What Causes Back Pain, and How Is It Diagnosed?

Medically Reviewed by Madeline Hubbard, RN, BSN

Photo Courtesy: PeopleImages/E+/Getty Images

In 2018, 25% of adults in the United States reported experiencing lower back pain. Because this is a common condition that can be very disruptive to daily life, back pain is a leading reason for people to seek out medical care. Back pain can be the result of lifting something heavy, a fall or a particular medical condition. No matter what the cause is, back pain is serious and may require surgery if you don’t get effective treatment. If you’re living with back pain now or want to know how to prevent back pain in the future, this guide is for you.

Symptoms of Back Pain

The human back is made up of the vertebral column (spine), which protects the spinal cord that runs down its center and has a characteristic curve that supports our weight as we move. The cervical, thoracic, lumbar, sacral and coccygeal regions of the spine are made up of bony vertebrae. Between each vertebral bone is a disc made of softer cartilage. These tissues act as cushions for the bones in the spine. Ligaments and muscles connect all along the vertebral column to support coordinated core movement.

Injury or breakdown can occur anywhere along your spine or back. Symptoms of back pain will vary from person to person, depending on what the cause of pain is and which region of the back is impacted. Symptoms that you might commonly experience with back pain include:

  • Aching muscles
  • Sharp pains
  • Stiffness
  • Inability to stand up straight
  • Pain that radiates down through your legs
  • Difficulty moving your back or having a limited range of motion

Causes of Back Pain

There are two types of back pain: chronic and acute. Chronic back pain is pain that’s constant or only goes away briefly and then continues coming back over time. Common causes of chronic back pain are:

  • Past injuries
  • Past surgery
  • Overuse from physical activity
  • Conditions such as fibromyalgia and arthritis
  • Curvature of the spine
  • Piriformis syndrome

Acute back pain is pain that occurs suddenly and lasts for a few days or weeks. The most common cause of acute back pain is a pulled muscle or ligament. Other causes include:

  • A ruptured or herniated disc
  • Muscle spasms
  • Sciatica
  • Compression fractures from osteoporosis
  • Improper lifting
  • Sudden movements
  • Infections and cancer of the spine
  • Cauda equina syndrome, which involves damage to a particular bundle of nerves in your spine

If you’re living with back pain, review the list below that discusses some of the most common causes of backaches. It might help you figure out what’s been causing your pain and how to avoid it. However, chronic or severe backaches may be a sign of something more serious, so you should always talk to a healthcare provider if you’re feeling this type of pain.

Sprains: Injuries are some of the most common causes of backaches. These can occur while you’re playing a contact sport, taking a fall or just twisting your body the wrong way. Most commonly, the injuries that cause backaches are tears in the ligaments and muscles supporting your spine. Sprains and strains like these usually come from an improper twisting or lifting motion and in most cases will heal quickly with rest and restricted movements.

Fractures: Like a sprain, a fracture may also occur in the vertebrae in your back due to injury from sports or falls. However, fractures are much more serious and can often result in chronic back pain. They may get much worse if you don’t visit a healthcare provider for treatment. In some cases, the weakening of the bones due to osteoporosis may cause fractures in the vertebrae.

Osteoarthritis: Osteoarthritis is a condition in which the discs and joints of your spine break down and become flatter and less flexible over time. This causes back aches and stiffness in the affected area. Osteoarthritis is more common in older adults because it develops as a result of years of physical activity. This is similar to another condition called intervertebral disc degeneration or degenerative disc disease, which occurs when discs in your back start to break down with age.

Herniated Discs: When the soft center of a disc in your spine is pushed out of its normal position, it’s called a herniated disc or slipped disc. This can be painless, but if the herniated disc pushes on a nerve in your spinal cord, you’ll feel pain almost immediately. Your healthcare provider may do an X-ray to diagnose this condition, which is usually treated with physical therapy and pain medication. It can require surgery in some cases.

Obesity: Having added weight on your body can place more pressure on your spine. People who are obese are more likely to develop conditions like osteoarthritis because of the added stress on their backs. Staying at a healthy weight or increasing your core strength can help reduce backaches.

Fibromyalgia: Fibromyalgia is a condition that causes pain in muscles, ligaments and tendons throughout your body. This means that backaches may only be one symptom of several to manage if you have this condition. Another key sign of fibromyalgia is fatigue.

Pregnancy: One of the most common symptoms of pregnancy is backaches, especially in the lower back. Most of this is attributed to the added weight that a person naturally gains while pregnant and the way in which this weight is distributed (having most of the extra weight in the lower abdomen makes it harder to keep the back straight and aligned). As the due date gets closer, some of that back pain may also result from the baby placing pressure on the lower back as it grows.

Sleeping Positions: Some of the causes of backaches are a result of personal tendencies rather than medical conditions. For example, sleeping on your stomach can arch your back in an uncomfortable way. Improper alignment at night can lead to significant back pain during the day.

