Back pain is a symptom of pain that could arise from more than one source. A doctor will carefully evaluate the exact cause of pain before suggesting a course of action.
Apart from referred pain (which is pain arising from other organs and felt in the back, such as intra-abdominal disorders like appendicitis, kidney disease, bladder infection, pelvic infection, ovarian disorder and aneurysms), back pain could be classified as pain arising from the spine or from the muscles supporting the spine.
Spinal back pain
The various types of back pain arising from spinal causes and their symptoms are as follows:
Nerve impingement
Nerve impingement refers to touching of a spinal nerve, often due to bulging or herniation of a spinal disc between the lower backbones.
Sciatica is a type of nerve root impingement in which the sciatic nerve that extends from lower back down the back of each leg gets irritated at its root of the lower lumbar and lumbosacral spine. The pain is sharp, in one spot and often associated with numbness in the leg it supplies. The pain may extend from the lower back to the back of thigh, and down to the leg. Nerve impingement may be caused by the following:
- Herniated spinal discs - The bones that form the spine (backbone) are separated from each other and cushioned by round, flat, compressible discs. These discs give flexibility to the spine, allowing it to bend and twist. However, injuries, normal wear and tear or disease can cause the discs to rupture or bulge abnormally into the space that surrounds a nerve root (spinal canal) and pushes against it, resulting in slipped or herniated discs. Herniated discs impair nerve function, and lead to weakness, numbness and pain in the leg or arm it supplies. It most commonly occurs in the discs of the lower back (lumbar region) and neck (cervical region). A small percentage of herniated discs lead to nerve impingement.
- Spinal stenosis - Spinal discs in between the vertebrae can lose moisture and volume with age, decreasing the disc space. This condition makes the spine vulnerable to inflammation and nerve root impingement even to minor trauma.
- Spinal degeneration - Spinal discs can undergo alteration that leads to degeneration. Coupled with lower back joint disease, this can cause narrowing of the spinal canal, a condition that is visible in x-rays. Individuals with spinal degeneration will experience pain in the back while standing for long duration or on walking even short distances, along with stiffness in the back in mornings.
- Cauda equina syndrome - If disc material expands into the spinal canal, it compresses the nerve, creating a medical emergency. A person will feel pain, bladder or bowel dysfunction and may lose sensation.
Infection of bone of spine
Low back pain can also be caused due to infection in the bone of spine. The pain is worse when sitting or standing for long time and at night.
Tumour/cancer - Skeletal pain that may radiate as back pain can also be due to tumour or cancer of the region.
Back pain due to soft tissues around spine
Soft tissues that surround the spine may also cause lower back pain. A large, complex group of muscles work to support the spine, keep the body upright and allow the body's trunk to move, bend or twist in many directions. Let's take a look at the three major types of back muscles that enable spine function, before delving into musculoskeletal pain syndromes:
- Extensor muscles are bound to the back of the spine and allow the body to stand and lift objects. This muscle group comprises of the erector spinae (paired muscle in lower back) that keep spine upright and the gluteal muscles.
- Flexor muscles are found in the front of the spine and allow the body to flex, bend forward, lift and arch the lower back.
- Oblique muscles are attached to the sides of the spine and enable spine's rotation and proper posture.
The two main types of back pain problems that arise due to issues with this musculoskeletal arrangement are:
#1 Fibromyalgia
This disorder is characterised by pain and tenderness in multiple tender points (in minimum 11 of 18 pain points or localised areas of tenderness around joints, as characterised by the American College of Rheumatology). The tender points hurt when touched, and one of them is the low back area.
Muscle ache, fatigue and generalised stiffness are reported, along with other symptoms such as sleep problems, irritable bowel syndrome and depression. The muscles feel overworked or pulled even without exercise, or may twitch, burn or ache with deep stabbing pain.
#2 Myofascial pain syndrome
This condition is characterised by muscle pain, spasm and tenderness over localised areas, loss of range of motion in the muscle, and a radiating pain restricted to a peripheral nerve. The muscles involved are focal or asymmetrical in myofascial pain while fibromyalgia pain is diffuse and symmetric, occurring on both sides of the body. Affected muscle caused upper and lower back pain generally on one side of the body more than the other, and there is pain and spasm in the affected area.
The exact cause of myofascial pain is not known but poor sleep patterns, prior injury, depression and stress are known to play a role. Pain relief occurs when the muscle is stretched, along with physical therapy and stress reduction.
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