Why Does My Back Hurt? 10 Common Causes of Low Back Pain

General Overview of Lower Back Structures

The low back is formed by several structures that frequently cause low back pain. These include:

• Lumbar Spine – five large vertebrae between the thoracic spine and the sacrum

• Musculature – Quadratus Lumborum, Transverse Abdominis, Lumbar Extensors, Latissimus Dorsi, Thoracolumbar Fascia, etc.

Common Causes of Back Pain

The following conditions/injuries are the ten most common causes of back pain:

Low Back Muscle Strain

The most common cause of back pain occurs from a muscle strain.

A muscle strain is the stretching or tearing of a muscle or tendon in the body. This type of injury is usually caused by a sudden, overloading force. Symptoms of a low back strain include pain, inflammation, tightness, and spasms within the muscle.

The cause of a back muscle strain is typically weakness in the muscle or the muscle was asked to perform against a workload (i.e. lifting an object) while in a mechanically disadvantaged position. Think of bending over from the waist and trying to lift a heavy object. In this example, the back muscles are placed in a stretched position, then a large force is placed through them when trying to lift the object. If the back muscles are not strong enough, or if they are fatigued from repetitive work, a muscle strain will likely occur.

Low back strains occur frequently with lifting, twisting, bending, and carrying activities. They usually involve some form of bending or twisting motion while the back muscles are under stress/load.

Back muscle strains are easily diagnosed as the pain with being a constant deep, dull, ache coming from the muscles in the back. The pain can be described as sharp and stabbing with some movements, though, if the injury is acute (within one week after the initial injury).

The injured muscle will be tender to touch and will feel tight limiting the ability to bend the back in multiple directions.

◊Treatment Options

Initial treatment of a back muscle strain is rest, ice, and gentle stretching (below pain threshold). The muscles are injured and will tighten up as a protective mechanism. The goal is to prevent the injured muscles from tightening up too much because if they do, they will restrict motion greatly and lead to spine stiffness. This can quickly spiral out of control leading to increased loss of motion and more pain.

Physical therapy exercises are beneficial as the first line of defense with back muscle strains. They can help intervene with the pain and inflammation process and help to maintain back range of motion. Check out my article on low back strains to learn the best physical therapy stretches to perform after a back strain.

A quality back brace is beneficial in temporarily reducing acute back pain after a muscle strain. The brace helps to reduce the workload and stress on the back muscles allowing them to recover from the injury. However, physical therapy exercises will still need to be performed daily to help improve the injured muscle/s mobility to promote a speedy recovery.

I recommend the FREETOO Back Brace to my patients. They have a good quality build and come at a decent price from Amazon.

9.4

Back Brace

• FREETOO BACK BRACE
• 360 DEGREE SUPPORT
• 4-WAY STRETCH ELASTIC
• RELIEF FROM DISC HERNIATION, STRAINS, SCOLIOSIS, ETC
• PERFECT FOR WEAR AT-HOME, OFFICE, GYM

Check Price

Oral Non-Steroidal Anti-Inflammatory (NSAID) medications such as Aleve, Advil, Ibuprofen, etc. can provide back pain relief after a muscle strain as they reduce inflammation in the muscles. These medications can be found over the counter in your local pharmacy or grocery store. Be sure to consult with your doctor or pharmacist before taking these medications to ensure that they are safe for you to take.

Muscle creams can also provide some light pain relief after a back strain. There are way too many creams out there to list, but some of the most popular ones with my patients are:

• Voltaren Gel – technically this gel qualifies as an over-the-counter NSAID, but is very effective in reducing muscle inflammation

10

Anti-Inflammatory Gel

• TWO 3.5oz/100g TUBES OF VOLTAREN PAIN GEL
• POWERFUL TOPICAL PAIN RELIEF
• NONSTEROIDAL ANTI-INFLAMMATORY
• NUMBER 1 DOCTOR RECOMMENDED TOPICAL PAIN RELIEF

Check Price

• Tiger Balm
• Boiron Arnicare Gel
• BioFreeze

9.7

Tiger Balm Ointment

• PAIN RELIEVING OINTMENT
• ULTRA STRENGTH
• NON-STAINING
• 1.7 OUNCES
• PROVIDES RELIEF FOR ACHES & PAINS

Check Price

A TENS unit is a hand-held electrical stimulator device that provides pain relief. It is very effective in providing pain relief for muscle strains. TENS units used to require medical prescriptions, but now you can purchase them online. They work via the “Gate Theory,” which means that when they are turned on, the mind only feels the electrical stimulation from the unit as it blocks (shuts the gate) on the pain stimuli. I recommend the TENS unit from Nursal as it has dual channels and comes with 14-electrode pads that can be reused several times each.

