Almost 65 million Americans have recently experienced back pain. It is the sixth most costly medical condition in the United States, costing the country over $12 billion a year in health care costs. While back pain affects people of all ages, it is most common between the ages of 40-60.
There are a variety of reasons you may experience back pain so it’s important to learn what symptoms to look for in order to determine the best course of treatment.
Understanding Your Spine
When talking about back pain, a good place to start is a basic understanding of your spine. The spine is the primary support system of your body, comprised of 33 interlocking bones, or vertebrae. These bones are stacked on top of one another, forming a canal, that protects your spinal cord.
In between each stacked bone, there is space for nerve roots to extend out of the spine and distribute nerves into the rest of your body. The spine has a high degree of flexibility, allowing you to rotate, flex forward, extend, and side-bend. The spine is divided into different regions:
- Cervical spine: There are seven cervical vertebrae numbered C1-C7 that support the weight of your skull.
- Thoracic spine: There are 12 thoracic vertebrae numbered T1-T12, which protect the lungs and heart, and support the rib cage.
- Lumbar spine: There are five lumbar vertebrae numbered L1-L5 to help support your body weight.
- Sacrum: There are five sacral vertebrae. Unlike the cervical, thoracic, and lumbar spine vertebrae, these vertebrae are fused together. The sacrum acts as a connection between your hip bones and spine.
- Coccyx: Similar to the sacrum, the four vertebrae of the coccyx are fused together. They act as attachments for the muscles and ligaments of your pelvic floor.
Types of Back Pain
Back pain can be a sign of a mechanical issue, such as lifting too much or sitting for a long time, or it can indicate an issue such as degeneration of the vertebrae (spinal bones), which often happens with age.
The three main types of back pain are:
- Radicular: Radicular pain can feel like an electric shock, and can radiate through the body. The cause of this type of back pain is inflammation or compression to a spinal nerve root. For example, inflammation of a nerve root in the neck could radiate pain to your hand. Radicular pain is also known as radiculopathy (if numbness/weakness are present) or sciatica. Causes of radicular pain include spinal stenosis or a herniated disc.
- Axial: Axial pain can exhibit itself in a variety of ways, including mild or sharp pain that is intermittent or chronic. It is always specific to one area of the body and does not travel to other locations. Common causes include muscle strains or disc tears. Axial pain is the the most common type of lower back pain, also known as lumbago.
- Referred: Referred pain usually feels like a dull ache. This pain often moves around in the body. For example, disc degeneration in the lower back can cause hip pain. Unlike radicular pain, referred pain does not follow specific nerves and is more generalized.
Common Causes of Back Pain
The most common cause of back pain is a pulled or torn ligament or muscle. This can happen from sudden movements or heavy lifting, which places strain on the back.
Other causes include:
- Herniated disc: A herniated disc is the rupture of a spinal disc’s center. Spinal discs are pads that act as cushions between the vertebrae. When the center ruptures, some of the disc’s cartilage can begin to protrude. This can press on a nerve, causing pain. A herniated disc can have no symptoms, or it can result in numbness or pain. The symptoms depend on where in the spine the herniation has occurred, and whether nerve tissue was irritated as a result. Disc degeneration can progress with age.
- Bulging disc: A bulging disc is the displacement of a spinal disc’s cartilage, which can press into the sides of the disc. Unlike a herniated disc, there is no rupture of the disc itself. Instead, the disc presses onto the spinal canal. Symptoms can range from mild tingling to intense pain. Like a herniated disc, it is usually due to spinal degeneration with age.
- Radiculopathy: Also known as a pinched nerve, this happens when too much pressure is placed on a nerve outside of the spine. Symptoms can include intense pain and muscle spasms. Sciatica is a common term for radiculopathy in your lumbar spine.
- Spinal stenosis: Spinal stenosis is the narrowing of the spinal column and subsequent compression of nerve roots. The degeneration of the spinal discs and compression of the vertebrae is most commonly caused by age-related spine degeneration. Symptoms vary depending on the location, but pain is usually a key symptom.
