Question

Back Pain

What causes low back pain?

A Answers (17)

  • ARonald Tolchin, DO, Physical Medicine/rehabilitation, answered on behalf of Baptist Health South Florida
    Low back pain to some degree is quite common, while its causes can range from mild strain to more serious lumbar spine issues.

    Pain in the low back can be linked to the discs between the vertebrae, ligaments, spinal cord and nerves, muscles of the low back and internal organs of the pelvis and abdomen.

    Treatment of low back pain depends on a doctor's diagnosis after determining a cause.

    Chronic low back pain is often attributed to discs, the spongy piece of cartilage that sits between the vertebrae. They prevent the vertebrae from scraping each other. As you get older, these discs can slowly wear out and shrink, a condition known as degenerative disc disease. Discs can also sustain damage from injury.

    A herniated disk can occur when all or part of its center pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the spinal nerves.
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  • ASamuel K. Cho, MD, Orthopedic Surgery, answered on behalf of The Mount Sinai Health System
    Back pain usually does not require immediate medical intervention, as the vast majority of back pain is self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase.

    One potential source of pain is the back muscles when they are strained (pulled), are in spasm, or are in imbalance. Another potential source of low back pain is the facet joints of the spine. Other common causes of back pain include disc herniation, degenerative disc disease, spondylosis (arthritis of the spine), spondylolisthesis, spinal stenosis, and fractures.
  • ALarry Husted , NASM Elite Trainer, Sports Medicine, answered

    Answering as a personal trainer, the back pain I hear about from clients comes from a variety of circumstances:

    • Muscle imbalances (too much tightness or lack of activity)
    • Poor posture
    • Prior injury
    • Repetitive overload (Doing some type of action poorly and often)
    • Poor exercise technique
    In most cases, back pain resulting from this list of causes is extremely treatable.  However, back pain can be more complicated, often needing a variety of interventions to get maximum relief.
  • Sometimes it can be from muscle imbalances, commonly seen in the following muscles.

    Short/Tight Muscles

    • Rectus femoris
    • Psoas Major
    • Adductor complex ( brevis ,  longus ,  magnus )
    • Bicep Femoris   
    • Piriformis
    • Tensor fascia latae  (TFL)
    • Quadratus lumborum
    • Erector spinae muscles
    • Latissimus dorsi
    • Soleus

    Long/Weak Muscles

    • Gluteus maximus
    • Gluteus medius
    • Inner unit musculature*
    • Posterior tibialis

    Here are steps to improve your low back pain.

    1. Have an assessment done by a Fitness Professional
    2. Integrated Warm-up:
    • Self-myofascial release (SMR)
    • Static stretching
    • Neuromuscular stretching
    • Active isolated stretching
    • Dynamic stretching
    • Treadmill warm-up
    • Elliptical warm-up
    • Cycling warm-up
    • Versa climber warm-up

    3. Improve Core Control

    4. Train to Improve Balance

    5. Train to Enhance Muscle Reaction Times

    6. Improve Integrated Strength

    7. Remember to do cool down exercises at the end of your workout

    •  Static stretching
    • Neuromuscular stretching
  • ABill Salt, MD, Gastroenterology, answered

    When pain is chronic, tests usually do not identify the cause.

    There are many potential causes, but usually a specific disease or abnormality in the spine causing the pain is not found with testing, and the back pain is a medically unexplained symptom.

    Chronic low back pain syndrome can be one of many interrelated functional symptom syndromes composed of medically unexplained symptoms, which are “caused” by dysfunction involving the mind/brain—body connection.

    To explain the unexplainable and cause, look at the terms used here and then “see the big picture.”

    LOOK AT TERMS

    Functional refers to how the body works.

    Symptom Syndromes are collections of medically unexplained symptoms. They are also known as functional somatic syndromes and chronic multisymptom illnesses. Nearly every specialty defines at least one syndrome. Examples include RHEUMATOLOGY (fibromyalgia) and GASTROENTEROLOGY (irritable bowel syndrome).

    Medically Unexplained Symptoms (MUS) cannot be explained by medical tests, because they are caused by dysfunction.

    Dysfunction is disturbance or “malfunction” of how the body works.

    Mind/Brain-Body Connection refers to how the mind/brain and body communicate and talk with one another.

    SEE THE BIG PICTURE
    MUS and symptom syndromes frequently overlap with one another and are commonly associated with and often attributed to stress, depression, anxiety, and/or panic. Medical and scientific research is showing how the mind/brain and body communicate and both how and why symptoms are generated. One of the most important discoveries is that the "central" mind/brain can become "sensitized" to "peripheral" body feelings, such as pain originating in the low back. So these symptom syndromes are now being called, central sensitivity syndromes

    This author and Thomas L Hudson, MDiv JD (StillHurtingFINDHEALTH.com), propose a new unifying and holistic medical model of medically unexplained symptoms and their related symptom syndromes as chronic disease, explain both how and why they occur, and show what people can do to help themselves and work effectively with their caregivers.

