Back PainËš


All Around Back Pain

The spine and back are made to provide a lot of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for freedom in all directions. But, there are many distinct parts of the spine which can create back pain, such as irritation to the large nerve roots that run down the arms and legs, irritation to little nerves within the spine, strains to the large back muscles, as well as any injury to the disk, bones, joints or ligaments in the spine.

Acute back pain comes on suddenly and usually lasts from a few days to a couple weeks. Chronic back pain is typically described as lasting over three months.

Back pain symptoms:

  • The pain may be constant, intermittent, or just occur with certain positions or actions
  • The pain may stay in one place or radiate to other areas
  • It may be a dull ache, or a sharp or piercing or burning sensation
  • The issue might be in the neck or low back but may radiate into the foot or leg (sciatica), hand or arm.

Fortunately, most kinds of back pain get better on their own: roughly 50% of individuals may experience back pain relief within two weeks and 90% within three months.

If the pain lasts for a few days, gets worse, does not react to back pain remedies such as rest, using heat or ice, back pain exercises and over-the-counter pain relievers, then it is usually a good idea to see a back doctor. There are two cases in which emergency medical care is needed:

  • Bowel and/or bladder dysfunction

Fortunately, these conditions are rare.

Pain Diagnosis

Diagnostic tests may indicate if a patient’s back pain is a result of an anatomic cause. However, because diagnostic evaluations in and of themselves aren’t a diagnosis, arriving at an accurate clinical diagnosis requires any evaluation to be correlated with the patient’s back pain symptoms and physical exam.

  • X-ray. This test offers information about the bones in the spine. An x-ray is frequently used to assess for spinal instability (such as spondylolisthesis), tumors and fractures.
  • CT scan. This test is a very detailed x-ray that includes cross section images. CT scans provide specific details regarding the bones in the spine. They may also be used to test for particular conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans.
  • MRI scan is particularly useful to evaluate certain conditions by providing detail of the intervertebral disk and nerve roots (which may be irritated or pinched). MRI scans are used to rule out spinal infections or tumors.

Injections may also be used to help diagnose specific types of pain. If an injection of a pain relieving medication into a certain area in the backbone supplies back pain relief, than it affirms that’s the area causing pain.


By far the most frequent cause of lower back pain is a muscle strain or other soft tissue damage. Although this condition is not serious, it may be seriously painful. Typically, lower back pain from a muscle strain will probably get better over a few weeks.

Treatment generally involves a short period of rest, activity restriction, use of hot packs or cold packs, and pain medications. Over the counter pain drugs used to treat muscle strain may include acetaminophen (e.g. Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g. Aleve). Prescription pain medications may be recommended for severe back pain.

Typically, younger people (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disk disease). Older adults (e.g. over 60) are more likely to suffer from pain linked to joint degeneration (e.g. osteoarthritis, spinal stenosis).

Sometimes, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower spine, including:

  • Lumbar Herniated Disc: The interior core of the disc may lead out and irritate a nearby nerve root, causing sciatica (leg pain).
  • Lumbar spinal stenosis. The spinal canal narrows because of degeneration, which may put pressure on the nerve root and lead to sciatica.
  • Degenerative disk disease. As the disc degenerates it can allow small amounts of motion in that segment of the spine and irritate a nerve root and lead to sciatica.
  • Isthmic spondylolisthesis. A small stress fracture allows one vertebra to slip forward on another, usually at the base of the spine. This can pinch the nerve, causing lower back pain and leg pain.
  • Osteoarthritis. Degeneration of the small facet joints at the back of the spine can lead to back pain and decreased flexibility. May also result in spinal stenosis and nerve pinching.

It’s important to know the underlying condition that is the reason for the back pain, as remedies will often differ depending upon the causes of back pain.

Risk Factors

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, smoking and pregnancy. With that said, back pain is so widespread that it can strike even if you don’t have any risk factors at all.

Patients with one or more of these factors might be at risk for back pain:

  • Aging. With the years, wear and tear on the spine that might come in conditions (e.g., disk degeneration, spinal stenosis) that produce back and neck pain. Individuals age 30 to 60 are more likely to have disc-related ailments, while individuals over age 60 are more likely to have pain associated with osteoarthritis.
  • Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For instance, degenerative disc disease seems to have an inherited component.
  • Occupational hazards. Any job that needs repetitive bending and lifting has a higher incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing with no break (e.g., barber) or sitting in a seat (e.g., software programmer) that does not support the spine well puts the person at greater risk.
  • Sedentary lifestyle. Lack of regular exercise increases risks for incidence of lower back pain, also increases the severity of the pain.
  • Weight. Being overweight increases strain on the lower back, in addition to other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.
  • Bad posture. Any type of poor posture prolonged over time create a risk for back pain. Examples include slouching over a computer keyboard, driving hunched over a steering wheel and lifting improperly.
  • Pregnancy. Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.
  • Smoking. People that smoke are more likely to develop back pain than people who don’t.

Time To Contact A Back Doctor

Generally, when the pain has any of the following characteristics, It’s a good idea to visit a doctor for an evaluation:

  • Back pain that follows an accident, such as a car accident or falling from a ladder
  • The back pain is ongoing and is becoming worse
  • The pain continues for more than four to six weeks
  • The pain is severe and does not improve after a few days of typical remedies, such as rest, ice and pain relievers (such as Ibuprofen or Tylenol)
  • Severe pain during the night that wakes you up, even from a deep sleep
  • There’s back and abdominal pain
  • Numbness or altered feelings in the upper inner thighs, buttock or groin area
  • Neurological symptoms, like weakness, numbness or tingling in the extremities — the leg, foot, arm or hand
  • Unexplained fever with increasing back pain
  • Sudden upper back pain, particularly if you are at risk for osteoporosis.

