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Back pain is a common condition that affects most people at some point in their lives. There are different kinds of back pain, and while some might be temporary, others might require medical attention.

Acute back pain lasts for a short period, from a few days to a few weeks. This kind of back pain is often the result of an injury incurred during an accident or fall, or if you lift a heavy object without taking care of your back. Acute pain in your back usually goes away by itself, along with some rest and perhaps the use of over-the-counter medications.

Chronic back pain usually lasts for more than three months. Chronic pain could be treated with a variety of therapies and does not necessarily require surgical intervention.

Basic Anatomy of the Spine

Your spine consists of 33 bones, called vertebrae, stacked on top of each other. Muscles and ligaments support your vertebrae. Intervertebral discs and facet joints connect the vertebrae together to form your spine.

Spinal Curves

Your spine has three natural curves, creating an S-shape in your spine. These curves absorb shock, help you keep your balance, and give you range of motion throughout your spinal column. Your spine curves in towards the front of your body in your neck (cervical) and lower back (lumbar) areas. The middle of your spine (thoracic) curves slightly to the back, as does the very bottom of your spine.

Back Muscles

Your back muscles work with your abdominal muscles to preserve your spine's natural curves and keep your spine stabilized. There are three main groups of back muscles:

  • Extensor muscles that are attached to the back of your spine. These muscles help to hold you upright and play a role when you pick things up.
  • Flexor muscles are attached to the front of your spine and include your abdominal muscles. These muscles assist with a range of movements in your lower back, like bending forward, flexing, lifting, and arching your lower back.
  • Oblique muscles are attached to the sides of your spine and help you to maintain proper posture. These muscles also function when you twist your spine.

Vertebrae

33 vertebrae make up your spinal column. These are individual bones stacked on top of each other. Your spinal column is divided into five sections from top to bottom: cervical, thoracic, lumbar, sacrum, and coccyx.

Your cervical spine is located in your neck – area and carries the weight of your head. The vertebrae in this area are called C1 to C7. The very first two vertebrae, called C1 and C2, are shaped differently than the vertebrae in the rest of your spine. This allows your head to move up and down and from side to side.

Your thoracic spine is in the middle of your back. In this area, the vertebrae are connected to your rib cage, protecting your lungs and heart. These 12 vertebrae are numbered T1 to T12 and have a limited range of motion.

Your lower back is called your lumbar spine, and this area carries your body weight. The vertebrae in this area are numbered L1 to L5, and they assist with absorbing stress when you are lifting and carrying heavy objects. Because they carry your body weight and allow you to lift heavy objects, these vertebrae are larger than the other vertebrae in your spine.

The five vertebrae in your sacrum are called your sacral vertebrae. These five vertebrae fuse together, and with ligaments, connect your spine to your hip bones, forming the sacroiliac joint.

Your coccyx, often referred to as your tailbone, has four vertebrae that are bonded together. These attach to the ligaments and muscles of your pelvic floor.

The central part of each vertebra is shaped like a drum. These stack on top of each other to form your spinal column. An arch-shaped bone, called the spinous process, grows from these structures. These structures are connected to the vertebrae above and below it by a facet joint. A small hole, the spinal canal, is formed between the body of the vertebra and encircled by this arch-shaped bone. Your spinal cord, blood vessels, some fat, and ligaments pass through this small hole. On the outside of this hole and each side of the spinous process are the transverse processes, which is where muscles attach.

Intervertebral Discs

Your intervertebral discs are small pouches of fibers, filled with gel. These discs sit between the drum-like bodies of your vertebrae and allow them to move without grinding against each other. Your intervertebral discs absorb the stress and shock that your body sustains when you move.

Facet Joints

The facet joints in your spine connect each vertebrae, creating a joint. These joints are not the same as your intervertebral discs. While your intervertebral discs are located between the main drum-like bodies of your spine, your facet joints are between the star-like structures that protrude from the arched parts of each vertebra. These contact areas are covered with cartilage and enable your spine to flex when you move. Your facet joints allow for range of motion, flexibility, and stabilization of the spine.

Different Types of Back Pain From a Musculoskeletal Point of View

There are numerous reasons why you might be experiencing back pain. It might be as simple as sprained or hurt muscles, or it could be a severe condition that requires medical attention.