    DISEASE IS DYSFUNCTION, AND SYMPTOMS ARE THE EXPRESSION. The cause of medically unexplained symptoms and pain can be understood as disease/dysfunction, regardless of whether the symptoms are widespread (e.g., the fatigue of chronic fatigue or the pain and fatigue of fibromyalgia) or localized to a specific area of the body (e.g., the pain of chronic low back pain syndrome).

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  • Yes, barre3 exercises can be performed by both men and women. Most exercises can be modified to help accommodate flexibility concerns that men may have.

  • As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae and causes back pain.
    Pain can occur when, for example, one lifts something too heavy or overstretches, causing a sprain, strain, or spasm in a muscle or ligament in the back. If the spine is overstrained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots are compressed or irritated, back pain results.
    Low back pain may reflect nerve or muscle irritation or a bone lesion. Most low back pain results from an injury or trauma to the back; but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, and congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also contribute to low back pain. Additionally, the scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. The buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.
    Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with such symptoms should contact a doctor immediately to prevent permanent damage.
    This answer is based on source information from The National Institute of Neurological Disorders and Strokes.
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  • ARealAge answered

    Low back pain is generally blamed on poor back-muscle tone, muscle tension or spasms, back sprains, tears in ligaments or muscles and joint problems. Sometimes nerves, as they leave the spinal cord, can be irritated by slipped disks. Such irritation can cause pain in the buttocks or legs and numbness, tingling or weakness in the legs.

    The causes of low back pain are not clear, but recent research has provided some valuable insights. Autopsy studies have shown that people who had back pain also had characteristic soft tissue injuries. In particular, small tears of the connective tissue membranes that link the outer shell of the disk to the vertebrae appeared to be responsible for the pain experienced. When these membranes tear, bleeding, inflammation and swelling occur. The chemical by-products of this tissue damage make the normally alkaline disk acidic. The acidity then irritates neighboring nerves and causes the pain.

    Because the disks do not have a blood supply of their own, enhanced fluid exchange is the only mechanism for improving cell nutrition and for removing offending chemical agents and excess acidity. Fluid exchange can be accomplished by physically moving extracellular fluid into and out of the disks by moving the spine. If time passes without adequate mobilization, the biochemical and mechanical changes caused by the soft tissue injury become less reversible, and the chances increase that the back pain will become chronic.

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  • AChristian Whitney, DO, Pain Medicine, answered

    Low back pain is one of the most common reasons why people seek medical care. It is estimated that 80% of the population will experience low back pain at some point in their life. Fortunately, most cases will resolve with conservative treatment within 6-8 weeks.

    The cause of low back pain is multi-factorial. Many conditions can cause low back pain. One of the most common reasons is muscle strain which is treated with NSAIDs, muscle relaxants, and physical therapy. Other causes, to name a few, include osteoarthritis, rheumatoid arthritis, degenerative disc disease, fractures, and spinal stenosis. An often overlooked cause of low back pain is Sacro-Iliac Joint dysfunction and inflammation. Low back pain can also be caused by tight hamstrings. More alarming causes include tumor, metastasis, bleeding and infection.

    If the low back pain persists for more than 4 weeks, it is important to see your doctor who can perform a physical exam and order necessary tests which may include blood work, an x-ray, CT scan, or MRI. "Red Flags" or alarming symptoms that accompany low back pain include night sweats, weight loss, fever/chills, loss of bowel or bladder control, weakness, foot drop, and pain that awakens you. If these symptoms accompany the low back pain, seek medical attention immediately. 

    The treatment is based upon the cause. When considering treatment, more conservative measures are tried first such as medication and physical therapy. Many patients find alternative treatments helpful such as acupuncture, spinal manipulation, and massage therapy. If that fails, then injections can be tried. As a rule of thumb, surgery is a last resort. In the more difficult cases, consultation with a pain management physician can help diagnose and properly manage the pain. 

  • AAkash Bajaj, MD, Pain Medicine, answered

    Back Pain is incredibly common and more often than not, not a medical urgency/emergency. Anatomically, there are many structures that can contribute to low back pain.

    Most commonly, the pain may be secondary to acute spasm or spasticity of the muscles of the back. If this is the case, the pain tends to come on suddenly, and there may be an inciting incident (i.e. sports injury, slept funny, etc.).

    Degeneration of both the intervertebral discs and/or the joints in the back and/or the vertebral bodies themselves may also contribute to pain. This can result in both a sharp and a dull aching consistently present pain.

    If the above-mentioned degeneration is affecting the nearby nerve roots, then the nerves themselves can become part of the problem. Nerve pain tends to be more sharp and electrical in nature. In this case, this may or may not involve the lower extremities as well.

    Of course a combination of the discussed elements can also manifest. If back pain does not self-resolve in 2-3 weeks, it may be a good idea to consider visiting with a healthcare professional.

