Back Pain: Symptoms, Causes and Treatments

Globally, back pain is a leading cause of disability, and many people seek medical attention or miss work because of it. The good news is that most back pain can be prevented or eased, especially in people under 60 years of age.

In most cases, back pain can be treated with home treatments and proper body mechanics within a few weeks, without requiring surgery.

What is Back Pain?

Back pain is one of the most common illnesses affecting a significant portion of the population. This condition can cause mild discomfort to severe debilitating pain that impacts daily activities and quality of life.

Based on duration, there are two types of back pain:

• Acute Back Pain: This type of pain starts suddenly and lasts for up to 6 weeks. It is often caused by a specific event or injury and is usually temporary.
• Chronic Back Pain: This pain persists for more than three months and may arise without an initial injury. Chronic pain can continue even after the injury or illness that caused it has healed or gone away.

Most back pain is nonspecific because its cause is difficult to determine. The cause could be a muscle strain, facet joint discomfort, or minor disc issues.

Back Pain Causes

Back pain can happen for various reasons. Some common causes include:

• Muscle or ligament strain: Doing heavy lifting or sudden movements can strain the muscles and ligaments in your back, especially if you’re not in good shape. This can lead to painful muscle spasms.
• Bulging or ruptured disks: Disks act like cushions between the bones in your spine. Sometimes, the soft material inside a disk can bulge or rupture, pressing on a nerve. However, not all bulging or ruptured disks cause pain, and they’re often found incidentally on scans done for other reasons.
• Arthritis: Osteoarthritis, which affects the joints, can also affect the lower back. In some cases, it can cause narrowing of the space around the spinal cord, known as spinal stenosis.
• Osteoporosis: When the bones in the spine become weak and brittle, they can develop painful breaks, especially in conditions like osteoporosis.
• Ankylosing spondylitis (axial spondyloarthritis): This is an inflammatory disease that can cause some of the bones in the spine to fuse together, making the spine less flexible.

Symptoms of Back Pain

Some common symptoms associated with back pain include:

• Increasing pain with lifting and bending.
• Worsening pain when resting, sitting, or standing.
• Intermittent back pain that appears sporadically.
• Stiffness in the morning.
• Pain that radiates away from the back.
• Numbness or weakness in the legs or feet.
• Severe back pain that does not improve with medication.
• Weakness, pain, or numbness in the legs.
• Dull pain in the lower back and upper buttocks.
• Loss of bowel or bladder control.

While most back pains will improve with self-care within a few weeks, chronic back pain may require more intensive treatment.

Diagnosing Back Pain

When doctors diagnose back pain, they often take a ‘wait and see’ approach recommended by national guidelines. Most cases of back pain get better on their own, so it’s common to hold off on further treatment initially. While this might feel frustrating as a patient, sticking to self-help measures could resolve the issue without needing additional treatment.

For further treatment, your doctor will assess your back pain based on your symptoms. In most cases, a simple examination is enough to diagnose most problems, and no special tests are needed.

It may be necessary to order tests if:

• You’ve had a back injury, like a bad fall.
• Your doctor suspects an underlying cause for your pain.
• The pain has persisted for an unusually long time.

If these conditions exist, your doctor may recommend a magnetic resonance imaging (MRI) or computerized tomography (CT) scan. Since X-rays cannot detect soft tissue issues, such as ligaments and muscles, which are often the cause of back pain, they are less commonly used.

It is true that X-rays can reveal changes in the spine caused by conditions like spondylosis, but these changes might not cause pain or problems. For this reason, X-rays are rarely useful in diagnosing back pain.

However, even after thorough testing, it may not always be possible to determine the exact cause of back pain.

Treatments

In many cases, back pain can be treated without requiring expensive treatments.

Medication

You can usually get by with over-the-counter pain meds including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil) or naproxen (Aleve). You can also try pain relievers like acetaminophen (Tylenol), but these don’t fight inflammation.

If you have kidney issues or stomach ulcers, just be careful with meds like ibuprofen. Stick to the recommended dosage – too much of anything can cause problems.

Other options include:

• Rubs and ointments: These products often contain active ingredients that can help reduce pain and inflammation.
• Muscle relaxants: These can help if your back pain comes with muscle spasms.
• Antidepressants: Sometimes docs use these to tackle back pain, especially if it’s nerve-related.
• Steroid injections: For certain types of back pain, your doc might suggest a cortisone shot.

You should consult with a healthcare provider to choose the most appropriate medication based on your specific symptoms and medical history.

Surgery

When considering surgery for back pain, it’s important to understand that it is typically seen as a last resort after conservative treatments have failed. Some common surgery options include:

• Discectomy: This procedure involves removing a portion of a herniated disc that is pressing on a nerve root or the spinal cord. Microdiscectomy is a less invasive form of this surgery, often resulting in quicker recovery times.
• Spinal Fusion: This is a common surgery for chronic nonspecific back pain with degenerative changes. It involves joining two or more vertebrae to limit motion between them and reduce pain.
• Nucleoplasty or Plasma Disc Decompression: A minimally invasive procedure where a needle is inserted into the disc to apply radiofrequency energy, reducing the size of the disc material and relieving pressure on the nerves.
• Interlaminar Implant: A minimally invasive alternative to more invasive surgery, where a U-shaped device is implanted between two vertebrae to keep the space open and ease pressure on spinal nerves.