Muscle or Ligament Strain

Injury or overexertion of the ligaments and muscles in your back could cause back pain. Back pain could also be caused by spending a lot of time sitting or standing in one position, especially when your posture isn't right, like when working at a desk. Chronic stress could lead to stiff muscles. Because these stressed muscles are always engaged, they use up energy that could be used to support the spine more efficiently, leaving your spine vulnerable.

Bulging, Ruptured, or Herniated Discs

A ruptured disc is when one of the gel-filled pouches between your vertebrae ruptures or bulges and presses against your spinal cord or a nerve. When it does become herniated, it is often an indication that the disc is degenerating. This disc degeneration can occur in any part of the spine but is more common in the spine's lumbar and cervical regions.

A disc could become herniated with this single disproportionate strain or injury in that area. Intervertebral discs naturally degenerate as you get older, and the ligaments that hold the discs in place start to weaken. When this happens, even a minor strain or twisting movements of the back could cause the disc to rupture.

Some people are more vulnerable to intervertebral disc injuries and might sustain more than one herniated disc in different areas of their spine. A family history of herniated disc problems could make you more vulnerable to this.

Osteoarthritis of the Spine

Osteoarthritis of the spine is also referred to as noninflammatory or degenerative arthritis. This kind of arthritis occurs when the cartilage between the joints in the spine wears down. It could lead to the development of spinal stenosis, affecting your spinal cord and nerves. Because osteoarthritis occurs in the joints, the pain could worsen when you move your spine by bending or twisting. While osteoarthritis often occurs due to normal wear and tear, a history of a back injury could lead to this condition's development.

Osteoporosis

Osteoporosis causes your bones to become weak and brittle. Bones are continuously regenerating new cells to replace the ones that are dying off. When you have osteoporosis, the rate at which the new bone cells generate is slower than the rate at which the older ones are dying off.

Because osteoporosis makes your bones less dense, suffering from this condition could lead to compression fractures in your spine. These fractures can occur even when your vertebrae experience slight stress like when coughing or bending. In extreme cases, daily pressure like walking could cause a compression fracture. People with advanced osteoporosis could experience multiple compression fractures throughout their spine.

Symptoms of Back Pain

Back pain could range from sharp or sudden shooting, burning, or stabbing sensations to a dull and consistent ache in the bones, muscles, or ligaments. The pain might get worse when you bend, twist, stand, walk, or lift something.

You might also experience back pain as a result of other issues.

Osteoarthritis:

  • Back and neck pain, often in the lower back.
  • Loss of range of motion or a feeling of stiffness in your spine. This stiffness and limited motion happens when you bend or straighten your back or turn your neck.
  • Signs of inflammation, like tenderness and swelling around the affected vertebrae. You might also experience this in other areas of your body.
  • Headaches – which could be caused by arthritis in the neck.
  • Pain, tingling, or numbness in your arms or legs if the nerves are affected.
  • Feeling as if the parts of your spine are grinding against each other.
  • Experiencing fatigue and weakness, including muscle weakness throughout your body.

Osteoporosis:

  • Back pain in the area of the compression fracture. The pain could start gradually or appear suddenly and could be severe.
  • Changes in the natural curve of your spine, especially in the upper back. The compression of the vertebrae often creates a visible hunch.
  • Reduction in height that could be caused by multiple compression fractures along your spine.
  • Issues in your respiratory and cardiovascular systems, possibly caused by the shortening of your chest and compression of your abdomen due to multiple spinal compression fractures.

Facet joint problems:

  • Experiencing severe back pain only on occasion and often unpredictable without any apparent cause.
  • The skin around the affected area is also sore or tender. Pressing on this area could involve involuntary tensing of muscles (guarding reflex).
  • The pain increases when you bend backward.
  • Pain in your neck or the upper spinal area is accompanied by a shooting or burning pain that spreads across your shoulders and upper back but is absent in your arms and fingers.
  • Low back pain is accompanied by pain that spreads into your buttocks and the backs of your upper legs.
  • Pins and needles, numbness, and weakness in your buttocks and legs.
  • Low back pain gets worse when you sit for long periods, and riding in the car is excruciating.