9.3

TENS Unit

• PROFESSIONAL PAIN RELIEF MACHINE
• REAL AB DUAL CHANNEL
• MEMORY FUNCTION & ACCIDENTAL TOUCH PREVENTION
• 24 MODES & 20 INTENSITY LEVELS
• 14 STRONG ADHESIVE THICKER REUSABLE ELECTRODE PADS

Check Price

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis has many medical terms that are used interchangeably. It can be referred to as OA, lumbar arthritis, spondylosis, DJD, etc. They pretty much all refer to the same idea though. This is a natural, degenerative process in the lumbar spine that occurs as the body ages. In the United States, osteoarthritis affects nearly 54 million people!

I always like to describe arthritis as similar to the tread on a pair of tires. As time goes on, they start to wear down.

Multiple joints in the lumbar spine can be affected by osteoarthritis. Symptoms will include joint stiffness, decreased muscular flexibility, and a constant dull, ache-type pain in the lower back.

Certain injuries throughout a lifetime can also speed up this degenerative process. Herniated discs (bulging discs), traumatic falls, and other injuries often sustained by those who work manual labor-type occupations will cause increased wear and tear in the lumbar spine.

Osteoarthritis typically causes low back pain that is chronic in nature as there is no way to cure or reverse this progressive condition. It is what it is, however, there are treatment options available that can help you manage it.

◊Treatment Options

Physical therapy exercises are the #1 way to help manage arthritic back pain. Therapeutic exercises can help to improve muscular flexibility, joint mobility, and core strength for joint stability. Providing an optimal environment for the lumbar spine will help the individual manage bouts of low back pain. Check out my article titled, “Five Key Stretches for Low Back Pain” for a perfect place to start.

In rare cases, spinal fusion surgery may be required if nerves begin to be compromised by the degeneration.

Degenerative Disc Disease (DDD)

Not to be confused with Degenerative Joint Disease (DJD), Degenerative Disc Disease (DDD) involves the intervertebral discs in between each vertebral body.

DDD can be seen simultaneously with DJD, however not always. DDD (disc) is a progressive degeneration of the disc material. Typically this begins with an acute injury such as a herniated disc, but then gradually degrades over the years causing back pain. As we get older, the ability of our discs to withhold water (they are made up of highly viscous material) decreases. As a result, the joint space shrinks.

Symptoms from DDD include:

• Back, buttock, and/or leg pain

• Leg numbness, tingling, or burning sensations

• Shooting pain down the legs

• Pain that worsens with bending, lifting, and twisting

• Sharp, shooting pain with coughing or sneezing

◊Treatment Options

Physical therapy exercises can help provide back pain management when someone is suffering from DDD. Therapeutic exercises should promote spinal mobility through active movements such as those provided in my “Sciatica Exercises” article. Muscular tightness is best addressed with low back pain stretching exercises.

In some cases when nerve compression is causing mild to moderate buttock or leg pain, numbness, tingling, or burning sensations, a home lumbar traction unit may be beneficial. Traction decompresses the intervertebral discs and can reduce the compression on any nerves. This may relieve the radiating pain down the legs.

9.4

Lumbar Traction Kit

• COMFORTRAC LUMBAR TRACTION KIT
• PROVIDES SIMPLE LUMBAR SPINE DECOMPRESSION
• DISCOMFORT RELIEF FOR A HOST OF BACK & NERVE PROBLEMS
• AT-HOME COMFORT
• EASY TO ADJUST

Check Price

Oral Non-Steroidal Anti-Inflammatory (NSAID) medications such as Aleve, Advil, Ibuprofen, etc. can provide back pain and mild nerve pain relief as they reduce inflammation in the joints and nerves. These medications can be found over the counter in your local pharmacy or grocery store. Be sure to consult with your doctor before taking these medications to ensure that they are safe for you to take.

