What's Really Making Your Back Hurt?

Back pain is one of the most common complaints doctors hear from their patients. In fact, studies show that more than 80% of Americans will suffer from at least one episode of back pain during their lifetime. Back pain can range from mildly annoying to completely debilitating depending on the cause and severity of the symptoms. 
So what really causes back pain? The answer is complex, but what we do know is the following people are at a greater risk of lower back pain: 
  • Adults between the ages of 30 and 55.
  • People who smoke. (Researchers theorize that smoking may decrease blood flow to intervertebral discs which can lead to accelerated cell death.)
  • Adults who had episodes of low back pain as teens.
  • People whose occupational activities require heavy lifting, pushing, pulling, etc. 
  • Those with a history of depression, anxiety or insomnia. (These conditions may affect a person’s ability to deal with pain.) 
Beyond these risk factors, there are a variety of problems that cause lower back pain. Here are the five most common causes of back pain—and what you can do about it. 
Strains or Sprains to Back Muscles
Strains (injuries to a muscle or tendon) and sprains (injuries to a ligament) are the most common causes of back pain. Moving suddenly, twisting or lifting heavy objects can cause microscopic tears in the muscles, tendons or ligaments in your back. Depending on the severity of the tear, this can cause mild to severe pain that comes on immediately or soon after an activity such as heavy lifting. The lower back area can be sore to the touch and achy, and muscle spasms can also occur.
Treatment:  Strains and sprains often heal on their own with home remedies, such as rest, ice and/or heat, gentle stretching and anti-inflammatory medication. Ice is generally used to reduce inflammation and swelling, while heat can help reduce muscle spasms. However, if you can’t walk more than four steps without significant pain, can’t move the affected area, or have numbness, you should see a doctor right away.
Degenerated Spinal Discs
Spinal discs are soft, fluid-filled "sacs" located between each vertebra of the spine. They provide a cushion for the vertebrae, helping absorb impact and shock. Over time, the discs can degenerate or wear out, especially in the lumber (lower back) region. Some disc degeneration is part of the normal aging process. Other disc issues can be caused by injury or trauma to the back. The wearing down of intervertebral discs causes chemical and physical changes within the discs that can lead to inflammation and nerve-related pain, usually contained in the lower back region and not extending into the arms or legs. It is usually brought on by activities that compress the spine, such as bending forward from the waist, sneezing, coughing or sitting for prolonged periods of time. Often, it is relieved by a change in position such as standing up or lying down.     
Treatment:  In most cases, anti-inflammatory medications and exercises that strengthen and stretch the back muscles can help.
Herniated Discs
With age, spinal discs become less elastic, increasing the risk of rupture. When a rupture occurs, a portion of the disc is pushed outside of its normal boundaries; this is referred to as a herniated disc. The most common area where people experience herniated discs is in the lumbar (lower back) region of the spine. Injury or trauma to the spine can also cause a disc to rupture as can prolonged sitting (which puts pressure on lower back discs) and heavy lifting.
A herniated disc results in sharp or throbbing lower back pain that can come on suddenly (as the result of a fall, sudden movement or accident) or gradually. Some people feel less pain when lying down; others experience less pain with increased movement or standing. Depending on the severity of the rupture and its location near the nerves, some people may experience nerve-related numbness, tingling, weakness or pain that shoots down the leg.