Herniated disc:

  • Pain shooting or spreading down the front of your legs.
  • Pain, weakness, or numbness in the area of your body to which the affected nerve travels.
  • Pain that radiates along the sciatic nerve. The sciatic nerve runs from your lower back through your hips and buttocks and down each leg.
  • Sciatica could include pain, burning, tingling, and numbness that spreads from your buttocks into your leg and sometimes down into your foot.
  • The pain is usually experienced only on one side and does not necessarily have to be accompanied by back pain. If the condition is severe, your leg pain will be worse than the pain you feel in your back.
  • A herniated disc in your neck could show up as dull or sharp pain in your neck or between your shoulder blades. The pain would often spread down your arm to your hand and fingers. You could also experience numbness or tingling in your shoulder or arm.

When to See a Doctor

Although back pain is a fairly common condition that sometimes is treatable at home, there are some cases where you might need medical attention. If you experience back pain more than once in any particular area without an exact cause, you should visit your doctor.

It might be time to see a doctor if you experience any of the following:

  • Back pain that lasts longer than a few weeks.
  • Severe back pain that does not get better with rest or over the counter medication.
  • If the pain spreads to your arms and legs.
  • If you have weakness, numbness, or tingling in your arms or legs.
  • Bladder or bowel dysfunctions and loss or altered sensation between the legs, over the buttocks, along the inner thighs and back of legs, and feet could indicate cauda equina syndrome. Cauda equina syndrome is rare but serious, and early detection and treatment are vital.

Diagnosing Back Pain and the Different Causes

Your doctor will use several methods to diagnose the cause of your spine pain. Since a number of things could cause your pain symptoms, you might need to undergo several tests to pinpoint the cause of your pain symptoms.

History

The first step in diagnosing back pain is to establish your medical history. Your doctor will ask you questions, including when your back pain started, how often you experience it, and whether there was any specific incident that caused harm to your back.

Physical examination

During a physical examination, your doctor will assess how you sit, stand, walk, and move around. They are likely to ask you to rate your pain on a scale from one to ten, how often you experience the pain, and how it affects your daily life.

A physical examination for evidence of osteoporosis would look at the curve of your spine. Your doctor will see if you have a hunch in your upper back or whether the inward curve in your lumbar spine is extreme.

X-ray

X-ray images can identify whether you have arthritis, osteoporosis, or broken bones. These images show the structure of your vertebrae and the outline of your joints.

Magnetic Resonance Imaging (MRI)

These scans produce 3-D images of your bones, muscles, tendons, tissue, nerves, ligaments, and blood vessels. They are used to establish whether there are problems with your bones and can be used to diagnose bulging, ruptured, or herniated discs. The images can show your spinal cord, nerve roots, and surrounding areas. It can also indicate whether any enlargement, degeneration, or tumors are present.

CT Scans

Computerized tomography (CT) scans make use of a computer interpretation of X-rays. They can show the shape and size of your spinal canal, its contents, and the structures around it.

Blood Tests

Blood tests establish whether you might have an infection or other conditions that could cause your back pain. They could test for hormone levels, biochemical markers, Vitamin D deficiency, Calcium levels, genetic markers, or RA antibodies that could indicate osteoarthritis or osteoporosis.

Bone Scans

Bone scans determine whether you might have fractures that are caused by osteoporosis. It could also identify whether you have a bone tumor. During a bone scan, a small amount of radioactive liquid gets injected into your veins. This liquid collects in your bones. The area is then scanned by a machine that detects the radioactive fluid and produces an image of the bone.

Electrodiagnostic Tests

Electromyography (EMG) can be used to measure the electrical impulses produced by your nerves and how your muscles respond to these impulses. This could diagnose herniated discs and spinal stenosis (the narrowing of your spinal canal). They could show whether you are experiencing nerve damage, whether your nerves are currently healing from a post-injury, or whether there is nerve compression.

Joint Aspiration

Joint aspiration tests the synovial fluid inside the joints. This fluid is located between moving joints and reduces friction between them.

Treatment Options

Treatment options for back pain relief vary and largely depend on the cause of the pain. In general, the most conservative treatment options should be pursued for pain management before more invasive options.

Rest

In some cases, merely resting your back for a few days could help the muscles, ligaments, and tendons to heal. This could include complete bed rest where you only get up to perform vital activities, although this is not always recommended for all kinds of back pain. For example, bed rest is not recommended for herniated disks. Some activities could help ease stiffness in your back and help you maintain your range of motion. Light exercise, like walking, is recommended.

