Back Pain: Symptoms, Causes, Diagnosis, Treatment

Medically Reviewed by Dr. K on 13 April 2021

Table of Contents :

  1. Back Pain
  2. Causes
  3. Symptoms
  4. Diagnosis 
  5. Treatment
  6. Prevention


Back Pain


Your spinal column has a lot of pressure placed on it. It is the primary structural strength of the body. It must hold you safe enough to stay upright while still allowing you to walk about. As a result, it's no wonder that many people experience back pain from time to time.


Sore muscles, ligaments, and tendons, as well as herniated disks, fractures, and other complications in your upper, middle, and lower back, may cause pain. The consequences may also be felt straight away. Back injuries, on the other hand, often worsen with time.




Back injuries are often caused by poor habits, such as:


  • Poor posture, such as sitting improperly at a desk or behind the wheel, is harmful to your health.
  • Overdoing it or repeating the same motion
  • Pushing, pulling, and lifting things carelessly


The spine is made up of 24 bones known as vertebrae. As seen from the side, a stable spine is S-shaped. It bends upwards at the elbows and inwards at the neck and lower back. It covers and houses the spinal cord, which is a network of nerves that transmits sensation and controls movement in your body.


Straining the bands of muscles that form the spine is one of the most frequent causes of back pain. The curve of the low back and the base of the neck are the most often affected areas. These parts bear more weight than the upper and middle back, which are less susceptible to injury.

Spine-Related Problems


Back pain is mostly caused by a problem with the way your spinal joints, muscles, discs, and nerves connect and pass. Your doctor will verify to see whether you have either of the following:


Herniated or slipped discs: If the doctor reports herniated or slipped disks, the sensitive tissue in the discs in the joints has protruded. Wear and tear are the most common causes. Since the nerves in your lower back and hip are squeezed, herniated discs may trigger pain and discomfort.


Bulging discs: Bulging disks protrude, or “bulge," though not quite as much as a herniated disk. Typically, there aren't any signs associated with this. If it presses into a nerve center, though, you'll notice it.


Degenerative disc disease: Degenerative disc disorder occurs as the disks between the vertebrae, also known as “shock absorbers," shrink or break. The bones begin to rub together as a result of this. This is something that will develop when you grow older.


Inflammation and wear of the sacroiliac joint: The sacroiliac joint, which connects your spine and pelvis, is prone to inflammation and wear. It doesn't move far, but it's crucial because it transfers the upper body's weight to the lower body. Swelling and deterioration of joint cartilage may occur as a result of an accident, inflammation, infection, or even pregnancy.


Spinal stenosis : If you have spinal stenosis, the spinal canal has shrunk. This puts more strain on the back and nerves. Your legs and shoulders are more likely numb as a result. Most individuals above the age of 60 experience this.


Cervical radiculopathy : Cervical radiculopathy is a pinched nerve in the neck. A bone spur or a herniated disk are the most common causes.


Spondylolisthesis: Spondylolisthesis is a condition in which a bone in the spine, usually in the lower back, slides forward and out of alignment. Arthritis is a degenerative form of this disease that weakens the joints and ligaments that hold the spine aligned. A disk may travel forward over a vertebra as a result of this.


Accidents and Injuries


Back pain may also be caused by car crashes, slips, muscle sprains, strains, and fractures. Any health symptoms may be caused by injuries, while others may induce discomfort of their own.


Spine or vertebral fractures: A back injury, a slip, or osteoporosis, a bone-weakening disease, may all result in a crack in the spine.


Sprains and strains: Back pain may be caused by injuries to the ligaments, tissues, and tendons that protect the spine and its joints. If you raise something and twist at the same moment, this is a common occurrence. It can also occur as a result of car accidents or sporting incidents.


Spasms: They occur as muscles and tendons in your lower back are broken. They normally happen while you're lifting weights or participating in sports.


Lifestyle Triggers


Back pain can be caused by activities you do, or don't do, on a daily basis, such as:


  • Slouching at your desk
  • Poor posture
  • Lifting heavy objects
  • Being overweight
  • Not exercising
  • Smoking
  • Wearing high heels


Emotions in Play


Don't underestimate the ability of emotions to cause pain. Back muscle strain may be caused and worsened by stress, and depression and anxiety can exacerbate the discomfort.


Other Causes


Back pain may be exacerbated by a variety of medical problems, including:


Arthritis: This induces stiffness, swelling, and inflammation in the joints.


Osteoarthritis: A form of arthritis that occurs when the cartilage and bones in your joints wear and tear. This is more common among people in their forties and fifties.


Ankylosing spondylitis: A form of arthritis that affects the spine's joints and ligaments.


Scoliosis, or curvature of the spine: A condition in which the spine curves inward. This is something that most people are born with. If there is discomfort, it usually begins in middle age.


