Low Back Pain, Mid-Back Pain, Upper Back Pain, Buttock Pain, Tailbone Pain...Pain is a Symptom: What Might Be Causing The Pain?
The following article outlines some of the types of back pain and the causes I regularly see at my chiropractic office in Lower Lonsdale, North Vancouver.
In the 20 years I've been treating patients, thousands (tens of thousands?) of people have come through my door with "back pain". In many cases, they have sought advice from other practitioners, friends, family, coworkers and even "Dr. Google". Many times, the advice they have tried prior to seeing me has been ineffective or, sometimes, made their pain worse. In my experience, this is often due to blanket advice treating all "back pain" the same way. What is important to realize though, is that pain, regardless of where a person feels it in the body, is a symptom. The big, important questions are: Why and What?
Why has this pain occurred? Is there injured tissue? If so, what tissue(s)? This is crucial because different structures and tissues that can cause "back pain" require different advice, exercises and treatment as what helps one source of back pain can worsen a different source.
If there isn't a tissue injury, or the level of injury does not explain the level of pain, the why becomes even more important. Are the external factors like stress or internal factors such as hormonal changes playing a contributing role?
This article focuses on the some of the many structural and functional causes of back pain; the "bio(logical)" component of the biopsychosocial model that is currently the means of understanding and addressing back pain. The psychosocial (psychological and societal) components will be addressed in a future article.
Back Pain is Common, But Not Always "Normal"
I inform patients that an aching back is common and normal. Think about the morning after the first ski day of the season, or in the spring after that first sunny day in the garden. Or after assembling a kid's room worth of IKEA flatpack furniture (yes, this was me recently). The muscles in the back can get used and can become aching and sore, no different to the muscles in the legs after a run that they aren't used to or your biceps following arm day at the gym. We're stiff and sore for a few days but then it settles down.
Back pain is different. It is common:
Up to 80% of people will experience ow back pain at some point during their lifetimes.1 2
At any given point in time, about 26% of U.S. adults have low back pain.3 4
The percentage of adults with back pain increase(s) with age, from 28.4% for those aged 18-29 and 35.2% for those aged 30-44 to 44.3% for those aged 45-64 and 45.6% for those aged 65 and over.5
However, despite how common back pain is, that does not make it normal. For instance, a notable study published in the Journal of Experimental Biology in 2015 examined the prevalence of musculoskeletal disorders, including low back pain, in several traditional societies. It found that hunter-gatherer populations, such as the Hadza of Tanzania, reported lower rates of low back pain compared to populations in industrialized societies.
Another relevant study published in PLOS ONE in 2014 looked at the incidence of back pain among the Ache people of Paraguay, a forager-horticulturalist society. The study found that the Ache had significantly lower rates of low back pain compared to Western populations.
In the simplest sense. this lower prevalence is thought to be related to their physically active lifestyle, varied physical activities, and the absence of modern sedentary behaviors, though in reality there is more underlying. That is fodder for a future article.
Fortunately, despite what Dr. Google tends to tell us, the cause of back pain is rarely serious, such as cancer, and it seldom requires surgery. This is why a thorough history and examination is crucial; to obtain an accurate diagnosis so the appropriate care can be provided.
Below is a list of the more common causes of back pain.
Common Causes of Back Pain
Acute Low Back Pain
"Acute" low back pain suggests that your symptoms developed recently. Acute pain is sharply intense and is often accompanied by muscle guarding or spasms. Sometimes the pain and spasms force your trunk to bend forward or toward the side into an "antalgic" posture. Because your back pain is considered acute, the following recommendations may be helpful in the early stages.
Lumbar Disc
A lumbar disc lesion means one of the five spongy discs in the lower part of your spine is damaged and irritated. Problems start when the disc's outer fibers become strained or frayed, allowing the inner jelly to bulge or protrude when compressed, much like a weak innertube. This can cause pain in the lower back that radiates into the buttocks or legs, called sciatica. Be sure to tell your provider immediately if you notice progressive weakness or numbness in your legs or groin, any loss of bowel or bladder control, or fever.
One-third of adults will experience pain from a lumbar disc at some point in their lifetime. Smokers and people who are tall or overweight have an increased risk of disc problems. Certain occupations may place you at greater risk, especially if you spend extended periods sitting or driving.