Treatment: Dealing with a herniated disc depends on a number of factors, including age and severity of symptoms. Treatment typically starts with rest and refraining from activities that aggravate the condition. Many times, the condition will resolve itself given time. Ice, heat and anti-inflammatory medications can help relieve symptoms. Physical therapy can also help to improve the stability and strength of the lumbar region to reduce the risk of further injury. 
"Sciatica" refers to pain along the sciatic nerve, which starts in the lower back and runs down the hip and buttock on each side of the body. Sciatica commonly occurs when a herniated disc or bone spur compresses part of the sciatic nerve. Sciatic pain is usually limited to one side of the body. It can result in inflammation and numbness in the affected leg, and can get worse with standing, sitting, sneezing or heavy lifting. Pain varies from a mild ache to a jolt or shock. 
Treatment: Prolonged inactivity can make sciatica symptoms worse, so it’s important to continue with regular activity (assuming it’s not the activity that caused the problem in the first place). Cold packs, heat packs, stretching the hamstrings and piriformis (which runs across the buttocks to the outer hip) and pain relieving medication can be helpful ways to self-treat the problem. If those aren’t successful, your doctor might prescribe stronger medication and/or physical therapy to help correct the problem. 
Spinal Stenosis
This is a narrowing of the open spaces within the spinal canal, which can put pressure on the spinal cord and nerves that travel through the spine. Degenerative changes typically cause this narrowing process to occur, which is why the condition normally affects people over age 50. Spinal stenosis can cause cramping in the legs (when sitting or standing for long periods of time), and pain, numbness or weakness in the back or legs. It can also lead to problems with bowel or bladder control.
Treatment: Anti-inflammatories, muscle relaxants and other types of medication might be prescribed by your doctor to relieve spinal stenosis pain. Exercises to improve balance, increase flexibility and stability of the spine and increase overall strength are also often part of a comprehensive treatment program.
Special Exercise Considerations for Back Pain
Although two-thirds of patients with back pain report improvements within seven weeks, as many as 40 percent will see a relapse within six months. The good news is that, in general, those who engage in a regular physical activity program are less likely to have back pain now and in the future. And for most individuals, exercise will be a key component of their treatment program. Although the standard recommendation for people with back pain used to be rest, recent research has shown inactivity may not only delay recovery, but can also make the symptoms worse.  
For most acute low back pain issues, low-impact cardiovascular activities such as walking are recommended. Patients are encouraged to resume daily activities as soon as possible. Specific back exercises, heavy lifting and prolonged sitting should be avoided when the issue is acute.
For many chronic low back pain issues, physical therapy is often helpful to correct muscle imbalances and prevent future problems. The goal is typically to develop a specific set of exercises that will increase strength, endurance and flexibility and also to learn correct movement techniques that will benefit the patient for the rest of their life. 
With the proper guidance, it's possible for many back pain sufferers to resume normal activities and exercise in a safe, pain-free manner.
Solomon, Jennifer. “Low-back Pain.” In ACE Advanced Health and Fitness Specialist Manual, edited by Cedric X. Bryant and Daniel J. Green, 489-507. 2012. 

