Back Pain — Causes, Symptoms, & Treatment

Things to remember

Back pain is a common problem
It’s usually not the result of a serious injury or disease
There are many things that you can do to live well with it
Learning about your back pain and the best ways to manage it is the first step

If you have back pain, you’re not alone. It’s a common problem experienced by many people. In fact, 1 in 6 Australians reported back problems in 2017-18. That’s close to 4 million people. (1)

How your back works

Your back is a complex structure that provides support for your pelvis, legs, ribcage, arms and skull. The spine is made up of bones called vertebrae that are stacked together to form a loose ‘S’-shaped column.

Each vertebra is cushioned by spongy tissue called intervertebral discs. These discs act as shock absorbers and give your spine its flexibility. Vertebrae are joined by pairs of small joints known as ‘facet’ joints. A mesh of connective tissue called ligaments holds the spine together.

Complex layers of muscle provide structural support and allow you to move. Your spinal cord runs through the centre of the vertebral column and connects your brain to the rest of your body.

Causes of back pain

The causes of back pain are not fully understood.

Most people with back pain don’t have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.

Common causes of back pain include:

arthritis – osteoarthritis and ankylosing spondylitis are two types of arthritis linked to back pain
muscle and ligament strains – if your back is out of condition or if you have pre-existing problems, you’re more vulnerable to soft tissue injuries such as sprains (stretching or tearing ligaments) and strains (injuring muscles or tendons). Stretching a ligament or muscle too far or too fast can result in a tear of the tissue. Excessive force and repetitive use may also damage muscles
sciatica – develops when the nerve that runs from the lower back into the leg is squeezed by a bulging intervertebral disc, causing pain
osteoporosis – is a condition where your bones lose density and strength. The vertebrae can become so porous and brittle that they break easily. Pain is due to a fracture of the vertebrae
stress – one of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and pain.
structural problems – lifelong bad posture, osteoporosis and genetic conditions (e.g. kyphosis, a curving of the upper back – sometimes called a hunchback), and scoliosis (which produces a sideways curve) can cause pain by putting added stress on the structure of the spinal column.

More persistent back pain may be associated with arthritis of the ‘facet’ joints and degeneration of the discs. However, people with this condition may not experience any pain.

Very rarely back pain can be a sign of a spinal fracture, an infection of the spine or cancer. Your GP will look for symptoms and signs associated with these conditions.

Lifestyle factors contribute to back pain.

Most cases of back pain are exacerbated by lifestyle factors including:

lack of exercise
being overweight or obese
sitting for long periods
poor posture
stress.

Diagnosis

Your doctor will discuss your back pain with you and will:

ask about your back pain, including potential causes or triggers, if you’ve had back pain before, things that make your pain worse, things that make it better
conduct a thorough physical exam.

Your doctor may also refer you for some tests, especially if they think there may be a more serious cause for your back pain.

However in most cases of back pain, imaging (e.g. x-rays, CT or MRI scans) isn’t useful and isn’t recommended.

Unnecessary tests can be expensive, and some scans involve exposure to radiation that should be avoided if the results won’t help with your treatment.

A thorough examination by your doctor will decide whether more investigations are appropriate or helpful in developing a treatment plan that’s right for you.

It‘s also important to know that many investigations show ‘changes’ to your spine that are likely to represent the normal passage of time, not damage to your spine.

For more information about questions to ask your doctor before you get any test, treatment or procedure visit the Choosing Wisely Australia website.

Prevention

The key to preventing back pain is keeping your back flexible and strong. In most cases back pain can be prevented by making a few lifestyle changes:

