There are a wide range of back pain causes. They include common acute conditions like muscle strain or more serious chronic issues like scoliosis or spinal stenosis. The symptoms can vary by the condition. Some cause pain described as throbbing, sharp, shooting, dull, aching, burning, tingling, or "all over." These descriptions offer clues as to the underlying cause.
Many back pain causes resolve within several days or weeks with rest, over-the-counter painkillers, and other self-help measures. Others require ongoing care and treatment, including surgery for conditions like sciatica.
This article lists 17 possible causes of back pain, including how they are diagnosed and treated. It will also help you to know if back pain is serious and when it is time to see a healthcare provider.
Common Back Pain Causes
There are many possible causes of back pain involving the spine, muscles, and spinal nerve. Here are some of the more common:
Strain or Sprain
Strains and sprains are the most common causes of back pain, especially in the lower back. A strain refers to the tearing of a muscle or tendon (which connects muscles to bones), while a sprain refers to the tearing of a ligament (which connects bones in a joint).
A torn tendon or ligament may be the result of a fall, sports injury, or overuse of a joint (known as a repetitive stress injury).
The pain can range from mild to severe and is often described as an "all-over pain" that moves into the buttocks. The pain tends to worsen with movement and improve with rest. Back stiffness is also common.
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Slipped or Ruptured Disc
Spinal discs located between the bones of the spine serve as shock-absorbing cushions. Over time, the discs can start to bulge due to aging, obesity, or repetitive stress or occur spontaneously as a result of a traumatic back injury.
When this happens, a disc can start to protrude outward, causing a bulging or slipped disc. The pain from a slipped disc is often described as throbbing, burning, or tingling due to the compression of nerves emanating from the spine (called spinal nerve roots.
A disc can also tear, resulting in a ruptured (herniated) disc. When this happens, the inner part of the disc called the nucleus pulposus will push out and compress nearby nerves, triggering significant nerve pain.
A ruptured disc can cause sharp lower pain that can into the buttocks, groin, or leg. A ruptured disc in the neck can cause pain that moves down an arm. Muscle weakness, numbness, and tingling are also common.
Muscle Spasm
A back spasm ischaracterized by sudden tightening of your back muscles. This causes pain ranging from mild to severe which people often describe as being deep and throbbing. It can occur due to the overuse of your back muscles or a traumatic injury that causes your back muscles to suddenly seize up.
Back spasms are due to some form of mechanical stress on the back muscles, such as sleeping in an awkward position, lifting heavy objects, or standing or sitting for long periods. Stress and anxiety can also cause an upper or lower back spasm in some people.
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Osteoarthritis
Spinal osteoarthritis is a form of arthritis that is caused by the wear and tear of cartilage between the bones of the spine. As the cartilage wears away, people will experience a dull, aching, or throbbing back pain that worsens with movement.
Spinal osteoarthritis tends to be persistent. It is generally worse in the morning and eases as you get on with your day. You may also have back stiffness and a popping sensation known as crepitus.
As the disease progresses, bony growths can develop. These bone spurs (also known as osteophytes) can compress nearby spinal root nerves, causing numbness and tingling sensations similar to that of a ruptured disc.
Spinal arthritis is the most frequent cause of lower back pain. Repetitive motion injuries, poor posture, and prior spinal trauma can all contribute to this aging-related condition.
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Sciatica
Sciatica is pain that shoots down the leg via the sciatic nerve originating in the lumbar (lower) spine.
Sciatica can be caused by a ruptured disc, bone spur, or an injury to the pelvis, buttock, or thigh. Diabetes, pregnancy, and prolonged sitting are also risk factors. A condition called piriformis syndrome can cause sciatica when the piriformis muscle situated on the top of your buttocks goes into spasm.
Sciatica causes shooting, burning, or cramping pain that extends from the lower back into a buttock (and occasionally down the leg and into the sole of the foot). Tingling, numbness, and muscle weakness are also common.
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Spinal Stenosis
As you get older, the spinal canal which contains the spinal cord can begin to narrow. This is referred to as spinal stenosis.
Spinal stenosis can cause the compression of the spinal nerve roots, leading to shooting pains in your lower back and buttocks. Muscle weakness, numbness, burning, and tingling sensations can also occur.
Spinal arthritis can cause the overgrowth of bone within the canal, leading to spinal stenosis. Other causes of spinal stenosis include scoliosis, Paget's disease of the bone, and spinal trauma.
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Spondylolysis and Spondylolisthesis
Spondylolysis is a stress fracture in one of the bones of the spine. It is most common in children who play sports that place repeated stress on the lower back (such as gymnastics or football). Spondylolysis can also be due to a spinal injury or the aging-related weakness of the spine.
If the fracture weakens the spine too much, the vertebra may start to slip, leading to a condition called spondylolisthesis. The slippage may either be forward (anterolisthesis) or backward (retrolisthesis).