About.com, "Herniated Disc," orthopedics.about.com, accessed on July 2, 2013.

About.com, "Discogenic Back Pain," orthopedics.about.com, accessed on July 2, 2013.
Mayo Clinic, "Spinal Stenosis," www.mayoclinic.com, accessed on July 2, 2013.
Mayo Clinic, "Sciatica," www.mayoclinic.com, accessed on July 2, 2013.
Spine Health, "Lower Back Pain Symptoms and Causes," www.spine-health.com, accessed on July 2, 2013.
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Member Comments

good info. Thanks! Report
Just had back surgery Feb 1, 2013. I had been in chronic pain for years but put surgery on the back burner due to fear and money. I should have had the surgery done years ago!!! To wake up then go to bed with no pain in between is indeed a blessing. DH had his second surgery last May, (he had another 20 years ago)........it is ALL about taking care of what takes care of you!!! Learn to use those legs. If it's too heavy.....LET IT BE!!! Ain't worth it. Men think they are indestructible...
......well ok, some of us women do to. Take care people and don't abuse the body........it can be a fierce pain to be reckoned with. Report
Be careful with the hot showers and baths. If you are experiencing pain because of muscle tension, the heat will help. If you are experiencing back pain due to joint problems, the heat will make it worse - you should use ice packs instead. Report
I have always leaned back at about a 135 degree angle in my chair because it takes the tension off my back and neck. I have some pinched nerves in my spine and leaning back like this really makes a difference. When I am sitting up straight working I find that I am tense and my neck and shoulders really hurt. Report
Thank you for a great article. I can attest to the fact that stress causes any back pain at all to increase in addition to stiffness in your entire back. A friend taught me about EFT, which I won't explain here, and it is helpful for pain reduction as well as stress reduction. And WATER, believe it or not, is the best pain medication on earth. Report
I had back surgery on 2 discs....sitting all day, working thru lunch, and long commutes all contributed to a bad back. It isn't enough to get some exercise before or after work. Sitting all the time is tough on the back. Getting up and taking breaks to stretch and move around is good for your back, your circulation, and your mind. Report
A diastasis can cause lower back pain as well. I'd advise everyone to check themselves for this problem. Diastasis Recti is a separation of the inner most abdominals. The transverse abdominus. This wraps around your whole body to your Spine like a band between your rib cage and hips. If it is separated where it meets the linea alba it gives your organs as well as your back a weak support system. This causes organs to protrude and gives you weaker core and back.. Look into it more on tuplertechnique.c
om for further help. Report
The article mentions women, but I think we have sexual equality here. I used to put my back out every few years, causing severe pain and distorted posture until it healed. It dawned on me that I got sudden severe back pain only if I neglected weight lifting for a year or two. The exercise that keeps my back strong is, believe it or not, straight leg dead lifts. My knees are only slightly bent, and I lift the weight from the floor, not with my legs, but with my back, not too much weight at first, and with no twisting or side bending. I don't spare my back, I strengthen it. Report
Don't let a chiropractor crack or pop your back.. I didn't have back problems tell I let them. After two back surgeries and a possible third. I will not let them touch me. Message is great if you can afford them. But I have found more people that has had back surgery had a chiropractor pop or crack thier back. So let this be a warning. Report
Regarding the comment about large breasts causing back pain. They also cause shoulder pain and because of this I was able to have a breast reduction and my insurance paid everything. Report
The article contains a lot of good and practical information. However, I found it missing what I believe is one important word of advice. The root of most ... not all ... back pain are your feet!

Your feet are like the foundation of a building. If there is a problem at the foundation, the building over time will crumble and fall. If your feet are not supporting your body properly, over time your skeleton will go out of alignment and thus put strain and undue pressures throughout the rest of your body.

To correct my foundation I purchased a pair of "real" orthotics! Not the junk orthotics you can buy over-the-counter but "bio-engineered ergonomic" orthotics made just for me.

Ever since I have been wearing them I have NO lower back pain ... my shoulder blade no longer starts hurting in the middle of the afternoon and I have found I can be on my feet literally all day and go home with plenty of energy to still do the family things.

Even if there are other issues with your back, I would highly suggest talking to your doctor about a pair of "real" custom orthotics. After all, what do you have to lose? They won't hurt you or make your condition any worse. But, they could possibly ease some of ... if not all ... the pain you may be experiencing like mine does for me!
I am surprised they didn't mention weak abdominal and core muscles as a cause of back pain. Report
I have exercised regularly for years. At age 63, after having increasing back pain for a few months, I finally found out I have slight scoliosis and spondylolisthesis
. I was told that there isn't much I can do to make it better but I now work on core muscle strength much more and it has helped with pain management. I don't know how long I've had this, but possibly since birth, and it has just become worse. Careful workouts with a therapist or trainer have been great. Still have some pain but much more manageable. Report
I have had a wonderful experience studying Alexander Technique. I took a full year of bi-weekly classes. At the beginning and into the first 3 months of taking the class, I had intense back pain. The changes I've made have not only reduced my back pain- it's gone! It's really an amazing thing, I think everyone should check it out! Report
One more cause of lower back pain and scatia is tight ham strings. The muscles in the back of your legs to have a connection. I have a genetic predisposition to short ham strings. I have to routinely stretch them or I will have bouts with back pain. My grandfather had this as well. If you have trouble with scatia and back pain (mine is L5) try stretching your ham strings. Report


About The Author

Jen Mueller
Jen Mueller
Jen received her master's degree in health promotion and education from the University of Cincinnati. A mom and avid runner, she is an ACE-certified personal trainer, health coach, medical exercise specialist, behavior change specialist and functional training specialist. She is also a RRCA-certified running coach. See all of Jen's articles.
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