Back Pain

The spine and back are made to provide a lot of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for freedom in all directions. But, many distinct parts of the spine can cause back pain, such as irritation to the large nerve roots that run down the arms and legs, irritation to little nerves within the spine, strains to the large back muscles, as well as any injury to the disk, bones, joints or ligaments in the spine.

Acute back pain comes on suddenly and usually lasts from a few days to a couple of weeks. Chronic back pain is described as continuing over three months.

It can take on a wide variety of characteristics:

  • The pain may be constant, intermittent, or occur in certain positions or actions
  • The pain may stay in one place or radiate to other areas
  • It may be a dull ache, or a sharp or piercing or burning sensation
  • The issue might be in the neck or low back but may radiate into the foot or leg (sciatica), hand or arm.

Fortunately, most types get better on their own: roughly 50% of individuals may experience relief within two weeks and 90% within three months.

If the pain lasts for a few days, gets worse, does not react to remedies such as rest, using heat or ice, exercises, and over-the-counter pain relievers, then it is usually a good idea to see a back doctor. There are two cases in which emergency medical care is of utmost importance:

  • Bowel and/or bladder dysfunction

Fortunately, these conditions are rare.


Diagnostic tests may indicate if a patient’s back pain is a result of an anatomic cause. However, because diagnostic evaluations in and of themselves aren’t a diagnosis, arriving at an accurate clinical diagnosis requires an assessment to be correlated with the patient’s back pain symptoms and physical exam.

  • X-ray. This test offers information about the bones in the spine. An x-ray is frequently used to assess spinal instability (such as spondylolisthesis), tumors, and fractures.
  • CT scan. This test is a very detailed x-ray that includes cross-section images. CT scans provide specific details regarding the bones in the spine. They may also be used to test for particular conditions, such as a herniated disc or spinal stenosis. However, CT scans tend to be less accurate for spinal disorders than MRI scans.
  • MRI scan is beneficial to evaluate specific conditions by providing detail of the intervertebral disk and nerve roots (which may be irritated or pinched). In addition, MRI scans are used to rule out spinal infections or tumors.

Injections may also be used to help diagnose specific types of pain. For example, if a dose of a pain-relieving medication is injected into a particular area in the backbone that supplies back pain relief, it affirms the area causing pain.


By far, the most frequent cause of lower back pain is muscle strain or other soft tissue damage. Although this condition is not severe, it may be severely painful. Typically, lower back pain from a muscle strain will probably get better over a few weeks.

Treatment generally involves a short period of rest, activity restriction, hot packs or cold packs, and pain medications. Over-the-counter pain drugs used to treat muscle strain may include acetaminophen (e.g., Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g., Aleve). There could also be recommended prescription pain medications for severe back pain.

Typically, younger people (30 to 60-year-olds) are more likely to experience back pain from the disc space itself (e.g., lumbar disc herniation or degenerative disk disease). Conversely, older adults (e.g., over 60) are more likely to suffer from pain linked to joint degeneration (e.g., osteoarthritis, spinal stenosis).

Sometimes, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower spine, including:

  • Lumbar Herniated Disc: The interior core of the disc may lead out and irritate a nearby nerve root, causing sciatica (leg pain).
  • Lumbar spinal stenosis. The spinal canal narrows because of degeneration, which may pressure the nerve root and lead to sciatica.
  • Degenerative disk disease. As the disc degenerates, it can allow small amounts of motion in that segment of the spine and irritate a nerve root and lead to sciatica.
  • Isthmic spondylolisthesis. A small stress fracture allows one vertebra to slip forward on another, usually at the base of the spine, which can pinch the nerve, causing lower back pain and leg pain.
  • Osteoarthritis. Degeneration of the small facet joints at the back of the spine can lead to back pain and decreased flexibility. It may also result in spinal stenosis and nerve pinching.

It’s important to know the underlying condition that is the reason for the back pain, as remedies will often differ depending upon the causes of back pain.

Risk Factors

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, smoking, and pregnancy. However, with that said, back pain is so widespread that it can strike even if you don’t have any risk factors at all.

Patients with one or more of these factors might be at risk for back pain:

  • Aging. Over the years, wear and tear on the spine might come in conditions (e.g., disk degeneration, spinal stenosis) that produce back and neck pain. Individuals age 30 to 60 are more likely to have disc-related ailments, while individuals over age 60 are more likely to have pain associated with osteoarthritis.
  • Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For instance, degenerative disc disease seems to have an inherited element.
  • Occupational hazards. Any job requiring repetitive bending and lifting has a higher incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing with no break (e.g., barber) or sitting in a seat (e.g., software programmer) that does not support the spine well put the person at higher risk.
  • Sedentary lifestyle. Lack of regular exercise increases risks for incidence of lower back pain also increases the severity of the illness.
  • Weight. Being overweight increases strain on the lower back and other joints (e.g., knees) and is a risk factor for certain symptoms.
  • Bad posture. Any poor position prolonged over time increases the risk. Examples include slouching over a computer keyboard, driving hunched over a steering wheel, and lifting improperly.
  • Pregnancy. Pregnant women are more likely to develop back pain due to carrying excess body weight in the front and the loosening of ligaments in the pelvic area as the body prepares for delivery.
  • Smoking

When To Contact A Doctor

Generally, when the pain has any of the following characteristics, It’s a good idea to visit a doctor for an evaluation:

  • Back pain that follows an accident, such as a car accident or falling from a ladder
  • The pain is ongoing and is becoming worse.
  • The pain continues for more than four to six weeks
  • The pain is severe and does not improve after a few days of typical remedies, such as rest, ice, and pain relievers (such as Ibuprofen or Tylenol)
  • Severe pain during the night that wakes you up, even from a deep sleep
  • There’s back and abdominal pain
  • Numbness or altered feelings in the upper inner thighs, buttock, or groin area
  • Neurological symptoms, like weakness, numbness, or tingling in the extremities — the leg, foot, arm, or hand
  • Unexplained fever with increasing pain
  • Sudden upper back pain, mainly if you are at risk for osteoporosis.

