Back Pain Causes

Medically reviewed by Beth Holloway, RN, M. Ed,
February 28th, 2020

Back pain is very common and has many causes. Every person will probably have it at some time in their lives. It often interferes with school, work, and other activities. Depending on the cause, back pain may last only a short time; a long time; or it may go away, only to return.

Most Common Causes of Back Pain

The back is made up of bones (vertebrae), discs, muscles, tendons, ligaments, and other structures. Any of these can may be involved in back pain. 

Sometimes, back pain can indicate a very serious condition. For most people, though, it does not mean something serious and it can be treated. 

The most common causes of back pain are due to problems with the spine or supporting structures. They are: strains and sprains; accidents, Injuries, and incorrect movements; and osteoarthritis.

        The musculoskeletal system

Strains and Sprains

Both strains and sprains mean that tissue is stretched or torn. Strains and sprains can affect the muscles, tendons, and ligaments of the back – the lower back (lumbar area) especially. 

Doctors use different terms depending on the structure that is injured. Here’s how: 

  • Muscles support the bones and allow for movement. A stretched or torn muscle is called a strain.

  • Tendons attach muscles to bones. A stretched or torn tendon is also called a strain.

  • Ligaments attach bones to other bones at joints . A stretched or torn ligament is called a sprain.

When a person sprains or strains the back, they may feel a stretch or tear followed by pain. There may also be swelling or bruising in the area. Movement can worsen the pain, making it difficult to take part in daily activities.

Accidents, Injuries, and Incorrect Movements

Minor accidents, injuries, and incorrect (or lack of) movement can cause back pain. Some examples include:

  • Slipping or other quick movements

  • Improper bending, lifting, or twisting

  • Overusing the back (for instance, while golfing or playing racquet sports) 

  • Underusing the back (for instance, sitting for long periods of time)

Serious accidents and injuries may also cause back pain. Those situations are medical emergencies.

Osteoarthritis

Arthritis is a group of conditions that affect the joints. The most common type of arthritis is osteoarthritis. It is also known as wear-and-tear arthritis or degenerative joint disease. Most often, it affects the hips, knees, spine, and hands. However, it can affect many different joints in the body.

Osteoarthritis becomes more common with age. Due to daily wear and tear, the spongy cartilage that protects many joints begins to break down. This results in pain and stiffness. 

When osteoarthritis affects the spine, it is called degenerative disc disease. This means there is wear and tear on the discs of the spine, which are made up of cartilage.  Extra bone (called bony spurs) may form on the edges of the vertebrae. 

Normal spine and osteoarthritis of the spine

Back Pain From Other Spinal Problems

Pinched Nerves

A pinched nerve (also called radiculopathy) is irritation or pressure on one of the nerve roots in the spine. 

A nerve root starts at the spinal cord and goes through a hole in one of the vertebrae. The nerve continues to some other area of the body.

A pinched nerve can happen anywhere along the spine. Depending on the location, symptoms affect different parts of the body. The symptoms may range from mild to severe. Common symptoms are pain, numbness, weakness, and tingling, although some people do not have symptoms.

Pinched nerves are common in the neck and in the lower back. In the neck, the symptoms affect the arms. In the lower back, the symptoms affect the buttocks and legs (also called sciatica). 

Although a pinched nerve is a problem with a nerve, it is due to different changes in the spine. These changes include spinal stenosis and disc disease.

  • Spinal stenosis means that the space where the nerve passes through the spine has narrowed. 

      Spinal stenosis with irritated nerves

  • Disc disease (also called a slipped disc) means that one of the discs is out of position. It may range from a bulge to a rupture or to a herniation. 

            An example of disc disease.

Fractures

A fracture is a break in any bone – including the vertebrae of the spine.

A type fracture, called a vertebral compression fracture (VCF) is a break in the rounded part of the front of a vertebra. As the name states, it is a type of fracture where the bone is compressed or flattened. 

        A vertebra, one of the bones of the spine

Compression fractures are most common in people with osteoporosis. This is a condition with weak, brittle bones that mostly affects women past menopause. With osteoporosis, even a simple movement may cause a fracture.

Fracture of one of the vertebrae of the lumbar spine

Another type of fracture is called spondylolysis, which is more common in young people. It is a crack in a specific area of one of the vertebrae. Sometimes the fracture weakens the vertebra and it slips out of position. It is then called spondylolisthesis.

Spondylolysis and spondylolisthesis

Spine fractures may also result from serious accidents or injuries. There may also be damage to the spinal cord. These injuries can cause paralysis (loss of ability to move) or death.

Abnormal Curvature of Spine 

Looking at it from the side, the spine has three major curves: the neck (called the cervical spine); the upper back (called the thoracic spine); and lower back (called the lumbar spine). 