Incorrect Posture: Slouching over is hard on your back. When you have improper posture, your muscles and ligaments have to work harder to keep your body balanced, which can lead to backaches or even headaches and fatigue.

Stress and Anxiety: Most of the common causes of backaches come from physical conditions or movements, but in the case of stress the cause is more emotional and psychological. When you’re extremely stressed or living with anxiety, you may experience increased tension in your back. Along those same lines, depression may also lead to feelings of back pain and stiffness.

Diagnosing Back Pain

If your back pain persists over multiple weeks and/or your symptoms seem to be getting worse, it’s important to see a healthcare provider right away. To confirm the source of the pain, your provider will ask you questions about the pain and perform a physical exam that’ll most likely include testing your reflexes and examining your back’s range of motion. They may also perform some of the following tests to determine what might be causing your pain:

  • MRIs or CT scan imaging
  • X-ray imaging
  • Blood or urine tests
  • A bone scan
  • Nerve compression tests

Treating and Managing Back Pain

Your healthcare provider will coach you on the best ways to treat your specific back pain, depending on what’s causing the pain and if it’s acute or chronic. Overall, long-term bed rest is no longer recommended. Instead, it’s best to continue with gentle daily movement, as tolerated, to help your back heal. The key is to balance resting a sore back while still remaining active. Some additional recommendations may include:

  • Medications. Over-the-counter or prescription pain medications or muscle relaxants can help you manage back pain in the short term.
  • Physical Therapy. If your back pain is chronic, you may need to visit a physical therapist, who can teach you exercises that work to strengthen the muscles in your back.
  • Massage or acupuncture. Seeing these specialists can sometimes help relieve symptoms of back pain by increasing your circulation.
  • Back brace. Wearing a back brace during the day, especially while at work, can give your back some extra support.
  • Cortisone. An injection of this strong steroid can help reduce inflammation and pain.
  • Surgery. If your back pain is related to an anatomical disruption (like a herniated disc), surgery may be an option to address the condition. Surgery is also available to implant devices that stimulate nerves in your back to adjust pain signaling to your brain.

In addition to these treatment recommendations, there are some things you can do at home to help manage back pain:

  • Heat or ice. Applying cold or hot packs on your back periodically can help reduce inflammation, allowing the muscles and ligaments to relax and improving mobility.
  • Mattress or pillow adjustments. Sleeping on an old mattress or one with little support can take a toll on your back. If you have back pain, changing your mattress or pillows may be one way to reduce discomfort. It may be helpful to add a pillow at the base of your abdomen when sleeping on your stomach, to sleep on your back with a pillow under your knees, or to sleep on your side with a pillow between your legs. The added cushioning in these positions may help to keep your back straight and aligned throughout the night.
  • Epsom salts. Adding Epsom salts to a warm bath is an easy home remedy that may help decrease back pain. Epsom salt decreases pain by reducing inflammation and swelling.

Dealing with back pain can be tough, and many of these treatments take time to produce their full effects. To keep your back strong and in good shape, follow these lifestyle tips:

Exercise consistently and find exercises that build back strength and flexibility. Also focus on developing strong core muscles to reduce back injuries and maintain proper spine alignment.

Make sure that chairs at home or at work are comfortable for your back. If they don’t offer good lower back support, use a back pillow or roll up a towel or small blanket and place it behind your lower back for support.

Pay attention to how you sit and stand. Avoid arching your back or slumping your shoulders, which both can contribute to back pain.

If your job requires you to lift heavy things, make sure you lift with your legs, not your back. Bend at the knees, keep your back straight and only move up and down. Don’t twist yourself or do any jerking movements. If what you’re lifting is too heavy, ask someone to help you.

When your back starts to hurt, whether from working or exercising or from a condition, don’t be afraid to take a short break to relax and rest your back. Listening to your body’s needs is the best way to prevent pain and injury.

Often, back pain is only a minor problem that you can successfully treat with home remedies. However, there are instances when a visit to your healthcare provider is advisable. If your pain persists for more than two weeks even with home treatments, doesn’t improve with rest or is getting progressively worse, you should contact your provider. If the pain spreads down your legs below your knee, if you feel numbness or tingling in your legs, or if you’re experiencing weight loss that cannot be explained with lifestyle changes, make an appointment with your healthcare provider. With proper assessment, your provider can work with you to make a treatment plan to manage your back pain safely.

Resource Links:

https://www.ncbi.nlm.nih.gov/books/NBK525969/

https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906

https://www.hopkinsmedicine.org/health/conditions-and-diseases/degenerative-disc-disease

https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095

https://www.ninds.nih.gov/Disorders/All-Disorders/Back-Pain-Information-Page

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

https://www.health.harvard.edu/back-pain/ask-dr-rob-about-piriformis-syndrome

https://www.mayoclinic.org/diseases-conditions/back-pain/multimedia/sleeping-positions/

https://www.niams.nih.gov/health-topics/back-pain

https://www.cdc.gov/acute-pain/low-back-pain/index.html