5 Common Types of Back Pain

When your back hurts, it’s not a one-size-fits-all situation. Pain can emerge anywhere in your spine or nearby muscles, and it can range from mild to intense, occurring more or less frequently. Since your spine safeguards crucial parts of your Central Nervous System, any type of back pain could indicate serious damage. If left unaddressed, some forms of back pain may even lead to permanent harm to your spine or nerves.

Many solutions in the market treat back pain as if it’s universally the same. But here’s the thing: “back pain” is more of a symptom description than a specific diagnosis. It’s akin to giving antibiotics to everyone with a stomach ache, even though there are various reasons why your stomach might hurt. Similar to the numerous causes of stomach pain, there are different types of back pain.

A skilled physiotherapist can identify your specific issue and create a tailored treatment plan just for you. Matching the right diagnosis with the appropriate treatment is crucial for relieving your back pain.

Here are some common types of back pain. Following each type, there are key considerations and strategies that should be part of a treatment plan for that kind of pain. However, it’s essential to remember that there’s no substitute for a thorough checkup by an experienced physiotherapist.

1. Flexion Dominant Back Pain

Flexion Dominant Back Pain is a type of back pain that primarily worsens with activities involving bending forward, sitting, or lifting heavy objects. This condition is often linked to issues with the spinal discs, where such movements increase pressure on these discs.

Here’re the symptoms you might experience:

• Increased pain during activities that involve spinal flexion such as bending or sitting.
• Difficulty in straightening up after being in a seated position.
• Tingling, numbness, or weakness in the legs, which may indicate nerve involvement.
• Temporary relief from symptoms after short walks or standing

Effective care involves a specific exercise or stretch performed throughout the day to maintain spinal flexibility and reduce pain. This stretch should ideally be recommended by a physiotherapist. A common starting point is gently extending the lower back. A skilled physiotherapist can customize this exercise for better results. 

You can watch a video demonstration of this exercise below:

Other effective treatments might include:

• Strengthening of core and hip muscles to support the lower back.
• Manual therapies such as massage or mobilization to improve spinal movement and reduce discomfort.
• Ergonomic adjustments to workstations and training on proper lifting techniques.

In severe cases, medications may be prescribed to manage pain and inflammation.

2. Neurogenic Claudication

Neurogenic Claudication is a specific type of back pain, mainly affecting those aged 60 and above. It occurs when nerves are compressed during standing and walking, significantly limiting the ability to walk long distances. Here’re the signs and symptoms:

• Mild discomfort to severe pain, often described as cramping or sharp shooting pains.
• Tingling and numbness felt in the lower extremities.
• A feeling of heaviness or weakness in the legs.

Relief is often found when sitting, bending forward, or leaning on objects (known as the “shopping cart sign”), as these positions decrease spinal canal pressure and relieve nerve compression.

Treatment options for Neurogenic Claudication vary based on the severity of the symptoms and include:

• Conservative Treatments: Medications, physical therapy, and epidural steroid injections to manage pain and reduce inflammation.
• Surgical Treatments: If conservative treatments fail, surgical options such as laminectomy (removal of part of the vertebra) or minimally invasive procedures to decompress the affected nerves may be considered.

3. Extension Dominant Back Pain

Extension Dominant Back Pain is a type of back pain characterized by discomfort that worsens with activities involving the extension of the spine, such as standing for long periods or engaging in high-impact activities like running or gymnastics. This pain is often localized to the spinal area.

Here’re the symptoms:

• Pain increases after activities that involve spinal extension.
• Temporary relief from symptoms when sitting or bending forward.
• Stiffness in the back that does not change quickly over time.
• Localized spinal pain and possibly leg pain, tingling, or numbness.

