Back pain can be hard to diagnose as imaging (and other diagnostic tests) are often unable to pinpoint any specific injury. So, how do you know what may be causing your low back pain and, if you don’t know what it is, how can you treat it and get better?
Back pain can be a debilitating condition and is known to affect around 80% of the population at some point in their lives. Back pain is also one of the leading causes of disability and lost workdays. To try to help you determine how to get to the root of your back pain we have listed the 5 most common causes of back pain below.
1. Muscle or Ligament Strain
This is the single most common cause of back pain. A strain can happen slowly over time, due to repetitive movements, or with one single sudden movement. Whether it is a sprain or a strain doesn’t really matter as 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 lie special discs that act as cushions between the bones. These cushions are filled with special fluid that helps prevent the bones from pressing on each other.
Over time the fluid in the discs can leak out causing tears in the disc wall and leading to feelings of pain. Bulging of the discs can occur when the material in the discs is put under pressure from an adjacent vertebrae. This can put pressure on nerves, leading to significant pain.
Sciatica is a common condition that is caused by bulging or herniated discs that press on the nerves and can cause sharp, shooting pains that travel 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 general, but true definitions tend to lean towards 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 looking at staying active and using conservative care 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 tends to be worse in the morning and then improves throughout the day with movement and 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 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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