Muscle creams can also provide some light pain relief as the lower back muscles tend to tighten up from the referred spinal discs that are involved. There are way too many creams out there to list, but some of the most popular ones with my patients are:

• • Voltaren Gel – technically this gel qualifies as an over-the-counter NSAID but is very effective in reducing muscle inflammation

10

Anti-Inflammatory Gel

• TWO 3.5oz/100g TUBES OF VOLTAREN PAIN GEL
• POWERFUL TOPICAL PAIN RELIEF
• NONSTEROIDAL ANTI-INFLAMMATORY
• NUMBER 1 DOCTOR RECOMMENDED TOPICAL PAIN RELIEF

Check Price

• Tiger Balm
• Boiron Arnicare Gel
• BioFreeze

9.7

Tiger Balm Ointment

• PAIN RELIEVING OINTMENT
• ULTRA STRENGTH
• NON-STAINING
• 1.7 OUNCES
• PROVIDES RELIEF FOR ACHES & PAINS

Check Price

A TENS unit is a hand-held electrical stimulator device that provides pain relief. It is very effective in providing back pain relief. TENS units used to require medical prescriptions, but now you can purchase them online. They work via the “Gate Theory,” which means that when they are turned on, the mind only feels the electrical stimulation from the unit as it blocks (shuts the gate) on the pain stimuli. I recommend the TENS unit from Nursal as it has dual channels and comes with 14-electrode pads that can be reused several times each.

9.3

TENS Unit

• PROFESSIONAL PAIN RELIEF MACHINE
• REAL AB DUAL CHANNEL
• MEMORY FUNCTION & ACCIDENTAL TOUCH PREVENTION
• 24 MODES & 20 INTENSITY LEVELS
• 14 STRONG ADHESIVE THICKER REUSABLE ELECTRODE PADS

Check Price

In severe cases of Degenerative Disc Disease, nerve compression may begin to cause muscle weakness in the legs. If any of the following “Red Flag” symptoms are present, seek immediate medical attention as you may require emergency lumbar decompression surgery.

• Bowel and bladder dysfunction (difficulty urinating, urinary/stool incontinence, etc.)

• Saddle anesthesia (numbness and tingling around the anus, genitals, or buttock)

• Sexual dysfunction

• Difficulty walking

• Sudden progressive weakness is observed

Poor Posture

Maintaining a “proper or good” posture takes effort and behavior change. All too many of us get into bad habits and perform slouching throughout the day. Most of the time our bodies can handle these positions for certain amounts of time with no problems. However, eventually, whether it’s days, weeks, or even years later, perpetually staying in poor posture positions will start to cause back pain.

Poor posture takes the spine and other joints out of their optimal alignment. This causes increased stress on the muscles that support those joints. Muscular tightness will begin to increase gradually and possibly lead to muscle strain as mentioned above.

Poor posture symptoms typically include back muscle tightness evolving into a constant dull, ache pain in the lower back. Spinal stiffness will set in as the muscles that attach to them tighten down and prevent them from moving through their normal range of motion.

A lot of these types of patients will become “self-manipulators.” Those are people who find that they need to crack their own back multiple times per day as it provides temporary pain relief.

◊Treatment Options

The primary treatment option for posture-related back pain is physical therapy. Postural strengthening exercises can help strengthen the postural muscles to better support the spinal alignment. Additionally, stretching key back muscles will be required to reduce the excessive tightness that has been built up over time.

Disc Herniation (Bulging/Ruptured Disc)

The intervertebral discs provide padding between every vertebral level of the spine.

Herniated or ruptured discs tend to occur in those under the age of 50. They occur suddenly with bending, lifting, and twisting motions. They are caused first by a tear in the outer annulus, which is a fibrous ring on the outside of a disc. Then, the gelatinous nucleus starts to leak out through the tear. This is similar to how jelly sneaks out through the hole in a donut.

If enough of the nucleus leaks out through the tear, it will likely begin to put pressure or “pinch” the spinal nerve exiting nearby. This compression on the nerve can cause back and leg pain. Depending on the severity of the herniation, it may also cause symptoms that include:

• Buttock pain

• Leg numbness, tingling, or burning sensation

• Leg or foot weakness

◊Treatment Options

Physical therapy exercises can provide back and leg pain relief from disc herniations. The exercises primarily target extension-based movements to promote the reduction of the nuclear material from pressing further onto the spinal nerve.

Home lumbar traction devices can provide decompression of the spinal nerves when mild to moderate buttock or leg pain, numbness, tingling, or burning sensations are present. Traction decompresses the intervertebral discs and can reduce the compression on any nerves. This can relieve the radiating pain down the legs.