- Spondylolysis: Spondylolysis is a stress fracture or crack in the vertebrae, most often occuring in the lumbar spine. It is a very common cause of back pain in individuals under 26, and symptoms include low back pain. Spondylolysis occurs because of weakness in the area that connects the upper and lower portions of the facet joints, a pair of joints located on the vertebrae. The cause of this weakness is unknown, though a genetic component may be involved.
- Spondylolisthesis: Spondylolisthesis occurs when the spondylolysis stress fracture weakens the bone so much that it begins to slip out of position, moving onto the bone below it. If it slips too far, it can put pressure on nerves and create severe back pain.
- Osteoporosis: Osteoporosis can cause the vertebrae of your spine to become fragile and brittle, which can lead to compression fractures. Compression fractures can cause pain, decreased range of motion, and nerve compression.
How Back Pain Is Diagnosed
In order to properly diagnose back pain and determine what may be causing the pain, it’s important to get a full physical evaluation and complete a medical history intake. Sometimes, the evaluation itself can be enough to make a diagnosis, though the following scans or tests may be ordered to get a complete understanding of the nature of the problem:
- X-ray: An x-ray will show the alignment of your vertebrae and whether any bones are fractured.
- CT scan: A CT scan is an imaging study that is performed with x-rays. However, these give a more detailed view of bones than a plain x-ray.
- MRI: An MRI can show whether there are any issues with the tendons, nerves, ligaments, discs, and even the spinal cord. This is the most detailed spinal imaging available.
- Bone scan: A bone scan can reveal compression fractures or bone tumors.
- Electromyography: Also known as an EMG, it can measure electrical impulses in your nerves, which helps determine if you have any nerve injury in addition to back pain.
Other Back Pain Symptoms to Watch For
Aside from obvious pain in the spinal region, back pain can manifest in other ways. Other back pain symptoms can include:
- Shooting or radiating pain in the back or spine
- Pain that subsides when reclining, but worsens with movement such as walking, bending, or standing
- Aching muscles
- Persistent pain anywhere on the spine
Treating Back Pain at Home
Back pain can be extremely debilitating. To help alleviate symptoms, you can consider the following at-home treatments:
- Over-the-counter (OTC) medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be used to help with back pain relief. Pain relief creams containing menthol can also reduce pain by dulling pain receptors.
- Ice or heat: Ice packs or hot compresses can help reduce back discomfort. Ice is usually best applied immediately after an injury, while heat is helpful for muscle aches.
- Exercise: Some types of exercise can be used for back pain treatment. The best exercises for back pain include low-impact activities like stationary biking, swimming, and walking.
- Stretching: Tight muscles may be contributing to your back pain, which is why certain stretches, like child’s pose in yoga, can help reduce lower back pain. To do child’s pose, sit on your heels with your arms outstretched, palms face down on the ground, with your head resting gently on the floor, and hold for 30 seconds.
To prevent back pain, incorporate the following guidelines into your daily routine:
- Avoid slouching: Sit up straight, especially while you’re working at a desk.
- Lift heavy objects with proper form: If you need to lift something heavy, make sure to bend your knees and allow your leg muscles to do the majority of the work.
- Stay active: Try to stretch or do strengthening exercises at least twice a week.
- Eat a healthy diet: Being overweight can place extra stress on the back. Eating a balanced diet and maintaining a healthy weight can help prevent back pain.
When to See a Doctor
You should see a doctor if your back pain symptoms don’t improve after 2-3 weeks of at-home treatment. While rare, back pain can be an indicator of more serious medical issues. You should make sure to get immediate medical help if you notice any of the following symptoms with your back pain:
- Bladder or bowel issues
- Significant weight loss
- A recent injury causing back pain
- Numbness, tingling, or weakness in your arms or legs
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