Back Pain

What is back pain?

Back pain is discomfort you feel anywhere along the back of your body, from the base of your neck to the top of your butt. It’s a common symptom of many different underlying injuries and conditions. Back pain is one of the top reasons why people visit healthcare providers.

What does back pain feel like?

Back pain can feel different depending on its cause. You might describe your pain as:

• Burning
• Aching
• Dull
• Sharp
• Shooting
• Stabbing
• Throbbing

You may also experience:

• Muscle tightness or stiffness
• Tingling, numbness or weakness
• Sudden muscle twitches or contractions, which can range from mild to extremely painful (back spasms)

Pain or other sensations may spread (radiate) from your back to other areas, like your butt, hips or legs.

Certain positions (like standing up, bending over or lying down) may worsen or improve your symptoms. Pain may come and go. It may be worse at certain times of the day (like when you first wake up).

What are the types of back pain?

Healthcare providers often describe back pain according to its location. You may have:

• Upper and middle back pain. This is back pain you feel between the base of your neck and the bottom of your rib cage. Your thoracic spine runs through this area.
• Lower back pain. This is back pain you feel below your ribcage. Your lumbar spine runs through this area.

Muscles, tendons, ligaments and nerves surround your spine and help you move. But many different injuries and chronic conditions can affect all these moving parts, leading to back pain.

Lower back pain is more common than upper and middle back pain. This is because your lumbar spine bears most of your body weight and also most of the stress when you lift or carry things. So, this section of your spine and the structures surrounding it are especially vulnerable to painful injuries and wear and tear from overuse.

Acute vs. chronic back pain

Besides its location, healthcare providers also describe back pain according to how long it lasts:

• Acute back pain lasts less than four weeks.
• Subacute back pain can last anywhere from four to 12 weeks.
• Chronic back pain lasts more than 12 weeks.

What are the most common causes of back pain?

Back strains and sprains are the most common causes of back pain. These injuries can occur suddenly (that “ouch” moment) or over time. Strains and sprains affect different parts of your back:

• Strains are injuries to your muscles or tendons. They can occur from a single event (like lifting a heavy object) or from prolonged, repetitive movements (like constantly bending down at work).
• Sprains are injuries to your ligaments. They typically occur after a sudden fall, twist or blunt force injury that stretches a ligament beyond its normal range of motion.

With a strain or sprain, you may notice:

• Muscle spasms
• Pain that gets worse when you move
• Decreased range of motion (it’s hard to walk, bend or stand like you normally would)

For a sudden injury, you might hear a pop or feel a tearing sensation right when it happens.

Other back pain causes

Besides strains and sprains, there are many other possible causes of back pain. These fall into several main groups:

• Mechanical or structural problems in your back
• Conditions that cause referred back pain (pain you feel in your back due to a problem somewhere else in your body)
• Infections
• Tumors

Mechanical or structural problems in your back

These are issues with any of the following:

• The bones that make up your spine (vertebrae)
• The flat, round cushions between your vertebrae (intervertebral disks)
• The soft tissues surrounding your vertebrae and disks, including muscles, tendons and ligaments

Examples of mechanical or structural problems that cause back pain include:

• Arthritis. There are several forms of arthritis that can affect your back, including osteoarthritis and ankylosing spondylitis. You may feel pain and stiffness in your lower back, with additional symptoms depending on the type of arthritis.
• Degenerative disk disease. You may feel pain in your lower back that extends into your arms, legs or butt. The pain may come and go or get worse after certain movements, like bending or twisting.
• Fractured spine. Sudden injuries that cause spinal fractures involve sharp, intense back pain that may get worse as you walk or move.
• Herniated disk. The damaged disk may press on nearby nerves, causing lower back pain and sharp, shooting pain down one side of your butt and leg (sciatica). Herniated disks can lead to cauda equina syndrome, which is a medical emergency.
• Myofascial pain syndrome. You may have aching, throbbing or vicelike pain, trigger points, weak muscles and/or other symptoms.
• Sacroiliitis. Inflammation leads to lower back pain, which may spread into your butt, hips or thighs.
• Scoliosis. This abnormal curvature of your spine can, in severe cases, cause back pain, trouble standing upright, leg pain, numbness or weakness.
• Spinal stenosis. Lumbar (lower back) spinal stenosis and related “pinched nerves” can cause lower back pain, sciatica, a heavy feeling in your legs, and pain that worsens with prolonged standing or walking.
• Spondylolisthesis. You may have lower back pain, muscle spasms in the back of your thigh, pain when bending over, and trouble walking or standing for long periods.
• Spondylosis. The most common symptom is lower back pain, which typically spreads into your thigh and butt. The pain gets worse when you move and eases when you’re less active or resting.

Conditions that cause referred back pain

Certain medical conditions can cause referred pain. This is pain you feel in one part of your body (in this case, your back) due to an issue in another part of your body.

Referred back pain can happen due to a wide range of conditions affecting organs in your abdomen (belly) or pelvis. Specific examples of conditions and how you might experience back pain include:

• Abdominal aortic aneurysm can cause steady, deep pain in your lower back or belly. You may also have pain in your leg, groin or pelvic area and a pulsing sensation in your belly.
• Gallbladder inflammation may make you feel pain in your upper right belly that may spread to your back. The pain may feel sharp, dull or crampy and worsen when you take a deep breath. You may also have nausea, vomiting and a fever.
• Kidney infection might cause pain in your lower back or side, along with fever, chills, pain when peeing, bloody or cloudy pee, and a frequent or urgent need to pee.
• Kidney stones may cause you to feel pain in your lower back, belly or side that may seem like it’s extending from your groin to your side. The pain may be dull or sharp and severe, and it may worsen in waves. You may have other symptoms like nausea and vomiting, blood in your pee, pain when peeing and inability to pee.
• Pancreatitis can result in moderate to severe abdominal pain that spreads to your back. The pain may feel worse when you lie flat, cough, eat a large meal or exercise.
• Urinary tract infection might lead to pain in your lower back, belly, side or pelvic area. You may also have cloudy pee that smells bad, pain when peeing, blood in your pee, and a frequent or urgent need to pee.

