relieve pain and reduce inflammation
• Radiofrequency ablation: This procedure involves a needle passing radio waves through the skin and into the nerves near the area of back pain. This disrupts the pain signals to the brain. This is only suitable for certain types of back pain and may be offered in chronic back pain where other treatments haven’t worked
• Surgery: This is often a last resort treatment for back pain when other treatments haven’t worked. The type of surgery that you get is dependent on the cause of your back pain. For example, you may get a partial discectomy (removal of part of a damaged disc) or disc replacement surgery if you have a damaged disk. In cases of complete vertebral collapse due to osteoporosis or infection, a type of cement may be used to recreate a functional vertebral structure.  

Diagnosis

Healthcare professionals will use a variety of methods to assist in the diagnosis of your lower back pain. Initially, they will ask about your symptoms, such as when and how it started, severity and quality of the pain, where the pain spreads to, and any other associated symptoms and also take a general medical and lifestyle history to rule out other causes, such as referred pain from organs. They will also ask about specific warning, or ‘red flag’, symptoms to rule out more serious causes of back pain.⁴

Your healthcare professional is then likely to perform a physical examination. This should involve inspection by observation and touch (palpation) of your spine and testing muscle strengths, reflexes and sensations in your legs along with specific orthopaedic tests.¹ These involve a series of specific movement tests to help identify the origin of the back pain. This is usually enough information for a diagnosis to be made, but occasionally extra tests may be required. These include: 

• X-rays: To detect bone fractures and/or arthritis
• DEXA scans: to detect bone ‘weakening’ due to osteoporosis
• MRI scans: To detect damage to the soft tissues in the spinal column, such as the discs, ligaments or nerves
• Blood tests: To see whether an infection, inflammatory or auto-immune condition is the likely cause of back pain
• Electromyography (EMG): This helps diagnose problems in the back muscles and/or nerves⁵

Risk factors

Several factors may increase the risk of developing back pain, including: 

• Age: back pain becomes more common as you get older and usually starts between ages 30-50
• Smoking: smokers have higher rates of back pain. Smoking reduces the blood flow to the spine, which can cause damage, and excess coughing as a result of smoking puts strain on the back
• Obesity: excess body weight can put extra strain on the back
• Sedentary lifestyle: back pain is more common in physically inactive people. This is because the weaker, unused muscles are less able to support the spine
• Job-related factors: jobs that require heavy lifting can result in back injuries; the opposite is also true, where jobs that require you to sit all day can also result in back pain due to poor posture or sitting on a chair without back support
• Mental health: anxiety and depression may increase the risk of back pain. Stress can result in muscle tension, which may also lead to back pain
• Genetics: genetics can play a role in some of the disorders causing back pain, such as ankylosing spondylitis⁸

FAQs

How can I prevent back pain?

Although you can’t prevent back pain that results from an underlying disorder in your spine, you can avoid injuries to your back.⁶ By doing the following, you can make both your back and lifestyle healthier: 

• Maintain a healthy weight to avoid excess strain on your back
• Practise good posture and get workstations/your desk set up according to ergonomic guidance
• Practice lifting correctly: Avoid lifting items that are too heavy for you to carry, and when lifting, try to lift using your leg muscles and not your back
• Keep active: By doing regular exercise, you strengthen your back muscles and reduce the risk of experiencing back pain
• Stop smoking: Smoking can increase the risk of back pain

How common is back pain?

Back pain is very common, with roughly 4 out of 5 people experiencing it at some point in their lives.¹ It is one of the most common reasons why people visit their doctor or take time off work. While it can affect anyone, it is more common with increasing age, starting between ages 30 - 50. Back pain is also more common in people with certain disorders, such as ankylosing spondylitis, or with certain risk factors, such as obesity or smoking. 

What can I expect if I have back pain?

If you have back pain, it is usually not due to a serious condition and will most likely get better on its own. You are likely to experience symptoms like pain, numbness and tingling, stiffness or weakness and these may radiate into the buttocks and legs. However, sometimes back pain can be down to a more serious issue and may require treatment, and in these cases, you should speak to a doctor.⁴ The instances when you should talk to a healthcare professional are discussed in the section below. 

When should I see a doctor?

You should see your doctor if you have been experiencing back pain for longer than a few weeks, if the pain getting worse or if it is increasingly affecting your daily activities.⁴

Seek immediate medical attention if you are experiencing any of the following symptoms: 

• Unintentional weight loss
• Pain gets worse during the night 
• Night sweats
• Lack of bladder or bowel control. This does not just mean incontinence or leakage but also includes not being able to urinate, difficulty commencing urination, inability to completely empty your blade and constipation.
• Numbness around your genital area, perineum, inner thighs or buttocks 
• Numbness or pins and needles in your legs, especially if in both legs 
• Fever
• Back pain after a trauma such as a fall or injury 

These symptoms suggest that there might be a more serious cause for your back pain.⁴

Summary

Back pain is extremely common and will affect most people at some point in their lives. Whilst it can affect your quality of life and your ability to work, it is usually not due to a serious condition and can be managed with rest – refraining from triggering activities while also keeping mobile – pain relief, physical therapy and relaxation. 

However, if your back pain is not going away, getting worse or stopping you from living your daily life, you should speak to a doctor. 

There are many different treatment options your doctor may offer you depending on the cause of your back pain that can help reduce your pain and improve your mobility. 

You can reduce the risk of back pain by staying active, maintaining a healthy weight and looking after your mental health – all of which will help keep both you and your back healthy.