9.4

Lumbar Traction Kit

• COMFORTRAC LUMBAR TRACTION KIT
• PROVIDES SIMPLE LUMBAR SPINE DECOMPRESSION
• DISCOMFORT RELIEF FOR A HOST OF BACK & NERVE PROBLEMS
• AT-HOME COMFORT
• EASY TO ADJUST

Check Price

Oral Non-Steroidal Anti-Inflammatory (NSAID) medications such as Aleve, Advil, Ibuprofen, etc. can provide back pain and mild nerve pain relief as they reduce inflammation in the joints and nerves. These medications can be found over the counter in your local pharmacy or grocery store. Be sure to consult with your doctor before taking these medications to ensure that they are safe for you to take.

A corticosteroid injection may be recommended by an orthopedic surgeon if the symptoms have continued to worsen or have not improved significantly. This procedure is performed via a CT-guided injection to ensure proper placement of the steroid anti-inflammatory. The steroid will be placed as close as possible to the area of the pinched nerve. It can provide quick pain relief as the inflammation decreases in the nerve.

Depending on the severity of the disc herniation, a diskectomy procedure may be required. This procedure trims out the herniated part of the disc while simultaneously removing the part of it that is pressing on the nerve.

In rare, severe cases of a herniated disc, significant nerve compression may begin to cause muscle weakness in the legs. If any of the following “Red Flag” symptoms are present, seek immediate medical attention as you may require emergency lumbar decompression surgery.

• Bowel and bladder dysfunction (difficulty urinating, urinary/stool incontinence, etc.)

• Saddle anesthesia (numbness and tingling around the anus, genitals, or buttock)

• Sexual dysfunction

• Difficulty walking

• Sudden progressive weakness is observed

Spinal Stenosis

Stenosis is simply the narrowing of an opening. Spinal stenosis is the narrowing of an opening in the spine. There are two types:

1. Foraminal Stenosis

2. Central Canal Stenosis

Spinal stenosis usually occurs in older individuals and it commonly occurs simultaneously with Degenerative Joint Disease (DJD). The gradual narrowing of the openings in either the foramen (small windows in the spine where the spinal nerves pass through) or within the central canal where the main spinal cord is located will cause progressive nerve compression.

Symptoms caused by spinal stenosis include:

• Low back pain

• Buttock pain

• Leg pain, numbness, tingling, burning

• Difficulty walking

• Drop foot

◊Treatment Options

Physical therapy exercises can provide improved joint mobility within the lumbar spine, improved posture, increased core and hip stability, as well as decreased back pain. Therapeutic exercises and stretches should target flexion-based movements that promote nerve decompression. Check out my full article on “Lumbar Spinal Stenosis” for further information.

Home lumbar traction devices can provide decompression of the spinal nerves when mild to moderate buttock or leg pain, numbness, tingling, burning sensations are present. Traction decompresses the intervertebral discs and can reduce the compression on the spinal nerves. This can relieve the radiating pain down the legs.

9.4

Lumbar Traction Kit

• COMFORTRAC LUMBAR TRACTION KIT
• PROVIDES SIMPLE LUMBAR SPINE DECOMPRESSION
• DISCOMFORT RELIEF FOR A HOST OF BACK & NERVE PROBLEMS
• AT-HOME COMFORT
• EASY TO ADJUST

Check Price

Oral Non-Steroidal Anti-Inflammatory (NSAID) medications such as Aleve, Advil, Ibuprofen, etc. can provide back pain and mild nerve pain relief as they reduce inflammation in the joints and nerves. These medications can be found over the counter in your local pharmacy or grocery store. Be sure to consult with your doctor before taking these medications to ensure that they are safe for you to take.

A corticosteroid injection may be recommended by an orthopedic surgeon if the symptoms have continued to worsen or have not improved significantly. This procedure is performed via a CT-guided injection to ensure proper placement of the steroid anti-inflammatory. The steroid will be placed as close as possible to the area of the nerve compression. It can provide quick pain relief as the inflammation decreases in the nerve.

Depending on the severity of the disc herniation, a diskectomy procedure may be required. This procedure trims out the herniated part of the disc while simultaneously removing the part of it that is pressing on the nerve.

In rare, severe cases of a herniated disc, significant nerve compression may begin to cause muscle weakness in the legs. If any of the following “Red Flag” symptoms are present, seek immediate medical attention as you may require emergency lumbar decompression surgery.

• Bowel and bladder dysfunction (difficulty urinating, urinary/stool incontinence, etc.)

• Saddle anesthesia (numbness and tingling around the anus, genitals, or buttock)

• Sexual dysfunction

• Difficulty walking

• Sudden progressive weakness is observed

If any of the red flag symptoms are present or if the symptoms continue to progress, an orthopedic surgeon will likely recommend a lumbar decompression back surgery. This procedure typically removes part of the vertebral body (foraminotomy) to remove the site of compression on the nerve.