Spondylolysis and spondylolisthesis both cause a dull, generalized pain extending from your back to your buttocks and thighs. There will also be significant back stiffness. Spinal nerve root compression can lead to shooting pain, tingling, numbness, and weakness.
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Osteoporosis
Osteoporosis is the thinning and weakening of the bones. Back pain associated with osteoporosis is usually due to a compression fracture in the spinal column. In severe cases, a break can occur without warning, often after doing something as simple as sneezing or bending over.
The pain can range from dull and aching to sharp and debilitating. It is often felt in the lower or middle back and tends to get worse with activity. In rare cases, the pain may radiate to the legs and abdomen or cause a condition known as kyphosis ("hunchback").
Scoliosis
Scoliosis is a condition in which the spine curves or twists like the letter "S" or "C." It usually develops in childhood.
In most cases, the cause of scoliosis is unknown, although it is linked to conditions like cerebral palsy and muscular dystrophy. It can also result from a birth defect or family genetics (as multiple family members are sometimes affected).
Scoliosis can cause chronic back or neck pain as well as a reduced range of motion. Spinal compression can cause shooting pains, numbness, heaviness, and weakness in the buttocks and legs.
In severe cases, a person may have trouble breathing due to the compression of the thorax (chest cavity) or diaphragm (the muscle that separates the chest and abdomen).
Sacroiliitis
Sacroiliitis is the inflammation of the joints that connect your spine and pelvis, called the sacroiliac joint. This condition can cause pain in the lower back, buttocks, and upper legs.
Sacroiliitis can be caused by back trauma, spinal infection, pregnancy, or degenerative conditions like spinal osteoarthritis.
Sacroiliitis pain is often described as deep and aching and can occasionally affect the entire expanseof your leg from the groin all the way down to your feet. Walking upstairs can make symptoms worse.
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Rare Back Pain Causes
Less commonly, back pain is caused by a systemic (whole-body) disease such as:
Ankylosing Spondylitis
Ankylosing spondylitis is an inflammatory disease that causes the small bones of the spine to fuse together. This leads to lower back pain similar to spinal osteoarthritis. Spinal stiffness and a hunched posture are also characteristic, often occurring before the age of 40. The pain tends to improve with exercise and worsen at night.
Spinal Cancer
A cancerous tumor in the spine may arise on its own (called a primary tumor) or can be caused by the spread of cancer from other parts of the body (called metastasis).
The pain is often described as persistent and gnawing and tends to worsen at night. The pain may radiate to the shoulders or neck and be accompanied by unexplained weight loss and fatigue. In the advanced stages, there may be reduced sensitivity to cold, heat, and pain.
Osteomyelitis
An infection in the spine, called osteomyelitis, causes severe and constant back pain along with local, swelling, and warmth. It can occur due to recent spinal surgery or when a local infection (such as a staph infection) enters the bloodstream.
Unlike most infections, fever is not common.
Cauda Equina Syndrome
Cauda equina syndrome is a rare disorder that is caused by severe compression of spinal nerve roots in the lower spine. This can cause extreme numbness or tingling that spreads down one or both legs along with the sharp sciatic nerve pain.
Other symptoms include "foot drop" (difficulty lifting the front of your foot) and problems with bladder or bowel control.
When to See a Healthcare Provider
Most cases of back pain last for a few days and resolve completely within a few weeks. If you have sudden, new back pain, contact your healthcare provider.
There are a few warning signs that immediate care is needed:
- The pain persists for more than a few days or is worsening.
- The pain wakes you up at night.
- You have a fever, chills, or other signs of infection.
- You have problems with bladder or bowel control.
- There are other symptoms you cannot explain.
Diagnosis
The diagnosis of back pain starts with a review of your medical history and a physical exam. You will be asked when the pain started, what it feels like, what makes the pain better or worse, and what other symptoms you have (such as numbness or swelling).
Based on the findings, your healthcare provider will order lab and imaging tests to explore the suspected causes.
Physical Exam
During your exam, your healthcare provider will gently press on muscles and parts of the spine, on or near the site of your pain. You will be asked to describe the location and type of pain.
You will have a neurological exam to assess your nerve and motor responses. The aim of the exam is to identify any areas of sensory changes, muscle weakness, or reflex changes.
One example is the straight leg raise test in which the healthcare provider lifts your leg while you lie flat on your back. If the movement causes pain below the knee, it suggests that nerves are being pinched at a specific part of the spine.
Lab Tests
Your healthcare provider may order lab tests, such as:
- A complete blood count (CBC), including a white blood cell count (WBC) to detect signs of infection
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to detect signs of inflammation
- HLA-B27 test to detect genetic signs of ankylosing spondylitis
- Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) tests to help detect certain types of bone cancer
Imaging Tests
Imaging tests are generally not needed for a flare-up of back pain unless there are signs of cancer, infection, a fracture, or cauda equina syndrome. They are typically done if pain persists for several weeks or if muscle weakness is getting worse.
