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

"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.