Knee pain is a common complaint that can occur as a result of a wide range of injuries, degenerative…
- Back pain is a common symptom. There are many different causes and types of back pain.
- Treatment for back pain will vary depending on the cause, frequency and severity of the pain.
- Most cases of back pain can be avoided, or the severity of symptoms reduced, by making some lifestyle changes such as maintaining good posture, lifting objects safely, exercising regularly, and taking regular breaks while standing, sitting or driving for long periods.
What is back pain?
The back is a complicated structure that serves many important functions: it provides support to other areas of the body, and allows movement of the legs, head and arms. The back is composed of many types of tissues including bones, muscles, tendons, ligaments, nerves and blood vessels. Back pain may be associated with damage, injury or inflammation to any of these components.
Back pain is common, and there are many different causes and types of back pain. Back pain is not a medical diagnosis, but a symptom of an underlying condition.
Signs and symptoms
The intensity, location and duration of symptoms associated with back pain may vary, but may include:
- Localised ache;
- Shooting or stabbing pain;
- Limited flexibility;
- Limited range of motion;
- Inability to stand straight;
- Stiffness, and;
- Pain, numbness or tingling that radiates down one or both legs.
Certain symptoms that require more urgent medical attention include:
- Fever or chills;
- Redness or swelling on your back;
- Loss of bladder or bowel control (incontinence), or difficulty passing urine, and;
- Unexplained weight loss.
The back is comprised of muscles and the spine (backbone): a structure made up of bones, called vertebrae, which are held together by ligaments. The vertebrae are separated by intervertebral discs that act as rubbery cushions between the vertebrae and prevent the vertebrae from rubbing against each other.
The spinal cord is a bundle of nervous tissue that runs inside the length of the spine (much like electrical wiring inside a cable). The spinal cord connects the brain to the rest of the body: nerves branch off the spinal cord at regular intervals, transmitting signals from the brain to to all parts of the body, and communicating sensations from the body to the brain.
This complicated arrangement of bone, muscle, nerves and connective tissue is particularly prone to experiencing problems, and many (though not all) cases of back pain have something to do with the spine.
Back pain can be categorised into many different types depending on:
- Duration of symptoms - it can be acute (lasting less than four weeks), sub-acute (four to 12 weeks) or chronic (more than 12 weeks);
- Age when symptoms started: children, teenagers, adults and pregnant women, or;
- Location of pain: it can be in the upper (thoracic) spine and/or the lower (lumbar) spine.
There are several different causes for back pain. Some common causes include:
Non-specific back pain
|Most causes of back pain have no clear cause. Fortunately, with appropriate treatment, these cases of back pain tend to improve over time.|
Back strains and sprains
Acute back pain is most often caused by strains and sprains of the back muscles. It generally occurs in the lower back (lumbar muscles).
Back strain occurs when the muscles or tendons within the spine are stretched, torn or otherwise injured. When this occurs, there is an initial period of sudden, intense pain in the back, followed by muscular spasms for 1-2 days. The back is usually sore to touch. Resting helps ease the pain.
A disc prolapse (also known as a slipped disc, herniated disc, or ruptured disc) is a common cause of back pain. It happens when one of the discs between two vertebrae tears, and the jelly-like substance inside it leaks out. The tearing causes irritation and sometimes an increase in the pressure to the surrounding nerves. This can lead to pain and numbness or weakness in the neck, arm or shoulder, buttocks, legs or feet.
Any disc can potentially rupture, but the ones in the lower back are most at risk. The pain is typically felt only on one side or in one leg and is usually worse after long periods of standing or sitting.
Degenerative disc disease
The discs of the spine often wear down as we age. In some people, these changes can cause back pain. This is more commonly felt in the lower back, because the lower parts of the spine support the majority of the body's weight.
Pain caused by degenerative disc disease is often constant, and mild to moderate. Generally it causes recurrent episodes of back pain that last from a few days to a few months. The pain is made worse by actions that increase pressure on the back such as sitting, coughing, sneezing and flexing.
|Healthy spinal joints experience little friction, as the protective cartilage and fluid within the joint space helps to make movements easy and smooth. However, in arthritis, the protective cartilage becomes worn down and the surfaces rub against each other, leading to pain and stiffness. There are several different causes for arthritis, such as osteoarthritis, rheumatoid arthritis and psoriatic arthritis.|
The spine can develop fractures, which can cause back pain. The most common type of spinal fracture is a compression fracture. A compression fracture is when the vertebrae are crushed by the weight of the body. It is generally caused by osteoporosis. Osteoporosis is a condition that causes bones to thin, which makes them less able to support a load.
Compression fractures are usually associated with acute back pain that may become persistent and can be associated with a loss of height and/or back deformity, as the spine becomes increasingly compressed and curved.