If needed, magnetic resonance imaging (MRI) is usually the test of choice, with a computed tomography (CT) scan being the alternative.
Differential Diagnosis
As part of your assessment, your healthcare provider will consider other medical conditions that can cause back pain. This involves a process called a differential diagnosis in which other possible causes are investigated and ruled out to ensure that the correct diagnosis is made.
A differential diagnosis is part of the process that will help you to tell the difference between muscle pain and kidney pain, for example. In the end, your back pain may be a part of a condition that doesn't directly involve the back muscles or spine.
Examples include:
- Abdominal aortic aneurysm
- Endometriosis
- Gallbladder disease
- Kidney infection
- Pancreatitis
- Pelvic inflammatory disease (PID)
- Peptic ulcer disease
- Prostatitis
- Shingles
The diagnosis of back pain involves a physical exam and a review of your medical history. Based on the findings, your healthcare provider will order lab or imaging tests to help pinpoint the cause.
Back Pain Treatment
The treatment of back pain often takes time. Most people recover by resting and avoiding activities that stress the lower back. Other treatments may be used to ease pain and restore the function of the spine or back muscles.
Self-Care
Rest, along with ice application or heat application, is among the fastest ways to relieve back pain. This treatment may speed the healing process because ice can help reduce swelling. Heat is good for back pain because it promotes blood flow and helps to relax tissues.
Keep in mind, though, that rest doesn't necessarily mean prolonged bed rest. Low-intensity physical activity is important to help shorten your recovery time.
It is also important to change certain habits, including sleep habits, to protect your back.
Start by buying a firm, supportive mattress. Sleeping on your side with your knees slightly bent and a small pillow in between them can help take pressure off the back. If you can only sleep on your back, place pillows under your knees and a small one under your lower back.
If you have a desk job, you will also need to make changes to reduce stress to the back caused by prolonged sitting. Start by getting up every 15 minutes or so and moving around. Adjust your chair so your knees and hips are bent at right angles with both feet flat on the floor. Position a small pillow or rolled-up towel behind your lower back to maintain a natural curve in your lumbar spine.
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Medications
If rest and ice/heat application are not enough to ease your pain, medications may be prescribed.
Over-the-counter nonsteroidal anti-inflammatories (NSAIDs) and prescription muscle relaxants are among the most commonly used medications for back pain relief.
Epidural spinal injections, in which steroids are injected into the space around your spine, may be used to treat sciatica and spondylolisthesis. For spine osteoarthritis, a steroid injection into the spinal joint can be used if the pain is severe.
Physical Therapy
Your healthcare provider may also advise physical therapy to help strengthen and stretch your back muscles, improve mobility, and ease back pain.
Walking is good for lower back pain, as are other low-impact exercises like swimming and biking that can help to improve your range of motion and flexibility.
You may find even more motivation if you use a wearable activity-tracking device. A 2019 study of wearables used by people with chronic back pain found that they did significantly more walking and other exercise than people in a control group. It's possible this may lead to reductions in the use of other back pain therapies, but more research is needed.
Complementary and Alternative Medicine
Some examples of complementary therapies used to ease back pain include:
- Massage therapy
- Acupuncture
- Tai chi
- Yoga
- Chiropractic care
Speak with your healthcare provider before taking any vitamins, herbs, or supplements to ensure they are right and safe for you.
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Spinal Surgery
Spinal surgery is reserved for people who don't get adequate symptom relief with non-operative treatment, and when the cause of pain is well-explained by the imaging studies.
There are some conditions for which surgery may be beneficial, such as conditions that undermine the stability of the spine.
A spine surgeon can help you to determine if surgery is the right option for you and what risks are involved.
Prevention
Back pain is one of the most common ailments affecting people of all ages. There are ways to reduce your risk factors for back pain and prevent it from worsening.
Some of the more useful prevention tips include:
- Maintaining a healthy weight
- Exercising regularly with low-impact activities to strengthen core muscles
- Practicing good posture and body mechanics (e.g., lifting with the knees)
- Sleeping on a bed that supports the spine
- Quitting cigarettes (chemicals in tobacco smoke promote the deterioration of spinal disks)
Summary
The causes of back pain are many. While strains, sprains, ruptured disks, sciatica, and spinal arthritis are common causes, there are others that do not involve the back muscles or the spine at all.
The diagnosis of back pain involves a physical exam and a review of your medical history. Based on the findings, lab and imaging tests will be ordered to help narrow the causes.
Back pain is often treated with rest, ice or heat application, and pain medications. People with persistent back pain or a severe back injury may benefit from physical therapy. Spinal surgery may be used when all other attempts to resolve the pain have failed.