What To Know and Do About Back Pain
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Medically reviewed by Amy Kwan, PT
Back pain is one of the most common types of pain worldwide, affecting almost 80% of people at some point during their lives. It can affect the upper to lower back and may feel like a sharp, searing pain, dull ache, stiffness, or burning that radiates down your buttocks and legs. There are many possible causes of back pain, including injury, inflammatory conditions like arthritis, and age-related degeneration of the spine.
Whether acute (short-term) or chronic (long-term), back pain can significantly affect your daily life, restricting your movement and mobility, disrupting sleep, and lowering your mood. While it may be tempting to push through the pain, ignoring back pain can delay healing, cause worsening pain, and reduce your quality of life. Seeking medical attention for back pain is the best way to prevent complications and live as pain-free as possible.
What Structures Are in the Back?
The spine is the body’s foundation, supporting the structure and movement of your body. You might not think about your spine much until you experience back pain, but knowing the structures in the back can help you understand how and why back pain develops. Here’s a breakdown of the structures that make up your back:
Vertebrae: The backbone (spine) consists of 26 bones (vertebrae). These bones are stacked in a vertical row from the base of the skull to the lower back, providing structural support for your body.
Intervertebral discs: Cushion-like structures between each vertebra that act as “shock absorbers,” preventing bones from grinding against each other and distributing pressure evenly throughout the spine.
Spinal cord: A long bundle of nerves running down the spine that transmits messages between the brain and the body.
Ligaments: Tough connective tissues that stabilize and support the spinal vertebrae.
Facet joints: Small joints that connect the spinal vertebrae, allowing controlled movement and providing stability to the spinal column.
Muscles: A network of muscle tissues in the back support movements (e.g., bending, twisting, standing, lifting) and provide stability and support to the whole body.
Regions of the Spine
There are three regions of the spine:
Cervical spine (neck): Runs from the base of the skull to the shoulders, supports neck and head movements
Thoracic spine (middle back): Runs from the base of the neck to the posterior (back) abdominal region, connects the spine to the rib cage and provides stability for the upper body
Lumbar spine (lower back): The lower back supports upper body weight and facilitates movements like twisting, bending, and lifting
How Back Pain Presents
The experience of back pain varies widely. It can affect any part of your back and range from mild discomfort to debilitating pain that limits your ability to move, sleep, or work. Back pain can be acute (short-term), lasting for a few days or weeks, or chronic (long-term), persisting for three months or longer.
Whether your back pain comes and goes or is constant, it may feel like:
Dull aching
Sharp, stabbing pains
Burning or radiating pain that travels from the back into the legs, buttocks, or hips
Stiffness
Soreness
Weakness or difficulty moving or lifting objects
Numbness or tingling in some regions of the back or legs and feet (sciatica)
Depending on the cause, back pain may worsen when sitting or lying down and improve with movement or it may worsen during certain movements, like bending, lifting, or walking.
Potential Causes of Back Pain
Back pain has many possible causes, including injury, structural or mechanical problems with the spine, and inflammatory conditions.
Muscle or Ligament Injury
Muscle or ligament injuries are among the most common causes of back pain. Lifting heavy items, sudden movements, accidents (e.g., falls), and gradual overuse can tear or stretch the muscle fibers, leading to muscle strain. Ligament sprains occur when ligaments (fibrous tissues that connect bone to bone and hold them in place) are torn, usually from sudden movements, twisting, or accidents.
With a muscle strain or ligament sprain, it's common to experience muscle spasms, swelling, and pain in the area of the injury that radiates into the buttocks. You may feel stiff, have difficulty maintaining your normal posture, or have a limited range of motion due to pain.
Most muscle or ligament injuries begin to heal within 10-14 days with rest and ice therapy (applying ice to the affected area). In some cases, pain may persist for more than two weeks and require additional treatments, like physical therapy.
Structural Problems
A structural problem with the spine is an abnormality in the bones, joints, discs, or ligaments that make up the spinal column. These abnormalities can affect the shape, alignment, or support of the spine and lead to back pain.
