Back Pain

Injury or arthritis are possible causes of back pain. 

Back pain is a common health problem in the United States. It can occur at any age in both men and women. Back pain usually starts after an injury or structural problem. Problems with the discs that cushion the spine and various types of arthritis are other causes of back pain. Figuring out the cause of back pain and treating it properly are vital for restoring function. 


Back pain can be caused by various forms of arthritis, such as: 

Most back pain is due to an injury to the muscles, tendons or ligaments that support the spine. These are usually short-term problems, but in some cases, these injuries can lead to arthritis. 

  • Strains or Sprains. When playing sports, gardening or even sneezing, muscles in the back can pull (called a strain) or ligaments can be stretched or torn (called a sprain). The pain of a sprain or strain can be severe and can be localized to one spot or it can hurt all over.
  • Spasms. Overworked muscles can go into spasm, causing painful cramps and trouble moving. Spasms are the body's way of protecting itself. When muscles are in spasm, they become painful and rigid, so no further damage can be done.
  • Ruptured or Herniated Discs. When the discs that cushion the bones of your spine are weakened, the hard outer covering can split open. This allows the squishy center to bulge out, causing pressure and irritation to nearby nerves.
  • Vertebral Fractures. Bones of the spine can break due to trauma. But more often fractures are the result of osteoporosis, which weakens the vertebrae and causes them to crumble. These are called compression fractures.

Other Causes
Back pain is very common, and has many other potential causes, including:

  • Pinched nerves. Nerves that get pinched when leaving the spine to the rest of the body (such as sciatica).
  • Overuse or inactivity. Strenuous activity can cause muscle soreness. Lying in bed or sitting still can cause muscle and joint stiffness.
  • Obesity. Being overweight puts added stress on the back and stomach muscles. 
  • Poor posture. Not standing or sitting straight shifts the body out of balance and causes or worsen back pain. 
  • Stress. Psychological stress can result in tight back and neck muscles. 
  • Kidney stones or infections. Located near your low back, kidney problems can be felt as back pain. 
  • Pregnancy. Weight gain can stress the back and stretch the muscles that support the spine.
  • Endometriosis. This condition (when tissue that lines the uterus grows outside the uterus) causes pain in the abdomen and back.
  • Tumors. In rare cases, tumors – either cancerous or non-cancerous – can affect the back, causing pain.
  • Scoliosis. A curvature of the spine can result in muscle imbalance and pain. 


Pain in your back can be position-specific or constant. It may feel achy or burning or sore. Being able to tell the doctor the location and nature of the pain will help in the diagnosis. 

If you have a severe fall or injury, call the doctor. If your back pain is accompanied by any of the following, make an appointment to see a doctor immediately:

  • Pain that doesn’t improve when you lie on your back.
  • Weakness, pain or numbness in one or both legs.
  • Fever or unintentional weight loss.
  • Pain during or difficulty urinating.


A primary doctor can evaluate and treat most cases of back pain. Some more complicated causes of back pain will require referral to a specialist.

A health history, a physical exam and possibly diagnostic tests will be used to make a proper diagnosis and rule out some possible causes of pain.

Some tests the doctor could order include:

  • Blood tests. Certain blood markers and genetic tests can help diagnose inflammatory forms of arthritis. 
  • Nerve evaluation. The doctor runs a device called a pinwheel along the skin to check for any areas that are either abnormally sensitive or insensitive.
  • Muscle tests. The doctor checks the strength of the different muscle groups to detect possible nerve problems.
  • Sciatic nerve stretch test. The doctor determines whether stretching the sciatic nerve causes pain, suggesting possible nerve-root problem.
  • X-rays. For most cases of simple back pain, X-rays are not necessary. They are most helpful if arthritis, infection, or a tumor is suspected.
  • CT, MRI and Bone Scans. Computerized tomography (CT), magnetic resonance imaging (MRI) and bone scans are usually not necessary but can be helpful in determining the cause of chronic back pain. 
  • Myelogram. In a myelogram, a special dye is injected into the spinal canal and X-rays are taken. 
  • Electromyography. This nerve test determines whether the electrical activity of the nerves has been disrupted because of problems in the back.


For most instances of back pain, self-care and over-the-counter (OTC) medications are all that are needed. If your back pain is caused by arthritis, your treatment plan will follow that for the specific type of arthritis. 

Learn more about the medications used to treat back pain at the arthritis drug guide


  •  Analgesics are drugs that relieve pain, but not inflammation. The most common OTC analgesic is acetaminophen. Topical analgesics (creams, gels, patches, rubs or sprays) may contain other ingredients to help ease pain, such as
  • Salicylates, such as aspirin, that inhibit pain and inflammation by stimulating blood flow.
  • Counterirritants - such as menthol, eucalyptus oil, or camphor -- which cause feelings of cold or warmth that distract attention from the actual pain.
  • Capsaicin, which is a popular ingredient in many topicals, can reduce pain signals being sent to the brain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) - such as aspirin, ibuprofen and naproxen - help reduce inflammation and relieve pain. If necessary, the doctor may prescribe a stronger NSAID. 
  • Other medication options would be considered if standard care didn’t provide relief. These options may include corticosteroids, opioids, muscle relaxants, antidepressants (which reduce pain), anticonvulsants (used for nerve pain), etc.
  • Biologics - if inflammatory arthritis is causing back pain, biologics such as Humira may be used.

Hands-On Therapy

Treatments that include physical therapy, occupational therapy, osteopathic manipulation, massage therapy, acupuncture, and chiropractic manipulation can help relieve back pain and recover  function. These therapists can do hands-on treatments to relax muscles,  improve alignment, and ease pain. They also construct programs to improve posture, movement patterns, and muscle strength.


Surgery is not usually recommended to relieve back pain. People with sciatica, spinal stenosis or tumors within the spinal canal may, however,  require surgery to relieve pressure on the spinal cord or nerves. 
Maintaining good posture, using natural and alternative therapies, getting exercise, losing weight and relieving stress are different ways to reduce back pain.


 Maintaining good posture can help reduce stress and ease discomfort in your back. Do the exercises and follow the suggestions made by a physical or occupational therapist. Practice good posture while sitting, standing, lifting and sleeping.

Hot and Cold Therapy

For the first two days after injury, apply cold to your back when pain is acute or severe. After exercise or physical therapy, ice can be used to ease muscle soreness. Switch to heat 48 hours after injury to relax muscles and soothe painful areas. Try hot showers or baths, warm compresses, hot water bottles, heat wraps, heating pads, or warm-water therapy. If you have arthritis, warming your muscles first may make it easier to do back exercises. 


Perform stretching and flexibility exercises prescribed by a physical therapist. Yoga and tai chi are safe programs to try as well; exercises should be modified as needed.  

Weight Loss

Carrying extra weight can make back pain worse. Losing weight can reduce back pain and improve general health. The best way to lose weight is by eating a balanced diet and exercising regularly. 

Stress Relief

Daily stress may cause tight shoulder and back muscles, which worsen pain. Relieving stress can help loosen those muscles.
•    Soak in a warm bath, hot tub or spa.
•    Get involved in a hobby.
•    Do therapeutic exercise such as yoga or tai chi after getting clearance from your doctor.
•    Plan fun and relaxing activities with your family or friends.
•    Learn to accept what you cannot change instead of feeling constantly frustrated.
•    Consider getting professional help for problems that you are unable to handle on your own.

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