Scoliosis

Scoliosis is a sideways curvature and/or rotational deformity of the spine. There are four main types of Scoliosis:

1. Idiopathic Scoliosis

   • Unknown cause. This can be up to 80% of cases

2. Congenital Scoliosis

   • Scoliosis develops as a baby before birth while the spine is developing. This may be detected by doctors soon after birth or it may not be discovered later on in the teen years.

3. Neuromuscular Scoliosis

   • This type is caused secondarily to other conditions that involve the central nervous system. These conditions include traumatic brain injuries, spinal cord injuries, spina bifida, etc. The affected nerves also innervate the muscles that support and attach to the spine.

4. Degenerative Scoliosis

   • Develops in elderly individuals. Is commonly seen with osteoporosis and degenerative joints.

Due to the curvature of the spine, the muscles on either side of the spine become either short and tight or long and weak. Symptoms caused by scoliosis include:

• Limited bending and twisting range of motion

• Constant dull, aching back pain

• Tightness in back muscles

• Muscle spasms

◊Treatment Options

Physical therapy exercises are critical for those suffering from scoliosis. Stretching exercises should target the muscles that are short and tight and strengthening exercises will target the muscles that are long and weak. Postural muscles should be targeted initially, but a general strengthening program should be developed for long-term health. Check out my article, “Five Key Low Back Pain Stretches” for a beginner’s guide to low back stretching.

Scoliosis surgery is reserved for all but the most severe of cases. There are certain angle requirements of the spine that will indicate whether this procedure is required or not. The surgery is a spine fusion using two rods placed on both sides of the spine to stabilize the spine. The goals of this surgery are:

1. Stop the curve’s progression

2. Reduce the deformity

3. Balance the trunk

Being Overweight or Obese

Your weight can be a significant cause of back pain. As this is a sensitive subject to many people, it is simply a matter of biomechanics. The more weight that you have in front of the spine (such as in the belly area..guys I’m looking at you), the greater the stress that you’re placing through your back muscles to hold that extra weight up. Not to mention the extra compression that the weight is causing within the spine joints and discs.

◊Treatment Options

A nutritionist consultation should be considered. I always say that knowledge is power and until we understand the nutritional value of what we put in our bodies, we’re just turning a blind eye towards the issue. The fastest way to reduce calories is by controlling what we eat, so choose wisely. Exercise is absolutely important, especially for cardiovascular health, but it will not reduce calories anywhere near as quickly as just controlling what goes into the body.

Physical therapy exercises can help target specific weaknesses in the core, hips, and lower extremities. As mentioned before, the back muscles are being asked to hold a lot of extra weight up day in and day out. These muscles will be tight and require careful stretching and strengthening.

Weight loss surgery is a consideration that should not be taken lightly. Some of these surgeries require stringent compliance with eating protocols. Some of them are irreversible. Speak to several doctors before deciding, so you fully understand the expectations.

Osteoporosis

Osteoporosis is a disease that causes decreased bone density throughout the body. As a result, the bone may become weak or break causing back pain. Osteoporosis most commonly occurs in the:

• Hip

• Wrist

• Spine

Symptoms caused by osteoporosis can include:

• Constant dull, aching back pain

• Intermittent sharp, stabbing back pain if compression fracture is present

• Low back muscle pain and tightness

◊Treatment Options

To begin with, a DEXA body scan is highly recommended as it is the most accurate way to measure bone density. A bone scan can also be performed if a DEXA machine is not available. These measurements will let you know if you fall into the normal, osteopenic (pre-osteoporosis), or osteoporosis level.

Did you know that strength training with weights is one of the best ways to combat osteoporosis?

Bone density is stimulated by compression and strengthening with weights provides that compression. Physical therapy exercises can provide you with specific strengthening exercises to target these areas safely. Check out this article by WebMD to read further on this topic.

Lack of Exercise

One of the things that we know for sure is, that back pain gets better with exercise. Lack of exercise can cause back pain because the muscles that support the spine and pelvis can become weak over time with disuse. Eventually, the muscles will tighten up as well causing back localized back pain.

I am a big fan of yoga because it helps maintain muscle flexibility and joint mobility. Strengthening exercises can be performed with body weight, resistance bands, dumbbells, almost anything. During the COVID-19 shutdown, I was using my cooler filled up with random tools to do deadlifts in my garage. Creativity is your only limitation here!