Back pain occurs when there is discomfort on the back or spine, ranges from mild to severe damage. In most cases, it is caused by strain to a ligament or muscle.

Tumors in chest, aorta disorder, and spine inflammation are the reasons for upper back pain.

Lower back pain (lumbago) occurs due to problems in some parts of the lower back (1). It is a symptom of several medical problems and not a disorder. For example, problems in nearby organs like kidney may also cause lower back pain.

Causes of lower back pain include:

• The skin covering the lumbar area.

• Internal organs of the pelvis and abdomen.

• Spinal cord and nerves.

• The spine is made of bony structures, defined as vertebrae or vertebral bodies.

• Intervertebral discs (discs between the vertebrae).

• Ligaments around the spine and discs.

• Muscles of the low back.

Symptoms of lower back pain can be defined based on the type of onset and duration as below.

Acute pain – It is a pain that occurs instantly and lasts for a few days or weeks. This pain is considered as the body’s normal response to injury or tissue damage. As the body heals, the pain subsides gradually.

Subacute back pain – Prolonged pain such as muscle strain or joint pain lasts from 6 weeks to 3 months. Medical advice is required if the pain is severe and stops one’s daily activities.

Chronic back pain – Pain lasts over 3 months, and it is also called lower back pain (2). This pain is generally severe and does not provide any response for initial treatment. Thus a thorough medical workup is needed to identify the exact source of the pain.

Components of the Spine

The spine is one of the most durable parts of the body that gives strength and flexibility. It is also named as backbone or spinal column. The lower back consists of five vertebrae (refers to L1-L5), and each one sits on top of the other in the lumbar region. It supports the significant weight of the upper body.

Intervertebral discs, maintains the gap between vertebrae and cushion the bones as the body moves. These are round and rubbery pads that act like shock absorbers throughout the spine.

Bones in the tailbone are at the bottom of the back with no discs in between, and they are fused together. From top to bottom, there are small joints on either side of the spine defined as facet joints.

Ligaments are a band of tissues that hold vertebrae in place, whereas tendons attach the muscles to the spine.

The spinal column has 31 pairs of nerves called nerve roots that control body movements. These nerves are rooted in the spine and also transmit signals from the body to the brain.

Other vertebrae regions include thoracic (upper back), cervical (in the neck), and sacral & coccygeal (below the lumbar area) segments.

Lower back functions are movement, structural support, and protection of certain body tissues.

Causes of Back Pain

The occurrence of back pain has numerous causes (3), and some of them are,

Congenital

1. Skeletal Irregularities

It include,

• Scoliosis – a lateral curvature of the spine.

• Lordosis – inward curvature of lumbar and cervical regions of the spine.

• Kyphosis – excessive outward arch of the spine.

• Other congenital anomalies of the spine.

2. Spina Bifida

It is a neural tube defect; the reason is the incomplete closing of the embryonic neural tube. It is a congenital problem that is present even before birth. Spina bifida leads to abnormal sensations, malformation of vertebrae, and even paralysis. Periodically in the affected skin area, there are abnormal bunch of hair. It is a minor bone abnormality that doesn’t show any symptoms. But at a later stage, this condition leads to critical nervous abnormalities.

Injuries

1. Sprains – stretching or tearing of ligaments

2. Strains – tears in muscle or tendons

3. Spams – a sudden contraction of a muscle or group of muscles

4. Traumatic Injury – injury from fall, accidents, playing sports, etc. that affects the spine by injuring ligaments, tendons, or muscles and causes discs to rupture.

Degenerative Problems

1. Interverbal Disc Degeneration

As you age, the rubbery disc wears down and loses its cushioning ability.

The symptoms may include:

• Pain gets severe while sitting

• Increase in pain while bending, twisting, or lifting

• Tingling and numbness in extremities

2. Spondylosis

As you age, the intervertebral discs lose moisture and volume, which reduces the disc height. This condition prompts a decrease in disc height, and in case trauma occurs, it will cause inflammation.

The symptoms may include:

• Loss of bowel or bladder control

• Lack of coordination and difficulty in walking

• Tingling, weakness, and numbness in your hands, arms, feet, or legs

3. Arthritis

Tenderness and swelling of your joints. Osteoarthritis and rheumatoid arthritis are the types of arthritis that occur commonly.

Based on the type of arthritis, the symptoms may include: 

• Stiffness

• Swelling

• Joint pain

• Redness

• Reduced range of motion

Nerve and Spinal Cord Problem

Below are the several spine problems (4) that causes back pain:

1. Spinal Nerve

It include inflammation, compression and injury. The symptoms are:

• Numbness and tingling

• Pain in the area of compression (neck or low back)

• Feeling weak for specific activities

• Radiating pain (such as sciatica)

• Burning sensation

2. Sciatica

Large nerve which originates from the lower back and extends to the back of each leg is the sciatic nerve. The pain in the sciatic nerve is also called radiculopathy. People with sciatica experience burning pain in the lower back, along with pain through the butt and one leg. The pain might extend to the foot or toes based on where the sciatic nerve is affected. The symptoms are,

• Lower back and hip pain

• When sitting, the pain in the rear or leg worsens

• Burning or tingling down the leg

• One side of the rear has constant pain

• Numbness, weakness, or difficulty moving the leg or foot

• Shooting pain causes difficulty in standing up

3. Spinal Stenosis

Narrowing of spaces in the spine puts pressure on the nerves which travel through the spine.