  • ASpencer E. Richards, MD, Sports Medicine, answered on behalf of Intermountain Healthcare

    There are many causes of low back pain, including muscle pains, injured discs, bone problems like arthritis, pinched nerves, and even pain being referred from the belly. As doctors we try to figure out the cause by looking for patterns: age and activity play a big role. For instance, teenage athletes who get back pain may be developing a stress fracture (called spondylolysis); a 30-40 year old laborer may be developing disc herniations or bulges; a 60-70 year old may have spine arthritis than pinches around the nerves (spinal stenosis). Other clues come from where the pain is located, if it travels or radiates, how long it's been there, etc. We will use physical exam and in some cases X-rays, MRI's or trials of treatment to help find the cause so it can be treated correctly.

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  • ADavid W. Brinton, MD, Sports Medicine, answered on behalf of Intermountain Healthcare
    The exact cause of low back pain is often hard to pinpoint. Most acute low back pain is probably caused by muscle strain -- usually from doing an activity you’re not used to (such as yard work, moving furniture, or heavy lifting). Or you may have sprained the ligaments between your vertebrae
    (the bones in your back) or in the sacroiliac (SI) joint in the lower back.

    Less often, one of the discs -- that normally act as cushions between your vertebrae -- can push out and press on a nerve.

    The good news is that acute back pain is rarely caused by damage to your spine, or by any other serious medical condition. In fact, in most cases
    you can recover quickly on your own -- at least to the point where you can do normal daily activities.
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  • AMatthew F. McCarty, MD, Anesthesiology, answered

    Back pain is very common and often goes away within days to a week. Back pain which lingers can have  deeper causes such as dried out bulging or painful discs. These same discs when bulging can irritate nerve roots leading to inflammation of the nerve root which can give aching pain down an arm or a leg. Arthritis of the small joints of the spine and of the sacroiliac joint itself can cause back pain. Cancer or fractures of the spine are less common causes.

    Obesity and generally being out of shape can allow for more stress on the spine and this is leading to a higher frequency of back pain complaints in  this country.

    It is the job of an interventional pain physician based on history and physical to uncover these likely sources of pain and then intervene.

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  • ALangston Holly, MD, Neurosurgery, answered on behalf of UCLA Health

    Low back pain can result from many causes. One of the most common is a strained muscle from lifting or overdoing it with too much physical activity. It is also common to get some arthritis with age and certainly this can flare up and lead to occasional pain and discomfort. There are many other structures in the spine, the disc, the facet joints, the ligament, etc., all of which can lead to some low back pain. There are also other medical problems such as systemic arthritis or inflammatory diseases that affect the spine and can lead to low back pain.

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  • ABrian Yee, Physical Medicine/rehabilitation, answered

    Many patients assume their low back pain is from a structural problem in their spine such as a herniated disc, degeneration, or stenosis. Although these diagnoses can be the cause, you should also consider other sources.

    Poor muscle stability of the smaller muscles of your trunk, such as the transversus abdominis, can lead to excessive forces on your spine. Post-partum women and chronic back pain patients usually have problems controlling these muscles. Trigger points in muscles such as the multifidus and quadratus lumborum commonly refer pain to the back. Sciatic nerve irritation is frequently associated with back pain as the nerve originates from the lower back and can also cause symptoms in the legs. If everything else has been ruled out, consider referred pain from your internal organs. For example, kidney dysfunction can present itself as back pain. There may also be an association of food allergies and vitamin deficiencies causing back pain. Lastly, serious medical pathologies as spinal based cancers should be considered.

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  • ACameron G. Peterson, MD, Physical Medicine/rehabilitation, answered on behalf of Intermountain Healthcare

    Low back pain can have many causes, and there are many structures in the low back that, when inflamed or injured, can cause pain. The most common cause of low back pain is due to muscle strain. However, other structures within the low back can also cause pain. This includes discs, ligaments, nerves, and joints.

    A herniated, bulging, or worn out disc can result in pressure on an exiting nerve resulting in inflammation and pain radiating into the legs. This is commonly called "sciatica". Many cases of low back pain due to herniated discs and pinched nerves resolve with time, anti-inflammatories, and possibly physical therapy, which can help, improve posture, core strength as well as improve how your spine moves.

    Typically, bed rest does not improve low back pain and remaining as active as able is beneficial in preventing further weakness and tightness of the low back.

    If your back pain persists despite the usual measures of giving it some time, anti-inflammatories and physical therapy, a follow-up visit with your physician and possibly imaging may be helpful to determine the cause of your low back pain. It is important to determine exactly which anatomic structure is causing your low back pain so that your treatments and rehabilitation regimen can target and correct the underlying cause of pain.

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  • AAngela Mark, MD, Neurology, answered on behalf of NorthShore University HealthSystem
    The most common causes of low back pain are muscle spasm or strain and arthritis of the back also known as degenerative disc disease or lumbar spondylosis. One common acute cause of low back pain is a herniated disc. Other conditions such as rheumatoid arthritis, Sjogren's syndrome, or other rheumatologic conditions may be less common causes of chronic low back pain.
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