Pregnancy: Gaining weight when pregnant will put pressure on your back.


Tumors: Tumors may occur in the back in unusual instances. A cancer that originated elsewhere in the body typically spreads them.


Less-common causes of back pain are:


  • Kidney stones and infections
  • Endometriosis, a buildup of uterine tissue outside the uterus
  • Osteomyelitis or discitis, infections in the bones and discs of the spine
  • Fibromyalgia, a condition that causes widespread muscle pain


Treatment can involve dietary modifications, drugs, or surgery, depending on the source of the pain. If your back is bothering you, see your doctor. They will assist you in determining the source of your discomfort and in making you feel comfortable.




Back pain, whether it's a constant ache or a shooting pain, is only one symptom of a problem with the back. You may even experience sensations in your legs or arms:


  • Radiating pain
  • Numbness
  • Tingling
  • Weakness

Uncontrolled urinating or defecating could mean a serious life-threatening medical emergency called spinal cord compression. Seek immediate help at the nearest hospital.




When to see a doctor:


  • After you get hurt, like in a fall or accident
  • When the pain gets in the way of your daily activities
  • If it lasts longer than 6 weeks, or spreads


If you are unable to move, the specialist can monitor your range of motion to assess the health of your nerves through the examination. That could be sufficient information to determine what to do next.


Imaging studies, such as X-rays, an MRI, or a CT scan, may be needed. However, these aren't necessarily helpful, because there isn't always a clear correlation between the outcome of these assessments and the severity of the pain.


Medical history


Since back pain may be caused by a variety of causes, the specialist can conduct a detailed medical history as part of the test. You may not think any of the questions are important to you. However, your doctor may need to know the answers to these concerns in order to figure out what's causing the discomfort.


Your doctor will begin by inquiring about the onset of your pain. (Did you experience immediate discomfort after removing a large object? Was it a slow onset of pain?) They'll like to see what causes the suffering to worsen or improve. They'll inquire whether you've ever experienced the discomfort before.


The doctor will often inquire about any new ailments and their effects, such as coughs, fevers, bladder problems, or stomach problems. If you're female, tell your doctor if you're experiencing any vaginal bleeding, cramping, or discharge. Back pain is frequently caused by pelvic pain.


Physical examination


Your doctor will then do a rigorous medical examination on you. While you step on your heels, toes, and soles of your foot, they will look for symptoms of nerve damage. A reflex hammer can be used by the doctor to assess the reflexes. This is generally performed behind the hip and at the knee. You'll be required to elevate one leg at a time whilst lying flat on your stomach, both with and without the help of the doctor. This is performed to measure the presence of pain on the sciatic nerve and to monitor nerve and muscle power. To measure the lack of feeling in the legs, the doctor can use a pencil, paper clip, broken tongue depressor, or other sharp object.


An abdominal inspection, a pelvic examination, or a rectal examination can be performed depending on what the doctor thinks is suspicious. These examinations scan for conditions that may induce back pain. The sensory field and muscles of the rectum are served by the lowest nerves in your spinal cord, and injury to these nerves may result in failure to regulate urination and bowel movement. As a result, a rectal test could be needed to rule out serious nerve injury.




Several examinations will be used by doctors to determine what is triggering the discomfort. There is no standard procedure that will accurately detect the absence or involvement of illness 100% of the time.


There is no need for imaging within the first 4 to 6 weeks of intense back pain since there are no “warning flags." Many physicians would not prescribe scans in the initial diagnosis of acute, uncomplicated back pain and 90% of patients recover within 30 days of the onset of the pain.


Plain X-rays aren't really helpful in determining the cause of back pain, particularly in the first 30 days. In the absence of red flags, they should not be conducted. If there has been severe trauma, minor trauma in those over 50, osteoporosis, or chronic steroid usage, they could be required.


A myelogram is an x-ray procedure that involves injecting a radio-opaque dye directly into the spinal canal. With the introduction of MRI scanning, its use has diminished significantly, and the procedure is now normally performed in conjunction with a CT scan. And so, it's rarely seen under exceptional circumstances, such as while surgery is being prepared.


A magnetic resonance imaging (MRI) is a technically complex and costly procedure. The test would not use x-rays to generate pictures, instead relying on extremely powerful magnets. Their normal usage is avoided in severe back pain unless a diagnosis exists that could necessitate emergency surgery, such as cauda equina syndrome or when red flags exist that indicate inflammation of the spinal canal, bone infection, tumor, or fracture, as in cauda equina syndrome or when red flags exist that suggest infection of the spinal canal, bone infection, tumor, or fracture. After 12 weeks of symptoms, an MRI can be considered to rule out more severe underlying issues.


MRIs aren't without flaws. Many MRIs of people who don't have back pain show bulging of the disks. These incidental findings may lead to treatment that is not vital and unnecessary.