The bottom line that everyone should remember is that if a person is in doubt, consult a physician. If back pain is getting worse over time, doesn’t get better with rest and over the counter pain remedies, or entails neurological symptoms then it’s a good idea to  see a back pain doctor.

Upper And Middle Back Pain



Pain in the upper and/or mid back is not as common than lower back or neck pain. The upper back is called the thoracic spinal column, and it is the most secure part of the spine. The reach of movement in the upper back is limited because of the backbone’s attachments to the ribs (rib cage).

Upper back pain is generally caused by soft tissue injuries, like sprains or strains, muscle tension caused by bad posture, or looking downward for long time spans (eg, texting, mobile phone use).

  • Pain
  • Tightness
  • Stiffness
  • Muscle spasm
  • Tenderness to touch
  • Headache

Upper And Middle Pain

An episode of upper back pain can be actuated by distinct moves and actions, iincluding:

  • Twisting
  • Excessive bending
  • Whiplash or alternative neck injury
  • Lifting improperly
  • Poor muscle tone
  • Persistent movements, overuse
  • Contact sports
  • Carrying a load that is heavy
  • Smoking
  • Being overweight

Poor posture working at the computer for a long time without taking a break to walk around and extend, or in general can promote upper back pain. Both muscle fatigue and muscle pull, which often result from poor posture, can trigger the pain.

What To Do?

Usually, upper back pain is not a cause for worry; however, it can be uncomfortable, painful, and inconvenient. Also, if pain develops suddenly and is serious—such as from an injury (eg, fall)—and, certainly if pain and symptoms (eg, weakness) progressively worsen you should seek medical attention.

Generally, the next home treatments can help relieve back pain that is upper.

  • Short term rest
  • Mild Stretches
  • Over the counter medicine, for example ibuprofen, (Motrin®), naproxen sodium (Aleve®), or acetaminophen (Tylenol®). Take with food, and don’t take more than the recommended dose.
  • Use a cold pack that is commercially available or fill a plastic bag with ice and seal it wrap it. Apply to the painful area for 20 minutes every 2-3 hours for the first 2 to 3 days.
  • Heat (after the very first 72 hours). After using heat, gently stretch the muscles to enhance mobility and alleviate stiffness.

Your physician may prescribe drugs, like a muscle relaxant or perform trigger point injections to greatly help break up muscle spasms. He or she may also recommend physical therapy to increase flexibility, mobility and alleviate pain. Other treatments your doctor may suggest include acupuncture and chiropractic care.

Most cases of upper back pain resolve in 1 to 2 weeks without additional treatment. When you’re able to perform them without pain restart your regular activities slowly. Don’t rush matters, however: you could interfere with your healing and risk re-injury.

Lower Back Pain

Low and lower back pain can differ from dull pain which develops gradually to sudden, sharp or persistent pain felt under the waist. Regrettably, almost everyone, at some point during life may experience low back pain that may travel downward into the buttocks and sometimes into one or both lower extremities. The most common cause is muscle strain often linked to heavy physical labor, lifting or forceful movement, bending or twisting to awkward positions, or standing in one position too long.

Other Causes: Low Back Pain

There are several different conditions that cause or lead to low and lower back pain. Many involve nerve compression (eg, pinched nerve) that can cause pain and other ailments. Kinds of spinal disorders include trauma-related and degenerative diseases; meaning age-related. A few of these spinal problems are given below.

  • Bulging or herniated disc. A disk may bulge outward. A herniated disc occurs when the soft inside matter escapes through a crack or ruptures through the disk’s protective outer layer. Both disc problems can lead to nerve compression, inflammation, and pain.
  • Spinal stenosis develops when the spinal canal or a nerve passageway abnormally narrows.
  • Spinal arthritis, also called spinal osteoarthritis or spondylosis, is a common degenerative spine problem. It affects the spine’s facet joints and may contribute to the development of bone spurs.
  • Spondylolisthesis occurs when a lumbar (low back) vertebral body slips forward over the vertebra below it.
  • Vertebral fractures (burst or compression types) are often caused by some type of injury (eg, fall).
  • Osteomyelitis is a bacterial infection that may develop in one of the spines bones.
  • Spinal tumors are an abnormal growth of cells ( a mass) and are recognized as benign (non-cancerous) or malignant (cancer).

Home Therapies

If you have recently injured your low or lower back, here are some things you can do.

  • Ice then heat
    During the first 24 to 48 hours, use ice wrapped in a towel or cloth. Ice will help to reduce swelling, muscle spasms, and pain. Thereafter, switch to heat. Heat helps warm and relaxes sore tissues.

Caution: Never use a cold or heat source directly on skin, always wrap it into something.

  • Over the counter medications
    Tylenol or Advil, taken according to package instructions, may help reduce inflammation and pain.
  • Take it easy
    While days of bed rest are no longer recommended, you might have to modify your everyday routine to give your lower back the opportunity to recuperate.

Time To Seek Medical Treatment

  • Low back pain is, or becomes severe and persistent
  • Doesn’t subside after a few days
  • Interferes with sleep and daily tasks

Symptoms listed below always require immediate medical attention:

  • Groin or leg weakness or numbness

Chiropractic Clinic Extra: Back Pain Treatment

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Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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