The success rates of surgeries can vary. For instance, the success rate for disc surgery is about 90%, but it is only considered if symptoms persist for more than 6 weeks.

Alternative Treatments

Alternative treatments for back pain can be an effective way to manage symptoms, especially for those looking to avoid or complement traditional medical approaches. Here’re some examples:

• Chiropractic Care: A chiropractor manipulates the spine to ease pain. Manual manipulation has been found to relieve low back pain in some people.
• Acupuncture: This traditional Chinese medicine practice involves inserting thin sterilized needles into the skin at specific points on the body. Acupuncture has been shown to be helpful in treating back pain.
• Massage Therapy: Massage can relieve back pain caused by tense or overworked muscles by increasing blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.
• Physical Therapy: Physical therapy for low back pain includes guided therapeutic exercises that strengthen the lower back muscles and condition the body, which can provide up to 60% improvement in lower back pain and other symptoms.

Home Remedies 

Home remedies for back pain can be effective for managing mild to moderate discomfort. Here are some methods that can help alleviate back pain at home:

• Heat and Cold Therapy:Ice or cold packs can provide temporary pain relief by reducing inflammation and numbing the area. It is especially useful after an injury. The use of heat, such as with a heating pad, hot water bottle, or warm bath, can also help relax and loosen tissues and stimulate blood flow. It is beneficial to heat muscles and joints if they are stiff or painful.
• Topical Ointments and Creams: Products containing menthol, camphor, capsaicin, or lidocaine can soothe the area by cooling, heating, or numbing it temporarily. Commonly used brands include Icy Hot, Tiger Balm, and Bengay.
• Exercise and Stretching: Exercise can strengthen the muscles supporting the back, which is crucial to pain relief and prevention. You can try exercises, including yoga, Pilates, and tai chi, which can increase flexibility and core strength. Other exercises like walking, swimming, or stationary cycling can also help without putting too much strain on the back.
• Massage: Massaging the affected area can help relieve muscle tension and pain. It can be performed by a professional or by a partner at home using medicated ointments for additional relief.
• Improving Posture: Posture plays an important role in reducing back pain. Using ergonomic furniture and keeping the spine aligned while sitting or standing can prevent and alleviate back pain.
• Mindfulness and Relaxation Techniques: Techniques such as deep breathing, meditation, and guided imagery can help manage the stress and anxiety that often accompany chronic pain.
• Dietary Changes: Eating anti-inflammatory foods such as fruits, vegetables, and whole grains can help reduce inflammation that may contribute to back pain.
• Herbal Remedies: Herbs like devil’s claw, willow bark, and arnica have been used to reduce pain and inflammation, though they should be used with caution.
• Aromatherapy: Essential oils such as lavender, eucalyptus, and peppermint can be used in massages or added to baths to help soothe back pain.

While these home remedies can provide relief, they are not a substitute for professional medical treatment in cases of severe or persistent back pain.

How to Reduce the Risk of Back Pain

Here are some ways to prevent back pain:

• Engage in low-impact aerobic activities that don’t strain or jolt your back to increase strength and endurance in your back.
• Perform muscle-strengthening and stretching exercises at least 2 days a week to support your spine.
• Stay within 10 pounds of your ideal weight to avoid putting extra stress on your back.
• Stand and sit up straight to reduce the strain on your back.
• Use ergonomic furniture and ensure your workstation is set up to support your back.
• Avoid heavy lifting when possible, and use your legs rather than your back when lifting.
• Bend your knees and keep your back straight while lifting.
• Practice relaxation techniques and engage in activities that reduce stress.
• Take regular breaks to stand and move around if you sit for long periods.
• Use a firm mattress and find a comfortable sleeping position that supports the spine.
• Get enough calcium and vitamin D.
• Quit smoking. 

Poor posture is the primary cause of many back pain issues. Certain products, such as back braces, can correct poor posture by stabilizing the clavicle area and pulling the shoulders back for better alignment. You might want to check out our list of the best back braces for more information.

When to See a Doctor

You should consider seeing a doctor for back pain if

• Your back pain lasts more than two weeks and prevents you from participating in daily activities.
• Your back pain is intense or doesn’t improve after 3 days.
• You experience back pain after trauma, such as a fall or injury.
• You have back pain accompanied by a fever.
• You experience loss of bladder or bowel control.
• You have loss of strength in your arms and legs.
• You have unexplained weight loss associated with back pain.
• You have radiating pain that extends below the knee.
• You have new or worsening motor weakness, sometimes with numbness or tingling.
• You have pain that wakes you up at night.

In addition to these specific situations, if you have a history of cancer, immune system problems, or if you have been experiencing chronic pain for more than 3 months, it’s important to consult a doctor.

It’s also recommended to see a doctor if home treatments such as painkillers and heat/cold packs are not having any effect after 72 hours.

Sophia Anderson, PT, DPT

Sophia Anderson, PT, DPT is a physical therapist who offers online pain management consultations. She helps people with various types of pain, especially neck, back, and knee pain.

She graduated from the University of St. Augustine with a Doctor of Physical Therapy (DPT) degree. She has experience in orthopedic physical therapy, sports medicine, neurological rehabilitation, advanced assessment and treatment of running injuries, and advanced treatment of the pelvic complex, spine, and extremities.

If you’re experiencing any pain, let Sophia Anderson, PT, DPT help you out.