Any of these can be curved more than normal. Depending on the severity,  it may cause back pain or other problems.

Normal curves of the spine

Kyphosis

One example of an abnormal curve is kyphosis. With kyphosis of the upper back, the curve is greater than normal. The result is a rounded appearance commonly called humpback

           Normal spine, spine with kyphosis

Scoliosis

When looking at the spine from the front or back, it should appear straight. When it has an abnormal curve to the left or the right, it is called scoliosis. The curve – which may range from mild to severe– can cause pain in the back.

      1: normal spine; 2 and 3: scoliosis

Back Pain from Other Parts of the Musculoskeletal System

The Hip

The hip joint is where the hip bone (called the pelvis) connects to the thigh bone (known as the femur). A person may have a problem in the hip, but they may feel it in the lower back. When pain is felt in one part of the body, but the problem is actually somewhere else, it is called referred pain.

           The hip joint

The Knee

Osteoarthritis or other conditions causing knee pain may change the position of the knee. This often changes how a person walks. This, in turn, may lead to low back pain.

Label: Bowed right knee affects walking

Back Pain from Conditions That Affect The Whole Body

Some conditions (known as systemic conditions) affect the whole body. Back pain is a symptom of some of these conditions.

Rheumatoid Arthritis (RA)

RA is a problem with the body’s immune system. A person may have general symptoms like fever, tiredness, and body aches. Without treatment, RA damages joints. Many different joints may be affected, including those of the back and hips. 

  Normal neck joints; neck joints affected by rheumatoid arthritis

Ankylosing Spondylitis (AS)

AS causes inflammation in joints. Most often it affects the joints in the back. A person with AS has severe pain and stiffness, usually in the lower back and hips. Some of the bones of the back may grow together. This results in the inability to move that area of the back.

     Normal spine and spine with ankylosing spondylitis

Pain Syndromes

Pain syndromes have many symptoms, some include back pain. 

One pain syndrome – fibromyalgia – affects different parts of the body, usually  the back. Other symptoms of fibromyalgia are problems with sleep, memory, and mood.

        Fibromyalgia pain locations, front and back views

Additional Causes of Back Pain

Mental Health

Many studies have looked at mental health problems and the pain-depression-stress cycle. This includes research specific to low back pain.

This cycle works in two ways.

  1. Pain worsens depressed feelings which increases stress/anxiety, which increases pain

  2. Pain increases stress/anxiety, which worsens depressed feelings, which increases pain

      The pain, depression, stress cycle

Excess Weight

Extra weight adds stress to the bones and joints. This is especially a problem with the lower back where the weight increases the risk of low back pain and problems like osteoarthritis.  

          Excess weight and low back pain

Other Systems/Organs

Serious problems involving other body systems and organs may include back pain. 

Sometimes the organ or part of the body system is in the back area, so the pain is local. The kidneys, for example on either side of the lower back. 

The pain may also be referred (As discussed, this is when pain is felt in one part of the body, but the problem is actually somewhere else). People with certain conditions affecting the heart, or large chest artery (aorta) may also have back pain. 

   The kidneys, heart, and aorta

Infections

A kidney infection (pyelonephritis) usually involves low back pain. Trouble urinating and fever are also common.

An infection of the brain (encephalitis) is very serious. A person will have neck pain and stiffness. Other symptoms include headache, fever, confusion, and tiredness.

Brain and meninges

Tumors/Cancer

Since the back is such a large part of the body, tumors or cancer in different organs or body systems may cause back pain. It depends on the type of cancer, the location of the tumor/cancer, and whether or not it has spread.

  • Type: It may be bone, lung, kidney, or pancreas, for example.

  • Location: It may be in the head or neck, chest, belly (abdomen), or back.

  • Cancer may spread (metastasize) to areas in or near the back.

When to See a Doctor Right Away 

In most cases, back pain does not mean a person has a serious condition. However, there are situations when one should see a doctor right away. Individuals should see a doctor when they have back pain and any of the following:    

     Risk factors

  • History of cancer

  • Recent infection

  • Decreased ability to fight infection (suppressed immune system)

  • Intravenous (IV) drug use

  • Osteoporosis (weakened bones)

  • Long-term use of steroid medicine

  • Recent serious accident or injury

     Symptoms

  • Fever, body aches, and tiredness

  • Pain extending to the arms or legs

  • Numbness, tingling, or burning in the arms or legs

  • Severe pain

  • Recent, severe headache

  • Weight loss, night sweats, loss of appetite, and tiredness

  • Trouble with urinating or bowel movements or numbness in the genital area

There are many causes of back pain.  With treatment, it is often possible to lessen the pain or even stop it altogether. 

GoodPath uses a well-rounded, personalized approach to treat back pain. Take our assessment to get a care kit, tailored to your medical history and current symptoms.