Research has shown that 97% of disc bulges and sciatica may be successfully managed with conservative care as we provide. To help reduce pain during coughing and sneezing, keep your back straight, bend your knees, and put your hands on a wall or tall counter for support.
Sciatica
Lumbar radiculopathy is a condition in which one or more of the nerves coming out of your lower back has become irritated or pinched, causing pain, numbness, or tingling in the specific area of the leg supplied by the irritated nerve. This is often called sciatica because it affects the sciatic nerve, which supplies the back and outside of your thigh and calf. Lumbar radiculopathy symptoms can range from a dull ache to severe, constant shooting pain and may be worse with certain positions or movements. Be sure to tell your provider immediately if you experience any
progression of pain, numbness, or weakness in your groin or legs.
Fortunately, chiropractic care is generally effective and lowers the likelihood of needing surgery. To treat lumbar radiculopathy, it is essential to address the source of the nerve irritation and follow your treatment plan and home exercises closely.
Chronic Lumbar Disc Pain
The low back consists of five stacked bones called vertebrae, separated by flexible cushions called discs - consisting of a soft inner part called the nucleus and a tough outer part called the annulus. Discogenic low back pain occurs when discs are damaged by repeated stressors, such as bad posture, a sedentary lifestyle, poor-fitting workstations, or improper lifting. Smokers, inactive people, and those who are tall or overweight have an increased risk of disc problems. Symptoms of discogenic low back pain can range from dull discomfort to severe pain that radiates into your hips and legs.
Lumbar Arthritis
Lumbar spondylosis, or back arthritis, means your spinal discs and joints have worn and thinned. Symptoms often begin as back pain and stiffness relieved by light activity and aggravated by strenuous work or complete inactivity. Sometimes, your nerves can become pinched in narrowed openings where they exit your spine, causing pain, numbness, or tingling radiating into your leg (i.e., sciatica).
Lumbar Stenosis
Lumbar spinal stenosis means the space around your spinal cord and nerve roots is too small, and the nerves are squeezed. Spinal stenosis is usually caused by long-term arthritis that narrows the canal. Symptoms include back and buttock discomfort that worsens with standing or walking and eases by sitting or flexing forward. You might feel pain, numbness, or tingling in your legs. Be sure to tell your provider immediately if you experience any leg changes, such as weakness, numbness, clumsiness, coldness, or swelling, or if you have groin numbness or loss of bladder control.
Lumbar Facet Syndrome
Your lower back is made up of five bones stacked on top of each other by a tripod, consisting of a shock-absorbing disc plus two smaller bony pillars capped with smooth "facet" joints. Facet syndrome means these joints have become irritated and inflamed from sprains, strains, or lack of movement. Symptoms include intermittent back pain that may radiate into your flank, hip, and thigh and worsens when you arch backward or return to an upright position after bending forward. Many patients report relief when they lie down. Be sure to tell your provider immediately if your symptoms include any radiation of pain below your knee, weakness, groin numbness, changes in bowel or bladder function, or if you have a fever.
Lower Crossed Syndrome
Your posture plays an important role in your overall health. Poor posture leads to chronic strain and discomfort. Lower crossed syndrome is a postural imbalance resulting from excessive tightness in your lower back and hip flexor muscles and weakness in your abdominal and buttock muscles. Patients with lower crossed syndrome often have a swayback. Patients who sit for prolonged periods are at greater risk of lower crossed syndrome. This postural problem commonly leads to painful conditions involving the back or hips.
Lumbar Spondylolysis
Envision a lower back vertebra as a coffee mug lying on its side. The cup represents the vertebral body, and the handle is the arch. The term lumbar spondylolysis means your body is breaking away from the arch. This stress fracture commonly occurs during adolescence and typically affects the lowest lumbar vertebra following repetitive activity, especially arching back. The problem affects 6-7% of the population but is more common in athletes. This can lead to a Lumbar Spondylolisthesis.
Lumbar Spondylolisthesis
Lumbar isthmic spondylolisthesis means your body has broken free from the arch and slid forward, creating a separation between the front and back halves of the vertebral bone. This condition is less stable than a Spondylolysis, but often responds very well to the appropriate conservative care.