It takes a combination of physical therapy and lifestyle changes to treat Extension Dominant Back Pain:

• Physical Therapy Exercises: Exercises like the modified Superman are recommended to reintroduce extension movements gently. This exercise helps activate the deep stabilizing muscles while reducing the load on the overactive, inflamed erector spinae muscles.
• Ergonomic Adjustments and Proper Posture: Making ergonomic changes to the work and living environments can help reduce the stress on the spine. Proper posture is crucial to avoid unnecessary extension of the spine.
• Stretches and Mobility Exercises: Exercises that enhance hip and core flexibility and strength can support the spine, reducing the likelihood of pain. These exercises include hip mobility stretches and abdominal stabilizing movements.
• Gradual Exposure to Extension Movements: Gradually increasing the spine’s exposure to extension movements can help desensitize the back to pain, making it more tolerant to everyday activities.
• Manual Therapies: Techniques such as massage or spinal mobilizations can help alleviate pain and improve spinal function. These therapies are often used to manage symptoms and improve overall back health.

During recovery, you should avoid activities that excessively extend the spine, such as arched back benching or certain types of rows, which can exacerbate the condition.

4. Chronic Pain Disorders

In chronic pain disorders, pain persists beyond the usual recovery period or is associated with a chronic health problem. The pain lasts for months or years and can be intermittent or constant.

A chronic pain condition can affect any part of the body, and can interfere with daily activities and negatively impact a person’s quality of life, emotional well-being, and ability to function at work.

Here are some signs and symptoms:

• Fatigue
• Sleep disturbances
• Decreased appetite
• Mood changes, such as depression and anxiety
• Physical disability

It’s hard to manage chronic pain disorders effectively. Treatment strategies typically involve a multidisciplinary approach, addressing both the physical and psychological aspects of pain. The most common treatments are:

• Medications: Such as NSAIDs, antidepressants, anti-seizure drugs, and opioids.
• Physical therapy: Exercises, stretching, and modalities such as heat or cold therapy to improve body function and reduce pain. 
• Psychological counseling: This helps you understand the thoughts and feelings that influence behaviors and is effective in managing the psychological aspects of chronic pain.
• Complementary therapies: Such as mindfulness meditation, massage and acupuncture that involves the insertion of needles into specific points on the body, which might help relieve pain for some patients. 
• Lifestyle modifications: Including diet changes, regular exercises and stress management techniques.

To address Chronic Pain Disorders, you should talk to physiotherapists. They can help you understand why you’re in pain, how to stay physically fit, and minimize the impact on everyday activities.

5. Inflammatory Back Pain

Inflammatory back pain (IBP) is a chronic condition characterized by pain localized to the axial spine and sacroiliac joints. Unlike mechanical back pain, which is often acute and results from injury or overuse of the back’s joints, bones, and soft tissues, IBP is associated with inflammation and is often linked to various types of spondyloarthritis—a group of inflammatory diseases that primarily affect the spine and other joints.

The symptoms of IBP can vary but typically include:

• Chronic pain localized to the lower back and buttocks, persisting for more than three months.
• Pain and stiffness that are worse in the morning or after periods of inactivity.
• Improvement in pain with movement or exercise.
• An insidious onset of symptoms before the age of 40.

Although not diagnostic on its own, IBP is strongly associated with conditions such as ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, juvenile idiopathic arthritis, and reactive arthritis.

Treatment for IBP focuses on reducing inflammation and managing pain, with strategies including:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription medications like ibuprofen or naproxen can help relieve inflammation and pain.
• Biologic Medications: For cases not responsive to NSAIDs, biologic agents such as TNF inhibitors or secukinumab may be prescribed to target specific pathways in the immune system that cause inflammation.
• Physical Activity and Therapy: Physical activity and exercises that strengthen the core and back muscles are recommended for supporting your spine and reducing symptoms.
• Lifestyle Modifications: Avoid activities that aggravate the condition and incorporate practices like yoga to help manage symptoms.

The Bottom Line

Some patients’ back pain may remain elusive even after many tests and visits to the doctor. In that case, you’ll still need to treat the pain, and there are nonsurgical options to manage or alleviate it.

In addition to a comprehensive treatment plan, psychological factors, like depression and insomnia, can make the pain worse.

If you have persistent back pain or neurological symptoms, you should always see a spine specialist. In the end, it may help you if you participate in the decision-making.

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.