Back pain: symptoms, causes and treatments explained

Almost everyone will experience back pain at some point in their lives. It's usually short-lived and gets better with time. However, it is nonetheless the leading cause of disability in the world.

Back pain can range from a muscle aching to a sharp shooting, burning or stabbing sensation in the back that can radiate into the legs. Bending, twisting, lifting, standing, sitting or walking can make it worse.

Most back pain gradually improves with time, a brief period of rest, over-the-counter analgesia (painkillers) and gentle mobilisation. You should, however, contact a spinal specialist if your back pain:

• Lasts longer than a few weeks
• Is severe and constant
• Radiates into your legs
• Causes weakness, numbness or tingling with difficulty walking
• Is associated with fever, unintentional weight loss and pain at night

In rare cases, back pain can signal a serious medical problem. Seek immediate care for back pain that:

• Causes new bowel or bladder problems
• Systemic symptoms, such as weight loss and fever
• Occurs after any fall or trauma to the spine

Causes of back pain

Back pain often develops without a cause and it usually improves. The following conditions are linked to back pain: 

Muscle or ligament strain

This is a common cause of back pain. Repetitive lifting or a sudden twist can strain your back muscles and spinal ligaments, especially if you have weak core muscles.

Bulging or ruptured spinal discs

Spinal discs act as cushions between the bones (vertebrae) in your spine. Occasionally, a disc tear or prolapse (bulge) can irritate nearby nerves and cause local spasms. With progression of the pressure, it can cause severe pain in the legs with difficulty walking, sitting and standing.

Spinal stenosis

In those aged over 50, a common cause of back pain is spinal stenosis, where the space running through your spine, through which your nerves pass, narrows. This leads to back pain and eventually leg pain and legs that feel numb and heavy, which makes walking difficult. 

Leaning forward usually helps temporarily improve these symptoms as it makes more room for the nerves passing through the spine. 

Osteoporosis

A fracture in one of your vertebrae can cause acute back pain that worsens on movement. This is especially common in women after menopause as their bone density decreases, which can lead to osteoporosis. In these cases, even a cough or sneeze can lead to a spinal fracture. 

Trauma, such as a fall or impact, can also lead to a spinal fracture at any age.

Ankylosing spondylitis

Also called axial spondyloarthritis, this inflammatory disease can cause some of the vertebrae in your spine to fuse. This makes your spine less flexible and consequently can cause back pain.

Risk factors for back pain

The following risk factors are associated with back pain:

• Age — back pain is more common with age, starting around age 30 or 40
• Lack of exercise — weak, unused muscles in the back and abdomen can lead to back pain
• Excess weight — excess body weight puts extra stress on your back
• Diseases — some types of arthritis and cancer can contribute to back pain
• Improper lifting — using your back instead of your legs can lead to back pain
• Psychological conditions — depression and anxiety increase your risk of back pain, while stress can cause muscle tension, contributing to back pain

Being a smoker also increases your risk of back pain. This may occur because smoking causes coughing, which can lead to prolapsed spinal discs. Smoking can also decrease blood flow to your spine and increase your risk of osteoporosis.

Prevention

Improving your physical condition and learning and practising how to use your body can help prevent back pain.

To keep your back healthy and strong:

• Perform regular low-impact, aerobic exercises eg walking, cycling, swimming, Pilates and yoga
• Build your abdominal and back muscle strength and flexibility ie exercises that strengthen your core muscles help support your back
• Stand, sit and lift with the correct posture
• Maintain a healthy weight
• Quit smoking

Diagnosing back pain

In most cases, a physical examination and a comprehensive medical history are enough to suggest what may be causing your back pain. You may then need an imaging test to confirm your diagnosis, such as an MRI scan, X-ray, CT scan or SPECT scan.  

Treatment for back pain

Although most back pain gets better with time, especially in young people, you can speed your recovery by ensuring you rest for a short period of time and then gently mobilising your back; hot and cold compresses can also help relieve back pain. 

You may need medication to help with your back pain, especially as you begin to mobilise. Medications include over-the-counter painkillers, nonsteroidal anti-inflammatory (NSAIDS), muscle relaxants, topical pain creams, narcotic drugs and low-dose antidepressants.

You may also need physiotherapy. A physiotherapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help prevent your back pain from returning. Physiotherapists will also teach you how to modify your movements during an episode of back pain to avoid flaring up your pain while continuing to be active.

Surgical treatment for back pain

If your back pain doesn’t resolve with rest, medication and physiotherapy, you may need more invasive treatment. 

This may include steroid injections to help relieve pain that radiates down the leg. This will decrease inflammation and your pain but the pain relief may be temporary.

Radiofrequency ablation can provide longer-lasting pain relief as it involves inserting a fine needle through your skin to burn the sensory nerve causing your back pain.

If all other treatments aren’t successful in relieving your back pain and it is significantly affecting your quality of life, your doctor may recommend surgery. 

In many cases, spinal surgery can be performed as a keyhole procedure, which has shorter recovery times than traditional open surgery. 

If a fracture caused by osteoporosis is causing severe back pain, a vertebroplasty may be performed where cement is injected into the fracture through a small needle as a day case procedure.