Nerve tests


Electromyogram, or EMG, is a procedure in which very tiny needles are inserted into the muscles. After that, the electrical behavior is tracked. It's typically used to treat severe pain and predict the severity of nerve root injury. The exam will also assist a specialist in distinguishing between nerve root and muscle disorder.




Your treatment would be determined by the source of the discomfort and where it is located in your back.


Staying in bed isn't always the solution, despite what you might believe or have been told in the past; gentle exercise is. It will help you get rid of spasms, strengthen your back, and increase your endurance. A physical therapist will collaborate with you to create a series of movements that can relieve the discomfort and help you back on your feet.


Much back pain may be relieved with over-the-counter pain relievers, ice, and heat. Stronger drugs can be prescribed by the doctor, but if you're not aware, some of them can leave you drowsy or addicted to them.


Chiropractic spinal therapy, acupuncture, and massage are examples of complementary treatments that may help relieve discomfort.


You may need surgery if you have a broken bone, a herniated disk, or a pinched nerve. Doctors, on the other hand, can try other therapies first if you have persistent back pain.


Counseling will be able to assist you with learning to cope properly with persistent pain and the effects of stress that may arise as a result of it.




Back pain management is a contentious topic in and of itself. Exercise and a safe diet have long been believed to be effective in preventing back pain. This isn't always the case. Several experiments also discovered that the wrong kind of activity, such as high-impact exercises, may raise the risk of back pain. Exercise, on the other hand, is important for good wellbeing and can not be ignored. Swimming, surfing, and bicycling are low-impact sports that will improve physical health without putting a burden on the low back.


  • Specific exercises: Talk to your doctor about how to perform these exercises.

    • Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease tendency to suffer back pain.
    • Stretching exercises can help relieve tense back muscles, but they aren't effective for treating back pain.
    • The pelvic tilt also helps alleviate tight back muscles.


  • Lumbar support belts: These belts are often needed for workers who do a lot of heavy lifting. There is little evidence that these belts protect the back. According to one report, these belts also raised the risk of injuries.
  • Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Avoid wearing high heels.
  • Sitting: Hold your head up and your stomach tucked back when seated. If you would stand for lengthy periods of time, a tiny stool should be available to rest one foot at a time. Avoid wearing high heels.
  • Sleeping: Individual preferences differ. Many people can suffer back aches if their mattress is so soft. Sleeping on a really hard mattress has the same impact. For those who suffer from constant back pain, several doctors prescribe a medium-firm mattress. It's possible that some trial and error would be needed. A comfortable bed may be stiffened by placing a piece of plywood between the box spring and the mattress. A dense mattress pad can tend to smooth a stiff mattress.
  • Lifting: Lifting things that are too large for you is not a good idea. Hold your back straight up and down, your head up, and rise with your knees if you need to lift anything. Keep the thing next to you and avoid bending down to lift it. To hold your back in place, tighten your stomach muscles.

Avoid smoking. It restricts blood flow, preventing nutrients and oxygen from reaching the muscles and tissues. This will result in fatigue and aches. Smoking also leads to many lung related diseases, causing you to cough. Coughing frequently will put pressure on your back.


Referenced on  10.4.2021 

  1. Oh, W. The Clinical Journal of Pain, January/February 2004. 
  2. Friedman, F. Outwitting Back Pain: Why Your Lower Back Hurts and How to Make It Stop, Lyons Press, 2004.
  3. Mayo Clinic: “Back pain: Symptoms."
  6. eMedicine Health: “Back Pain Tests"
  7. UpToDate: “Approach to the diagnosis and evaluation of low back pain in adults."
  8. ACP Clinical Guidelines.
  10.  American Academy of Pain Medicine web site: “Commonly-Reported Pain Conditions.”
  11. Chien JJ. Curr Pain Headache Rep. Dec 2008.
  12. Arthritis Foundation: “Degenerative Disc Disease;” “Understanding Arthritis;” and “What is Ankylosing Spondylitis?”
  13. National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Fast Facts About Back Pain;" “Low Back Pain Fact Sheet;” and “What is Spinal Stenosis?”
  14. UCLA Spine Center: “Sacroiliac Joint Disease” and “What You Should Know About Radiculopathy.”
  15. Spine Universe: “Common and Uncommon Causes of Back Pain.”
  16. American Academy of Orthopaedic Surgeons: “Lumbar Spinal Stenosis;” “Fractures of the Thoracic and Lumbar Spine;” and “Sciatica.”
  17. UpToDate: “Patient information: Low back pain in adults (Beyond the Basics).”
  18. Cedars-Sinai web site: “Back Spasm.”
  19. National Institute of Neurological Disorders and Stroke: “Recommendations for Keeping One’s Back Healthy.”
  20. “Sacroiliitis.”
  21. “Osteoarthritis.”
  23. eMedicine Health: “Low Back Pain Prevention."

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