exercise regularly – exercise is key to a healthy back. It will improve your posture and increase muscle support of the spine. The main types of exercise that will help to keep your back strong, and reduce the risk of back pain/ injury, include:
- low impact aerobic exercise – aim for 30 minutes of moderate physical activity most days. This can be broken into shorter blocks of exercise if you prefer. Low impact aerobic exercises include Pilates, walking, swimming, yoga, tai chi or group exercise classes
- core muscle strengthening – strengthening exercises build muscle strength, provide stability to your joints and improve functionality (the ability to move and provide structural support for your body). Examples include lifting weights, climbing stairs, hiking hills, and body weight exercises such as planks, partial abdominal crunches, bridges and squats
- stretching exercises – help maintain flexibility. Stretching your back regularly means that your muscles are more supple and less prone to injury. Examples of stretching exercises are yoga and Pilates.
manage your weight – try to maintain a healthy weight to lessen the strain on your back.
quit smoking – smoking increases your chances of developing back pain.
develop good posture – be aware of your posture particularly when sitting at home, at work or in the car. Don’t slouch, and use supports such as a lumbar support or footstool where needed.
take regular stretch breaks – when you’re driving, standing or sitting for long periods of time, take a moment to stretch or move about. Try to do this every hour. This will help change the position of your joints and loosen your muscles.
lift and carry safely – if you’re picking up a heavy load, squat down, hold the object as close to your body as practical and lift by using your legs. Make sure you keep your back straight. Get some help from another person or use equipment (e.g. a trolley) if the load is too heavy to manage comfortably on your own.
relax – learn some relaxation techniques to reduce stress levels and related muscle tension. Try massage, heat or cold packs and gentle exercise. Seek advice from a physiotherapist.
try mindfulness – this is a form of meditation that has been scientifically proven to reduce levels of pain.
sleep on a good mattress – a medium to firm mattress is best for preventing back pain. It should be firm enough to support your shoulders and hips and buttocks without sagging and should keep your spine straight.Try to avoid sleeping on your stomach and use a pillow that doesn’t push your neck into a steep angle.
Shoes -try to wear flat shoes as they place less strain on your back.

When to seek help

In many cases of back pain, the first and most important treatment is to keep active and resume normal activities – work, sport and recreation – as soon as possible. The majority of back injuries will improve by themselves.

However there are times when it’s important to see your doctor to check there are no medical problems that may be contributing to your pain.

See your doctor if you have back pain and any warning signs such as:

severe pain that gets worse instead of better over time
you’re generally unwell with your back pain or have a fever
problems with passing/controlling urine or bowel movements
numbness around your anus or genitals
numbness, pins-and-needles or weakness in your legs, back or anywhere else
unsteadiness on your feet
back pain occurring with unexplained weight loss
redness or swelling on your back.

Self-management

Most cases of back pain will get better on its own and you won’t need to see a doctor. If your back pain is recent, the following may help relieve your symptoms and speed up your recovery.

Learn more about your back pain – what makes it better, what makes it worse? Knowing as much as possible about your condition means that you can make informed decisions about your healthcare and play an active role in the management of your condition.

Rest your back (temporarily) – avoid strenuous activity but where possible continue light activity (e.g. walking). If severe pain means you need a break from standing or sitting, then limit the time you spend lying down to just a few hours at a time. Bed rest for more than a day or two isn’t helpful and will actually make your back pain worse.

Get back to your normal activities – try to be as active as possible and get on with your day to day life, including work and exercise. If you’re returning to heavy manual jobs this may take longer.

Use medication as prescribed – pain-relieving and muscle relaxant medication may be prescribed temporarily by your doctor.

Learn ways to manage pain – there are many strategies you can use to deal with pain. Knowing about these different strategies and what works best for you is an important part of living with back pain. Check out the How we can help section below for links to great videos on managing pain using your brain.

Apply heat and cold therapy – hot and cold packs applied to the area of pain may be helpful in relieving pain temporarily. Make sure you take measures to protect your skin from heat and cold (e.g. wrap your ice pack in a tea towel).

Try an anti-inflammatory or analgesic cream or gel – There are many different kinds that may provide some temporary pain relief. Talk with your doctor or pharmacist for more information.

Treating ongoing back pain

Back pain can be an ongoing problem for many people. About half of the people who get back pain will experience it again. It’s important to strengthen and condition your back, and be aware of your posture, even after the pain has subsided.

Talk to your physiotherapist or exercise physiologist about exercises you can do on an ongoing basis to maintain the health of your back and for your general wellbeing.