Herniated disc: Injury or excessive strain on the spine can cause an intervertebral disc to slip out of place, most commonly in the lower back or neck. A slipped disc can cause sharp pain or numbness that radiates to other body parts, including the buttocks, hips, legs, shoulders, and arms.
Degenerative disc disease (DDD): The gel-like intervertebral discs break down as you age, causing the vertebrae (bones) to rub together. With DDD, pain may worsen after certain movements (e.g., bending, sitting, lifting, twisting) and limit your range of motion.
Scoliosis: Abnormal sideways curvature of the spine can put uneven pressure on muscles, joints, and nerves in the back, leading to pain most commonly felt in the lower and middle back.
Kyphosis: Increased rounding of the upper spine causes a “hunchback” or slouched posture. Pain, stiffness, and tenderness in the middle and lower back are common kyphosis symptoms.
Spinal stenosis: Narrowing of the spinal canal can compress nerves, causing lower back pain, muscle cramps, stiffness, weakness, and numbness that extends to the legs.
Facet joint problems: Injury or age-related wear and tear is common in the small joints connecting spinal vertebrae, leading to sharp pain in the lower back that radiates to the legs. An estimated 15% to 45% of all lower back pain may be due to facet joint problems.
Inflammatory Conditions
Conditions that cause inflammation of the spine and sacroiliac joints (joints that link your lower spine to your pelvis) can cause back pain. Inflammatory back pain can range from mild to severe and may feel like stiffness, aching, or burning sensations. Inflammatory conditions associated with back pain include:
spondyloarthritisAxial : A form of chronic, autoimmune arthritis that primarily affects the hips and spine. Axial spondyloarthritis-related back pain is often worse in the mornings or after resting and improves with movement throughout the day.
Osteoarthritis: The breakdown of cartilage in the joints in the spine can cause lower back pain, stiffness, limited range of motion, and difficulty moving, which often feels worse in the mornings or after physical activity.
Enteropathic arthritis: A form of chronic, inflammatory arthritis common in people with inflammatory bowel disease (IBD) that affects the sacroiliac joint and causes lower back pain.
Psoriatic arthritis (PsA): An inflammatory form of arthritis that affects the skin and joints. About 20% of people with PsA have inflammation that affects the spine, causing back pain and stiffness.
Reactive arthritis: Triggered by an infection elsewhere in the body, reactive arthritis can cause inflammation in the sacroiliac joint, leading to lower back pain and stiffness.
Other Conditions
Some medical conditions can cause back pain, including:
Kidney stones or infections
Pregnancy
Endometriosis, a condition in which uterine-like tissue grows outside of the uterus, causing severe pain around the pelvic area
Fibromyalgia, a chronic condition that causes pain and tenderness throughout the body
Bone infections that affect the spinal vertebrae
How Is Back Pain Diagnosed?
Back pain is one of the most common reasons people visit their healthcare providers—second only to the common cold and the flu. To determine what’s causing back pain, your healthcare provider will perform a physical examination, review your medical history, ask about your symptoms, and order diagnostic tests.
Your provider will ask for details about your pain, including the location, intensity, duration, and what improves or worsens the pain. Depending on your symptoms and pain severity, your healthcare provider may order diagnostic tests, including:
Imaging tests: X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans can help visualize the structures in your back, including the bones, discs, ligaments, muscles, and nerves. This can help your provider see abnormalities like disc herniations, fractures, and other structural problems.
Blood tests: Certain blood tests can look for markers of inflammatory conditions or other underlying medical conditions.
Electromyography (EMG): This test measures electrical activity in the muscles to look for muscle and nerve problems.
Bone scan: A bone scan involves using a small amount of radioactive material to see details in the spine, including infections, fractures, and other abnormalities.
Depending on the cause of your back pain, your primary healthcare provider may refer you to a specialist for additional diagnostic tests or treatment. Specialists with expertise in back pain include:
Orthopedists: Doctors with specialized training in bone and joint diseases
Neurologists: Doctors with specialized training in brain, spine, and nerve disorders
Rheumatologists: Doctors specializing in treating autoimmune and musculoskeletal disorders and diseases
Physical therapists: Healthcare providers specializing in strengthening and movement exercises to improve flexibility and function
Physiatrists: Doctors specializing in treating spine, nerves, and brain diseases
How Is Back Pain Treated?