The bottom line that everyone should remember is that if a person is in doubt, consult a physician. If pain worsens over time, doesn’t get better with rest and over-the-counter pain remedies, or entails neurological symptoms, then it’s a good idea to see a spine specialist.

Upper/Middle Back

Pain in the upper and mid-back is not as common as lower back or neck pain. This is because the upper part of the spine is called the thoracic spinal column, and it is the most secure part of the spine. In addition, the movement’s reach in the upper back becomes limited because of the backbone’s attachments to the ribs (rib cage).

Upper back pain is generally caused by soft tissue injuries, like sprains or strains, muscle tension caused by bad posture, or looking downward for long time spans (e.g., texting, mobile phone use).

  • Pain
  • Tightness
  • Stiffness
  • Muscle spasm
  • Tenderness to touch
  • A headache

Causes Mid/Upper

An episode can activate by distinct moves and actions, including:

  • Being overweight
  • Contact sports
  • Carrying a heavy load
  • Excessive bending
  • Lifting improperly
  • Poor muscle tone
  • Repetitive movements, overuse
  • Smoking
  • Twisting
  • Whiplash or alternative neck injury

Poor posture working at the computer for a long time without taking a break to walk around and extend, or in general, can promote upper back pain. In addition, both muscle fatigue and muscle pull, which often result from poor posture, can trigger discomfort.

What To Do About It?

Usually, upper back pain is not a cause for worry; however, it can be uncomfortable, painful, and inconvenient also, if pain develops suddenly and is serious—such as from an injury (e.g., fall)—and, indeed, if pain and symptoms (e.g., weakness) progressively worsen, you should seek medical attention.

Generally, the next home treatments can help relieve upper back pain.

  • Short-term rest
  • Mild Stretches
  • Over-the-counter medicine, for example, ibuprofen (Motrin®), naproxen sodium (Aleve®), or acetaminophen (Tylenol®). Take with food, and don’t take more than the recommended dose.
  • Use a cold pack that is commercially available, or fill a plastic bag with ice and seals it wrap it. Apply to the painful area for 20 minutes every 2-3 hours for the first 2 to 3 days.
  • Heat (after the very first 72 hours). After using moist heat, gently stretch the muscles to enhance mobility and alleviate stiffness.

Your physician may prescribe drugs, like a muscle relaxant or perform trigger point injections to help break up muscle spasms. They may also recommend physical therapy to increase flexibility, mobility and alleviate pain. Other treatments your doctor may suggest include acupuncture and chiropractic care.

Most cases of upper back pain resolve in 1 to 2 weeks without additional treatment. Once you’re able to perform them without pain, then restart your regular activities slowly. Don’t rush matters, however: you could interfere with your healing and risk re-injury.

Low Back

Low and lower back pain can differ from dull pain, which develops gradually to a sudden, sharp, or persistent pain felt under the waist. Regrettably, almost everyone, at some point during life, may experience pain that may travel downward into the buttocks and sometimes into one or both lower extremities. The most common cause is muscle strain, often linked to heavy physical labor, lifting or powerful movement, bending or twisting to awkward positions, or standing too long.


Several different conditions cause or lead to pain. Many involve nerve compression (e.g., pinched nerve) that can cause pain and other ailments. Kinds of spinal disorders include trauma-related and degenerative diseases, meaning age-related. A few of these spinal problems are below.

  • Bulging or herniated disc. A disk may protrude outward. A herniated disc occurs when the soft inside matter escapes through a crack or ruptures through the disk’s protective outer layer. Both disc problems can lead to nerve compression, inflammation, and pain.
  • Spinal stenosis develops when the spinal canal or a nerve passageway abnormally narrows.
  • Spinal arthritis, also called spinal osteoarthritis or spondylosis, is a common degenerative spine problem. It affects the spine’s facet joints and may contribute to the development of bone spurs.
  • Spondylolisthesis occurs when a lumbar (low back) vertebral body slips forward over the vertebra below it.
  • Some injury causes vertebral fractures (burst or compression types) (e.g., fall).
  • Osteomyelitis is a bacterial infection that may develop in one of the spine’s bones.
  • Spinal tumors are an abnormal growth of cells ( a mass) and are recognized as benign (non-cancerous) or malignant (cancer).

Easing Pain At Home

If you have recently injured your low or lower back, here are some things you can do.

  • Ice then heat
    During the first 24 to 48 hours, use ice wrapped in a towel or cloth. Ice will help to reduce swelling, muscle spasms, and pain. After that, switch to heat. The heat helps warm and relaxes inflamed tissues.

Caution: Never use a cold or heat source directly on the skin; always wrap it into something.

  • Over the counter medications
    Tylenol or Advil, taken according to package instructions, may help reduce inflammation and pain.
  • Take it easy
    Days of bed rest are no longer recommended; you might have to modify your everyday routine to allow your lower back to recuperate.

When To Seek Medical Attention

When the pain becomes severe and persistent

  • Low back pain is or becomes severe and persistent
  • Doesn’t subside after a few days
  • Interferes with sleep and daily tasks

The symptoms listed below always require immediate medical attention:

  • Groin, leg weakness, and/or numbness


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The information herein on "Back Pain" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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