What causes your Back Pain

Ever wonder why you experience back pain or try to understand what actually causes your back to ache? Let me share with you a little information as to what may contribute to this annoying back pain.

First a little insight into back pain itself. Back pain is the most common problem in Australia after the common cold. In my day-to-day practice, I often think that the occurrence of Lower Back Pain (LBP) is even higher. Almost everyone we know may experience some form of back ache throughout the years. To be more exact 60-80% of the population have back pain at some time in their life. I therefore often look at low back pain as a common cold rather than a serious pathology.

Approximately 90% of pain in the back is mechanical in nature and the other 10% are due to secondary systemic illnesses. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae or soft tissue. Mechanical back pain implies that the source of pain is in the spine and/or its supportive structure and the surrounding muscles and ligaments may develop a reactive spasm causing pain.

In practice, clients who present with mechanical lower back pain is usually caused by a combination of everyday factors such as the following:

• Prolonged positions
• Repetitive movements
• Poor abdominal or leg strength
• Heavy lifting when you are not used to it
• After prolonged rest e.g. following an illness
• Another injury elsewhere e.g. hip pain
• Sporting injury or some other form of trauma

Please note that I am referring to general mechanical back pain. Serious pathologies such as infections, tumors, disc prolapse and inflammatory sources of back pain may be very different in nature and are not considered mechanical per say. Please talk to your physiotherapist/ GP about this further.

In research, these are the medical terms that we may refer to as the causes of mechanical lower back pain:

• Sprains and strains: Sprains are caused by overstretching or tearing ligaments, and strains are caused by tears in tendons or muscles. These account for the majority of acute back pain. Sprains or strains usually happen when twisting or lifting something improperly, lifting something too heavy, or overstretching.
• Muscle spasms: Caused as a result of some postural abnormality or secondary to some articular source of pain, muscles become chronically active and therefore painful.
• Intervertebral disc degeneration: This occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
• Herniated or ruptured discs: This can happen when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
• Radiculopathy: A condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
• Sciatica: A form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression can present with shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally going into the foot/ toes.
• Spondylolisthesis:A condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
• Spinal stenosis:A narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
• Skeletal irregularities:These may include scoliosis, which is a curvature of the spine that does not usually cause pain until middle age. Lordosis, which is an unusually accentuated arch in the lower back and other congenital anomalies of the spine.

As you can see the causes of back pain can be very complex with many structures of the spine contributing to your pain. During examination with a physiotherapist or GP we will likely be asking you various questions to try and understand where the source of pain is coming from. Best advice to you would be to try and remember as much information to be able to describe it to us. Things such as the mechanism of injury, the location, severity, type of pain, aggravating activities or positions that may make the pain better or worse and any patterns of pain that you may recall.

Back pain can be a frustrating thing for many of us so I hope this blog helped you understand the many different causes as to why you may be experiencing back ached. To clarify what may have caused your back ache in the first place and get clear on the diagnosis be sure to visit your local physiotherapist or GP.

Natasha Chan (APAM)

Physiotherapist

References:

American Association of Neurological Surgeons. Lower back pain symptoms and causes (1999) Available at: http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-and-causes (Accessed: 18 November 2016).

Bogduk, Nikolai. (2005). Clinical anatomy of the lumbar spine and sacrum / Nikolai Bogduk ; foreword by Stepen M. Endres. 4th ed. New York : Churchill Livingstone, 2005. pp. 183-216

Brukner, P. and Khan, K. (2007). Clinical Sports Medicine (3rd ed.) McGraw-Hill, Sydney.

Clevland Clinic. (1995). Acute mechanical back pain. Retrieved November 18, 2016, from http://my.clevelandclinic.org/health/diseases_conditions/hic_your_back_and_neck/hic_Acute_Mechanical_Back_Pain

National Institute of Neurological Diseases and Stroke. Low back pain fact sheet (2015) Available at: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#3102_3 (Accessed: 18 November 2016).

Waddell, Gordon. (2004). Diagnostic Triage. Back pain revolution / Gordon Waddell. 2nd ed. Edinburgh : Churchill Livingstone, 2004. pp 9-26.

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