Spinal stenosis is a narrowing of the spinal canal. It may be caused by a birth defect, or from degenerative changes associated with arthritis. It occurs more commonly in the ageing population.
Stenosis can produce symptoms related to spinal cord and nerve root compression ('pinched nerve'). People with spinal stenosis that causes nerve compression may experience leg pain when walking, and may feel numbness and tingling that radiates from their lower back into the buttocks and legs (this symptom is known as sciatica). The pain associated with spinal stenosis is usually made worse by activity, and relieved by rest.
Spondylolisthesis is a spinal condition in which one vertebral body (the main weight-bearing region of a vertebra) slips forward onto the one below.
Spondylolisthesis can be either degenerative (caused by repeated wear over time), or it may be caused by fractures within the spine.
|Spondylolysis refers to a condition where there is a weakness in an area of the vertebrae of the lower spine. Excessive strain in the back, particularly in teenagers, results in a fracture through this area of weakness, which results in back pain.|
In rare cases, back pain may be associated with a spinal cancer. The symptoms of a spinal cancer may vary, depending on its location. They can either originate from the spine or, more commonly, spread from another part of the body.
Some of the more typical symptoms that may be associated with a spinal cancer may include:
|In rare cases, an infection can develop in the spine. The resulting back pain is not always associated with a fever. Urgent treatment is required before the infection damages the spine and spreads throughout the body.|
Back pain can also arise from causes outside the spine, particularly the abdomen and pelvis. Examples of referred back pain include:
You can be at greater risk of experiencing back pain due to factors such as:
- Older age;
- Being female;
- Manual labour;
- Being physically unfit and/or overweight;
- Sedentary work, and;
Methods for diagnosis
A thorough medical history and physical examination will help your doctor diagnose the cause of your back pain.
Your doctor will take a thorough medical history. Your doctor may also ask you about things such as:
- Details relating to the onset of your back pain;
- The intensity and location of the pain;
- If other symptoms accompany your back pain;
- What makes the pain better and worse;
- Your work history details;
- Whether you have recently suffered an accident or trauma, and;
- A history of other medical conditions such as osteoporosis, arthritis or cancer.
During a physical examination, your doctor may ask you to perform a series of movements while you stand, sit and lie down. Your doctor may then be able to determine what may be causing your back pain. Your doctor may also feel for tenderness and carry out a general examination of your trunk and legs.
In most people with acute back pain, imaging is generally not necessary, especially if the symptoms improve within 6-8 weeks with simple pain-relief medications (see "Types of treatments" below). If the treatment has failed to resolve the symptoms, or you have unexplained chronic back pain, X-rays may be obtained to help make a definitive diagnosis. If there are signs of serious disease such as significant nerve compression, fractures or a cancer, scans such as computerised tomography (CT) or magnetic resonance imaging (MRI) may be needed.
Standard X-rays can be used to assess bones, but are very limited when attempting to look at discs, muscles, ligaments or nerves. CT scans are more useful for a closer look at bone-related causes. MRI scans are particularly useful when looking at discs, nerves, ligaments and muscles.
Types of treatment
Acute back pain
For an acute case of back pain, your doctor may initially suggest rest or reduced activities for a few days. Medication may be used to treat the pain and swelling.
As the back pain eases and mobility is restored, the goal of treatment changes to restoring proper function, strengthening your back, and preventing recurrence of the injury. You may be given an exercise plan.
Chronic back pain
Treatment for chronic back pain will vary depending on the cause, frequency and severity of the pain. It is generally more difficult to manage than acute back pain. Treatment focuses on controlling the pain and improving your quality of life. Often, more than one treatment is needed to help manage symptoms. It follows the same principles as managing other causes of chronic pain. More information on chronic pain can be found here.
Back pain can lead to various complications, such as:
- Nerve damage and muscle wasting;
- Sleep disturbances;
- Weight gain, and;
- Dependence on pain-relief medications.
Most people with back pain make a full recovery by making lifestyle changes that may include:
- Following an exercise program;
- Adopting good posture, and;
- Maintaining a healthy body weight, which may reduce recurrent episodes of back pain.
The long-term outlook for most cases of back pain is generally good.
Some cases of back pain are the result of underlying medical conditions. In those cases, back pain cannot be prevented. However, most cases of back pain can be avoided, or the severity of symptoms reduced, by making some lifestyle changes such as:
- Maintaining good posture;
- Lifting objects safely;
- Exercising regularly to improve posture and increase muscle support for the spine;
- Eating a healthy diet that helps to achieve and maintain a healthy body weight to ease the strain on the back;
- Taking regular breaks while standing, sitting or driving for long periods, and;
- Adopting effective stress management approaches.