In people assigned female at birth (AFAB):

• Endometriosis can cause pain in your lower back, belly and pelvic area. You may also have very painful menstrual cramps, heavy bleeding during periods, spotting between periods and pain during sex.
• Uterine fibroids may make you feel lower back pain, stabbing pain in your belly, pain during sex and heavy bleeding during periods.

Infections

Infections that may cause back pain include:

• Spinal epidural abscess, an infection in the space between your vertebra and the outermost layer of meninges (dura mater). Besides back pain, you may also have other symptoms like a fever, difficulty emptying your bladder or loss of the ability to control peeing and/or pooping.
• Vertebral osteomyelitis, an infection of the bones in your spine. It typically causes lower back pain that persists when you’re resting. The affected bone(s) may also feel tender to the touch, and you may have other symptoms like a fever.

Tumors

Spinal tumors cause deep, aching back pain that starts slowly and gradually increases. The pain may be dull, persistent (even when you’re resting) and worse overnight. You may also have sharp, shooting pain that spreads from your spine to your arms, hips, legs or feet.

Why does my back hurt?

It’s not always easy to tell the specific cause of your back pain on your own. You might be able to pinpoint a moment where an injury happened — for example, when you twisted a certain way or lifted a heavy object. But other times, the pain may start without a clear trigger.

Seeing a healthcare provider is the best way to learn what’s causing your back pain and how to help it feel better.

Diagnosing the cause of back pain

A healthcare provider will do a physical exam and ask you some questions about the pain, including what it feels like and what makes it worse or better. They’ll also review your medical history and talk to you about the types of physical activity you do from day to day.

You may not need any testing, but if you do, your provider will explain which tests are necessary and why. These might include:

• Imaging tests, like X-rays, MRIs (magnetic resonance imaging) or CT scans (computed tomography scans)
• Electromyography (EMG)
• Blood tests

This information helps your provider learn possible causes for your back pain and plan appropriate treatment.

How can I find back pain relief?

Back pain treatment depends on the cause and type (acute or chronic). Your healthcare provider may recommend one or more of the following treatments to address the underlying cause and/or ease your pain.

Therapies

• Physical therapy
• Integrative medicine therapies, like acupuncture, chiropractic adjustment, massage therapy or yoga therapy
• Osteopathic manipulation
• Transcutaneous electrical nerve stimulation (TENS), which is a type of pain relief therapy
• Cognitive behavioral therapy (CBT) to help you cope with severe or chronic pain

Medications

• Medication injections, like an epidural steroid injection (ESI) or a nerve block
• Muscle relaxers, like cyclobenzaprine, metaxalone or methocarbamol (these medications require a prescription and have addiction potential, so closely follow your provider’s guidance on when and how to take them)
• Acetaminophen
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen
• Prescription pain-relieving medications, like duloxetine (because opioids have strong addiction potential, providers typically only prescribe them as a last resort when the benefits outweigh the risks)

Surgery

• Spine surgery (often minimally invasive).
• Surgery to treat an underlying cause of pain.

Keep in mind that a treatment that helped someone you know may not help you. This is because the effectiveness of certain treatments can vary widely according to the underlying cause of your back pain. For example, an ESI injection is more likely to help if you have a condition affecting your nerves (like a herniated disk or degenerative disk disease). But some people experience little or no relief.

If you’re frustrated by treatments that don’t seem to be working, or if your pain gets worse, let your provider know right away. They’re prepared to adjust your treatment plan and find what works best in your unique situation.

How can I relieve back pain fast at home?

We all wish we could get rid of back pain instantly. But most injuries and conditions that cause back pain take some time to heal. There’s no quick and easy fix. Your provider may recommend home remedies to make you more comfortable, including:

• Using a heating pad to ease pain and stiffness
• Using an ice pack to manage pain and swelling
• Doing careful, purposeful movements (exercises and stretches for back pain include some yoga poses combined with deep breathing techniques)

Your intuition might tell you to lie down and rest if your back hurts. But in many cases, gentle movement can help more than bed rest. It depends on the cause of your back pain. Check with your provider about the level of physical activity that’s safe and helpful for you.

When should this symptom be treated by a healthcare provider?

Call a healthcare provider if:

• You have severe back pain
• Your back pain doesn’t improve after one week
• You have back pain along with sudden or severe weight loss
• You notice additional symptoms like cloudy or bloody pee, pain when you pee or groin pain
• You have chest and back pain when coughing (this can be a sign of an infection like pneumonia or bronchitis)

When to go to the emergency room

Call 911 or your local emergency services number if you have back pain or spasms along with any of the following:

• Fever, nausea and/or vomiting
• Severe abdominal pain
• Numbness, tingling or weakness in your arm(s) or leg(s)
• Severe pain, muscle spasms or muscle weakness
• Loss of the ability to control peeing and/or pooping (urinary and/or fecal incontinence)
• Problems fully emptying your bladder (urinary retention)
• Problems with walking, balance or coordination

These are potential signs of serious issues that need quick treatment.

Can pregnancy cause back pain?

Yes, it’s common to experience back pain during pregnancy. This can range from mild to severe. You should tell your provider if you’re experiencing any pregnancy aches and pains so they can help you find ways to feel better.