5 Main Causes of Back Pain

Low back pain is one of the most common and frustrating health issues that people face. Around 80% of the population end up dealing with it at some point in their lives.

It can also be a bit of a challenge in terms of pinpointing its cause, since traditional imaging and diagnostic tests (like x-rays and MRIs) often don't reveal a clear injury.

So, how do you identify what’s triggering your low back pain, and more importantly, how can you treat it effectively?

What Are The Main Causes Of Back Pain?

Chronic back pain doesn’t just limit your mobility—it’s also a leading cause of disability and missed workdays. If you’re struggling with persistent pain, understanding its root cause is key to finding relief.

In this article, we’ll explore the 5 main causes of back pain and give you some actionable insights to help you address the issue and start feeling better.

1. Muscle or Ligament Strain

Muscle and ligament strains are the single most common cause of back pain. A strain can happen slowly over time, often because of repetitive movements, or it can happen with just one single, sudden movement. Whether it's a sprain or a strain doesn’t really matter because both will be treated the same way.

Some common causes of muscle strain include sports injuries, lifting heavy objects, twisting in the wrong way, poor posture (that affects the spine over time), or falls. Standing or sitting for long periods of time, long driving sessions, or sleeping on a mattress that does not fully support your body are other every day common culprits in causing muscle strains and sprains.

How To Treat:

Research has shown that taking a multidisciplinary approach to treating strains and sprains can have the best results. Starting off with non-medical treatments like exercise, physical therapy, biofeedback, cognitive behavioral therapy, and chiropractic care has been shown to get patients back to their regular activities the fastest.

This approach, also known as the biopsychosocial model, has a ton of data to show just how effective it is at managing low back pain. What's more these treatments are often inexpensive and have few to no side effects to worry about.

2. Bulging Or Ruptured Discs/ Sciatica

Between the spinal vertebrae are intervertebral discs, which act as shock absorbers and cushions to prevent the bones from rubbing against each other. These discs are filled with a gel-like fluid that helps maintain their flexibility and cushion-like function.

As we age (or due to injury) the fluid in the discs can begin to dehydrate, causing the discs to lose their shape and integrity. This can lead to tears in the disc wall, bulging, or herniation. When the disc bulges out, it can press on nearby nerves, causing pain, tingling, or numbness.

A common condition associated with this is sciatica, which occurs when a bulging or herniated disc compresses the sciatic nerve. This can result in sharp, shooting pains that radiate from the lower back through the buttock and down the back of the leg.

How To Treat:

For most patients, non-pharmacological care is going to be the best option but some people might end up needing surgery for the condition. Interestingly enough, there actually isn't a whole lot of research on how to treat sciatica, with some of the main information coming from trials that were done over 20 years ago!

Something else that doesn't help is the lack of a proper definition of sciatica. Very often the term is used to describe back pain in a general sense, but stricter definitions tend to lean towards it being more of a neurological issue, when there is compression on the spinal nerve root.

When we look at the true definition and treat accordingly, more recent research published in the Lancet medical journal indicates that staying active and using more conservative care models and treatments is a much better option for sciatica patients than medication or surgery.

3. Arthritis

Arthritis occurs when there is pain, inflammation, and stiffness in the joints. Arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition which is known as spinal stenosis.

Arthritis in the spine is often caused by inflammatory conditions such as infections and autoimmune disorders as well as general wear and tear. Stiffness is often worse in the morning and then improves throughout the day as people get moving and go about their various activities.

How To Treat:

When it comes to treating spinal arthritis, the American College of Physicians (ACP) recommends 'superficial heat, massage, acupuncture, or spinal manipulation as first-line therapy for acute or subacute non-radicular low back pain'. Again, exercise therapy is highly encouraged to manage this condition and help reduce the pain.

4. Skeletal irregularities

There are a few different skeletal irregularities that lead to low back pain but scoliosis is one of the most common. Scoliosis is a sideways curvature of the spine that can occur during the growth spurt just before puberty.

Often the cause of scoliosis is unknown, but it can be caused by conditions such as cerebral palsy or muscular dystrophy. Most cases of scoliosis are mild, but some can be painful and distressingly disabling.

How To Treat:

Sadly there is not a lot of research around the treatment of scoliosis, but this is starting to change, even if the change is somewhat slow in coming. Traditionally surgery and bracing were really the main options, but new research is leaning towards more conservative management, of which exercise is a key component.

5. Osteoporosis

Over time, wear and tear of the disc and facet joints can cause osteoarthritis of the low back. Aging is the primary cause of this and spinal osteoarthritis (also known as spondylosis, or, degenerative joint disease) is often progressive, getting worse over time.

How To Treat:

In the early stages of degenerative disc disease, treatment options are generally focused on things like physical therapy, analgesics, and anti-inflammatories that can help address the various symptoms.

As the condition progresses, many patients find themselves using treatments like epidural steroid injections and even surgery to get relief and increase mobility. More experimental treatments are starting to be explored like platelet rich plasma injections and growth factor cocktails designed to help boost collagen and regenerate platelets.

Conclusions

These are a few of the most common causes of back pain but there are some more serious medical conditions that can cause back pain. Typically, most back pain cases will gradually improve by themselves over the course of a few weeks, with a little bit of home care and quite a bit of patience.

Knowing what to expect can make a big difference in helping to reassure patients that they will get better and that conservative care is often the best option.

If your back pain lasts more than a few weeks, then you should make an appointment with your healthcare provider to discuss your situation in more detail. It could be a sign of something more serious.

Also, you should seek immediate care if your back pain causes new bowl or bladder problems, follows a fall or other injury directly to your back, or if your back pain is accompanied by fever. These may indicate a serious medical issue (see our blog on 'When Should I Worry About Low Back Pain').

Depending on your specific symptoms or underlying conditions, there are a wide variety of options to help reduce pain and improve your mobility so that you can get back to doing all of the things you want to do. Don’t let back pain slow you down.

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