Thoracolumbar Junction Syndrome
Thoracolumbar junction syndrome (Maigne syndrome) is an often-overlooked cause of discomfort in the low back, hip, and buttocks. This problem affects the cluneal nerves, which originate from your mid- to-lower spine, then travel downward toward your hip. Inflammation or irritation in your spine or anywhere along the course of these nerves can cause unwanted pain, tingling, or numbness. The condition has been nicknamed "sciatica of the mid-back." Patients often describe their discomfort as chronic and nagging. Symptoms can sometimes radiate into your groin. Prolonged walking or sitting in a slouched position probably increase your symptoms. You may also notice increased discomfort when squatting, bending, twisting, arising from a chair, or rolling from side to side in bed. Be sure to tell your provider if you notice a fever, flu-like symptoms, or any urinary changes, including increased frequency or cloudiness.
Sacroiliac Joint Dysfunction
Your "SI" or sacroiliac joint connects each leg to the rest of your body. SI joint dysfunction means one or both joints have lost their normal motion. These restrictions cause the surrounding muscles to become overworked, leading to tightness, compression, inflammation, pain, and more restriction. Sacroiliac problems may be caused by repetitive activity, trauma, poor posture, leg length differences, flat feet, or any other condition that affects how you walk. Pregnancy can also trigger sacroiliac problems due to weight gain, gait changes, and postural stress. Sl problems often begin as a focal discomfort in your back just below the beltline, slightly to one side of the center. Your pain might travel into your buttock or thigh and is usually provoked when you change positions- like exiting a chair, car, or bed, or during long car rides. The pain is often relieved by lying down.
Thoracic Joint Restriction
Thoracic segmental joint restriction means that one of the twelve bones in the middle of your back is slightly misaligned or restricted. To help visualize this, imagine a normal spine functioning like a big spring moving freely in every direction. A spine with a joint restriction is like having a section of that spring welded together. These restrictions cause the surrounding muscles to become overworked, leading to tightness, compression, inflammation, pain, and more restriction.
Many things can cause a joint to become restricted, including injuries, repetitive strain, or poor posture. Symptoms include limited mobility and discomfort that increases with movement, sometimes even radiating around your ribs. Be sure to tell your provider if you have unusual cough, indigestion, fever, rash, or flu-like complaints. Seek immediate medical attention if you experience chest pain or shortness of breath.
Scheuermann's Kyphosis
Scheuermann's kyphosis is a condition where your back curves more than usual, which might give your back a gently rounded appearance. This often starts in pre-teen or teenage years, especially during growth spurts, and is more common in boys. Up to 8 percent of people have this condition, and it could be related to genetic factors. X- rays can show when the bones in your spine, called vertebrae, have grown unevenly, causing your spine to curve more.
Scheuermann's kyphosis can cause pain and stiffness in your middle and lower back. However, our office can help with hands-on care and specific exercises that strengthen your back muscles and improve flexibility and posture. Staying active and using proper posture can help you feel better and manage your symptoms.
This list may seem a bit overwhelming, and, admittedly, it is not a complete list of all causes of back pain. But there is hope!
What Can Be Done About MY Back Pain?
There is plenty that can be done to address the sources of back pain. Research has consistently shown that a combination of education, exercises and effective treatment (the right treatment for the right type of back pain) has a very high average rate of improvement; 71%-100% within 30 days for the conditions listed above.
Ready to get back to doing all the activities that you want and need to do? To book an Initial Chiropractic Assessment in Lower Lonsdale, North Vancouver, to determine the cause of your back pain, please click here or follow the "Book Appointment" buttons on the homepage.
Experienced, effective, evidence-informed care.
References
Biering-Sørensen F. A prospective study of low back pain in a general population. III. Medical service--work consequence. Scand J Rehabil Med. 1983;15(2):89-96. [PubMed]
Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T. Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg Am. 1983 Feb;65(2):213-8. [PubMed]
Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006 Nov 1;31(23):2724-7. [PubMed]
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008 Jan;58(1):26-35. [PMC free article] [PubMed]
Centers for Disease Control and Prevention. (2023). Data brief: The relationship between childhood asthma and obesity (No. 415). National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db415.htm
*references prepared in part with GPT
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