There are many treatment options for back pain, including lifestyle modifications, medications, and specialist interventions. Your healthcare provider will recommend a personalized treatment program based on the cause and severity of back pain to help you find relief.
Lifestyle Modifications
At-home treatments and lifestyle modifications may help relieve back pain and prevent it from worsening. Your healthcare provider may recommend:
Rest: Taking breaks from strenuous activities allows your body to heal and recover
Heat/ice therapy: Apply heat and ice to the affected area to increase blood flow, reduce inflammation, and promote healing
Stretching and gentle exercises: Specific stretches and exercises recommended by a healthcare provider or physical therapist can improve flexibility, strengthen muscles, and prevent recurrent or worsening back pain
Maintain good posture: Practice good posture while standing, sitting, lifting heavy items, and sleeping to reduce strain on your back
If you smoke, quitting can help promote healing and lower your risk of chronic back pain. Maintaining a healthy body weight can help reduce demand and stress on your spine, which may help protect your spinal health.
Chronic stress can also worsen pain, so finding ways to reduce stress—like meditation, breathing exercises, and muscle relaxation techniques—can help manage your stress levels and improve your quality of life.
Medications
Over-the-counter and prescription medicines can help reduce inflammation and pain. Depending on the severity and cause of your back pain, your healthcare provider may recommend or prescribe:
Over-the-counter pain relievers: Medications like Advil (ibuprofen) or Tylenol ( acetaminophen) can help manage pain and inflammation.
Muscle relaxants: Over-the-counter (OTC) and prescription muscle relaxers help relieve muscle spasms and back pain.
Opioid pain relievers: Healthcare providers may prescribe opioid pain relievers for severe back pain. These medications block the feeling of pain and are generally for short-term use as they are highly addictive.
Antidepressants: These medicines may provide relief from chronic back pain by changing the levels of certain neurotransmitters (brain chemicals) to reduce back pain.
Corticosteroids: Oral, injectible, or intravenous steroids can help reduce inflammation and pain to provide short-term relief.
Physical Therapy
People with chronic back pain may benefit from physical therapy. A physical therapist creates a personalized training program with targeted exercises to help strengthen muscles and improve flexibility and range of motion. They also provide education on self-management strategies, such as proper posture and movement techniques, to help manage back pain.
Surgery
Surgical intervention may be necessary for certain causes of back pain when other treatments are ineffective. Your healthcare provider may recommend surgery for treating nerve compression, nerve damage, fractures, spinal stenosis, or a herniated disc. However, surgery on the back and spine often comes with high risks and long recovery times.
A Quick Review
Back pain is one of the most common types of pain worldwide, affecting almost 80% of people at some point during their lifetimes. Injury, inflammatory conditions, age-related degeneration, and certain medical conditions can cause back pain, ranging from mild to severe.
Living with chronic back pain can take a toll on your physical and emotional well-being. Fortunately, at-home treatments, lifestyle modifications, medications, and physical therapy can help manage back pain.
Frequently Asked Questions
How do you know if back pain is serious?
Back pain is common, but certain symptoms may be a sign of an underlying condition that requires medical attention. See a healthcare provider if you develop back pain after an injury or accident or if you have back pain along with numbness or tingling, trouble urinating, fever, unintentional weight loss, or severe pain that does not improve after a few weeks or with medication.
Is it better to rest or move around when you have back pain?
Rest can initially help with acute back pain, but prolonged inactivity can lead to stiff or weakened muscles and worsened pain. As your back heals and pain lessens, your healthcare provider may recommend slowly reintroducing exercise into your daily routine. This may involve gentle stretching, strength training, and cardiovascular exercises like cycling, walking, and swimming.
What makes back pain worse?
Several factors can worsen back pain, including a sedentary lifestyle, poor posture, obesity, stress, obesity, intense exercise, and lifting heavy objects. Talk to your healthcare provider about how to manage back pain. They may recommend light exercise (e.g., walking), stretching, medications, or physical therapy to help manage pain.
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