Hot and Cold Treatment

Heat relaxes muscles and could soothe painful areas, while cold treatments can numb the pain and reduce inflammation.

Medications

Over-the-counter medications like pain medications and muscle relaxants could help to reduce your back pain. If the pain is severe, you might need to ask your doctor to prescribe more vital pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids could be prescribed for some conditions to reduce the pain and swelling. An epidural steroid injection could be administered for a herniated disc. In this case, the steroid is injected directly into the area where the disk has a ruptured.

Physical Therapy

Physical therapy for your back focuses on strengthening and stretching your back muscles and increasing the range of motion in our spine.

Your physical therapist could include pelvic traction, gentle massages, ultrasound, ice and heat therapy, and electrical muscle stimulation as a part of your treatment process.

Surgery

Surgery could be an option if other treatments aren't effective. Surgery for osteoarthritis could focus on decompressing the spinal cord and releasing nerve roots that might be pinched by the structures in your spine. Spinal fusions could also be a treatment option for osteoarthritis. This procedure connects two or more vertebrae to stabilize vulnerable areas.

You might also consider surgery if your back pain limits your everyday activity and affects your quality of life. You might also consider surgery if there is evidence of progressive neurological issues like weakness or numbness in your legs, and if you have difficulty standing or walking.

How to Prevent Back Pain

The best way to prevent back pain is to ensure that your back and spine is strong and healthy.

Regular Exercise

Regular, low-impact exercise can help to strengthen your back and abdominal muscles. Stronger core muscles protect your spine by functioning as a natural back brace.

Maintain a Healthy Weight

Being overweight can place a lot of strain on your back muscles and spine, especially in your lower back. Maintaining a healthy weight could prevent back pain.

Quit Smoking

Smokers experience more back pain than non-smokers, and individuals who smoke more seem to experience higher back pain rates than people who smoke less or who do not smoke. Many factors could cause this, including smoking's contribution to osteoporosis development and the tendency for smokers to cough more than non-smokers. This increase in coughing could lead to a higher risk of developing a herniated disk.

Posture

Your spine has a natural S-curve. Sitting or standing incorrectly could cause your spine to curve awkwardly and strain your spinal column.

Take Care When Lifting Heavy Objects

Lifting heavy objects could place a lot of stress on your spine. When lifting something heavy, use your legs by bending your knees while keeping your back straight and avoiding twisting your spine. When you are carrying heavy objects, keep the weight close to your body.

Get Enough Vitamin D and Calcium

Vitamin D and calcium are both critical for good bone health. A deficiency in either or both could increase your chances of getting osteoporosis, which could lead to compression fractures.

Take Care of Your Feet

This might seem counter-intuitive, but wearing proper, supportive footwear provides your feet with the support they need to carry your body weight. Better support means less shock, and stress gets transferred to your spine. Your feet absorb much of the force from walking, and if your foot does not absorb it correctly, it can create a lot of pain in your knees, hips, and back. If you have problems with your feet or ankles, you may be placing additional strain on your muscles, which causes them to work harder and leads to misalignment of the spine. Wearing the correct type of shoe can reduce the pressure placed on your muscles and helps you avoid back pain. Proper footwear can also help keep your entire body, especially your spine, in alignment, leading to an overall healthier spine.

Who is at Risk

While anyone could experience back pain, some factors could put you at a higher risk.

Back pain becomes more common as you get older. Your bone density naturally decreases with age, and your muscles and ligaments might lose some of their strength. Loss of bone density and muscle strength make older individuals more susceptible to experiencing back pain.

A lack of exercise means that your muscles, especially your back and abdomen muscles, might not be strong enough to adequately support and protect your spine. On the other hand, intense exercise and extreme sports could also increase the risk of developing back pain.

Smoking decreases the blood flow to your spine and could increase your risk of developing osteoporosis.

Individuals who are overweight are at a higher risk of developing back pain as more weight places larger amounts of stress on the spine. Pregnant women could also experience back pain due to the extra weight that she needs to carry.

Back pain is a common ailment that affects most people at least once in their lives. While, in some cases, pain symptoms go away with rest and over-the-counter pain treatment, it could be an indication of more serious problems.

Ensuring that you stay healthy and fit, and taking proper care of your spine by maintaining good posture could lower your risk of developing back pain.

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