Types of stenosis are,

Cervical Stenosis: narrowing occurs in the part of the spine in the neck. The symptoms include,

• Weakness in the arm, hand, foot, or leg

• Numbness or tingling in the arm, hand, foot, or leg

• Issues with walking and balancing

• Neck pain

• In severe cases, bladder or bowel dysfunction (urinary urgency and incontinence)

Lumbar Stenosis: a common type of spinal stenosis, narrowing occurs in the part of the spine in the lower back. The signs are

• Weakness in a foot or leg

• Tingling or numbness in the leg or foot

• Pain or cramps in one or both legs while standing for a longer period or while walking

• Back pain

4. Spondylolisthesis

occurs when a vertebra of the lower spine moves out of place and compresses the nerves exiting from the spinal column. The symptoms are,

• Stiffness and tightness of the muscle

• Lower back pain

• Pain in the butt

• Pain radiates down to the leg

5. Herniated or Ruptured Discs

occurs when the intervertebral discs get compressed and bulge outward. The signs include,

• Numbness or tingling

• Arm or leg pain

• Weakness

6. Cauda Equina Syndrome

It is a rare disorder that affects the bunch of nerve roots at the lumbar end of the spine. It occurs when the nerve roots in the lumbar spine are compressed due to which the movement and sensation are cut off. Nerve root that controls the function of bladder and bowel will get damaged easily. The symptoms are,

• Dysfunction of bladder and bowel makes you retain urine, or you will be unable to hold it

• Severe or progressive problems in lower extremities such as loss of or altered sensation over the butt, inner thighs, between the legs, back of the legs and feet

7. Osteoporosis

It is a progressive decrease in bone strength and density that prompts painful fractures of vertebrae. Signs are,

• Loss of height over time

• A stooped posture

• Back pain, caused by a collapsed or fractured vertebra

• Bone breaks easily

8. Infections

There are several problems related to infections in bones such as 

• Osteomyelitis – Infection in vertebrae.

• Discitis – Infection in the intervertebral discs.

• Sacroiliitis – Infection in the sacroiliac joints, that connects the lower spine to the pelvis.

Non Spine Sources of Pain

• Kidney stones usually cause sharp pain on one side of the lower back

• Endometriosis causes the growth of uterine tissue outside the uterus

• Fibromyalgia, a chronic pain syndrome, involves widespread muscle pain accompanied by fatigue

• Tumors that destroy the bony spine or spinal cord and nerves or outside the spine in the back

• Pregnancy causes back pain symptoms, and it disappears after giving birth

Diagnosis

Doctors will ask you to take some tests if they find any severe condition (5). The tests can be:

• Urine and blood test to check underlying conditions

• X-rays of the spine to check the alignments of bones and breaks, if any

• CT scan or MRI to assess muscles, discs, nerves, ligaments and blood vessels

• Bone scan to check for any abnormalities in bone tissue

• EMG for testing nerve conduction

Treatment

Treatment (6, 7) may vary based on the level of pain as below:

1. Home Treatment

Applying an ice pack or a hot compress to the pain area may reduce pain. You can also take over-the-counter (OTC) pain relief medications such as ibuprofen that helps to relieve pain.

2. Medical Treatment

Medications – If OTC drugs don’t ease pain, you may need a prescribed NSAID. Narcotics such as hydrocodone or codeine can be prescribed for a short period and should be monitored by the doctor. Muscle relaxants can also be used in some cases.

Physical Therapy – Apply ice, heat, electrical stimulation, ultrasound, and muscle release techniques to the soft tissues, and back muscles help reduce pain.

Cortisone Injections – An anti-inflammatory drug, effective for reducing inflammation around nerve roots. It is injected in the epidural space around the spinal cord if other treatments didn’t work. These injections can also be used to numb the areas causing pain.

Botox – Botulism toxin may paralyze sprained muscles to relieve pain, which is effective for 3 to 4 months.

Traction – For stretching the back, weights and pulleys are used, which may move the herniated disk back to its position. Pain reduces only when the traction is applied.

Cognitive Behavioral Therapy – CBT includes maintaining a positive attitude and relaxation techniques that help people to become more active. It results in a lower risk of back pain recurrence.

3. Complementary Therapies

Complementary therapies (8) can be used on their own or along with other conventional therapies.

An Osteopath is an expert who treats the skeleton and muscles.

A chiropractor specializes in treating muscle, joint, and bone problems, but their main focus is the spine.

Shiatsu, otherwise called as finger pressure therapy, is a type of massage. In this massage, the pressure is applied along energy lines in the body.

Acupuncture originates from China, which uses needles. These fine needles are inserted in the specific points in the body.

Yoga involves some poses and movements that aid in strengthening the back and improving the posture.

Transcutaneous electrical nerve stimulation (TENS) is a machine that carries small electrical pulses into the body through electrodes placed on the skin. It is good therapy for people with chronic back pain (9).

Risk factors for people using TENS include,

• Pregnant women

• People who have a pacemaker

• People who have a history of epilepsy and heart disease