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Causes of back pain


Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due July 2021

Back pain is very common, especially lower back pain. Around six out of 10 people are affected by lower back pain during their lifetime. You can also get pain in your upper back, your neck, hips and shoulders, and pain that travels down your leg.

Back pain doesn’t normally have a serious cause. In most cases, the pain will improve within:

  • a few weeks if you’ve pulled or strained a muscle in your middle or upper back
  • four to six weeks if it’s your lower back that hurts (this is called acute lower back pain)

However, for some people, back pain can become chronic (long term) and continue for many months or even years.

Girl taking a photo

About your back

It can help to know more about how your back is constructed.

Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons. Your spine supports your back. Your spine is made up of 24 separate bones called vertebrae that are stacked on top of one another. Below these are the bones of your sacrum and coccyx, which are at the bottom of your spine. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord passes through the vertebrae. It carries nerve signals between your brain and the rest of your body. The spinal cord ends in your lower back as a bundle of nerves. This is called the cauda equina (Latin for horse’s tail, which it’s thought to resemble).

An image showing the different parts of the spine

What is non-specific back pain?

Non-specific lower back pain is the most common type of back pain. This means your doctor or physiotherapist probably can’t tell you exactly what’s causing the pain, but it’s not usually due to a serious problem. Non-specific back pain is often caused by a pulled muscle or ligament in your back, but no one knows for sure. You can also get non-specific pain in your neck and upper back.

What activities or events might cause back pain?

There may be an event or movement that started your back pain. Perhaps you were straining, twisting or lifting something heavy. Or your back pain may have come on gradually. In some people, it’s linked to repetitive tasks at work or sitting in one position for a long time. You use and move your back all the time, so there are lots of reasons why you might hurt it. We have spoken to several people who’ve had back pain in the past and below are some of the reasons why they got it.

  • poor posture sitting at a desk or on the sofa to work from a laptop
  • dragging a suitcase
  • gardening
  • doing some household chores such as loading or unloading the washing machine or bending over the sink or ironing
  • playing with the kids or picking them up
  • pulling or straining a muscle while exercising
  • working long hours on your feet, such as standing behind a bar for a long time
  • waking up with back pain which might be caused by an unsupportive mattress
  • being overweight

Specific causes of back pain

Sometimes, damage to parts of your spine can be the cause of back pain. This might be from an injury such as whiplash or a fall. Or it might be caused by a particular condition. We’ve described some of the main ones below.

Arthritis (osteoarthritis)

There are different types of arthritis, but osteoarthritis (pronounced os-tee-oh-ar-thry-tis) is the most common form. It affects your joints, making them painful and stiff. In your back, it’s commonly the joints in your neck or the lower back that are affected. You can also get osteoarthritis in other parts of your body such as your knees and hips. If you have osteoarthritis, the cartilage that covers the ends of your bones gets rougher and thinner. The bone underneath thickens and your joints can become inflamed. The whole joint may be affected including the surrounding tissues and ligaments. There can be a build-up of fluid inside the joint. These changes can cause pain and make it difficult to move as easily as you once could.

The pain is usually worse when you’re moving and using your joint. The stiffness can be worse after you’ve been resting – when you wake up, for example. If your osteoarthritis is severe, you might have symptoms all the time. The weather can affect your symptoms too – for example, if it’s damp or rainy. You might also feel a grinding or crunching sensation when you move the affected joint.

For further detailed information, read our topic about osteoarthritis.

Degenerative disc disease

Degenerative disc disease is when the discs that are located between the bones in your back (vertebrae) become worn down or damaged. This is usually as a result of ageing or repeated injury.

As you get older, the discs between the bones in your spine don’t absorb shock as well as they did when you were younger. And daily activities can cause the discs to become damaged. If you injure your back, the discs can be swollen, sore and not as stable.

The symptoms of degenerative disc disease are wide ranging. The pain might be mild but it could be severe and difficult to ignore. You might find it gets worse when you lift things or twist or bend your body. The pain might ease when you change position or lie down. It might also ease if you move and walk around, but it might get worse if you’re sitting down for a while.

Symptoms are usually felt in your neck or lower back. So the pain can affect your neck and your arms; or it might affect your lower back, buttocks and thighs. It can feel like numbness, tingling or weakness in your arms or legs (which might mean there is pressure on a nerve).

Osteoporosis

Osteoporosis (pronounced os-tee-oh-por-o-sis) is a condition where your bones become thinner or weaker. This increases the risk of the bones fracturing. Any bone in the body can fracture more easily but because your spine is always carrying weight when you are upright, the vertebrae bones can fracture at any time even without an injury. This causes sudden and severe back pain that can last many months. If this keeps happening, your spine can become misshapen and hunched forward.

For further detailed information, read our topics about osteoporosis and fractures.

Spinal stenosis

Spinal stenosis (pronounced sten-oh-sis) is when your spinal canal narrows. Your spinal canal is the tunnel-like passage that your spinal cord passes through. If the canal becomes narrow, it can press on the nerves inside it and cause back pain. This mostly happens because of changes happening to the bones in your spine as you get older. Spinal stenosis can cause back pain and pain in your legs (sciatica, pronounced sy-at-i-ka). The pain is often brought on by walking, and eases when you sit down.

Spinal stenosis can affect your neck and upper back, but it’s mainly the lower back that is affected. It narrowing is higher up, your spinal cord may be compressed. This may cause you to lose feeling in your legs and lose control over your bladder and bowel.

Spondylolisthesis

Spondylolisthesis (pronounced spon-dih-loh-lis-thee-sis) is where a bone in your spine (vertebrae) slips forward out of place. It usually happens in your lower back, but can happen higher up too. Spondylolisthesis might be caused by a fracture, an injury or as a result of the wear and tear that happens to your bones as you get older. Pain might be mild or severe; you might also have pain or tingling down your leg (sciatica, pronounced sy-at-i-ka).

Scoliosis

Scoliosis (pronounced skoh-lee-oh-sis) is a condition in which your spine curves in either a C or an S shape. It mostly happens in adolescents. A symptom of scoliosis can be pain in your lower back that gets worse as the bend in your spine increases. This pain may spread down the legs in older people. You may notice a feeling of tiredness in your back after sitting or standing for a long time.

For further detailed information, read our topic about scoliosis.

Ankylosing spondylitis

Ankylosing spondylitis (pronounced an-kih-loh-sing spon-dih-lye-tis) is a condition in which your immune system causes inflammation in the spinal joints and ligaments. It’s a type of arthritis which can be painful and you might find it difficult to move freely. You might wake up in the early hours with stiffness and pain. You might notice that exercise helps ease the pain.

Ankylosing spondylitis develops when the bones in your spine become inflamed where the tendons are attached and between the joints. Your body tries to mend the damage by producing new bone and as this grows, it can eventually join the bones of your spine together. Ankylosing spondylitis can also affect other joints in your body too such as your knees and hips.

Symptoms can flare up and settle down over time, and pain can be mild or severe. Some of the main symptoms include pain in your lower back, your spine curving, and pain in your buttocks.

For further detailed information, read our topic about ankylosing spondylitis.

Depression

There is a link between back pain and depression. Aches and pains such as back pain can be a physical symptom of depression. Furthermore, having depression can increase the risk of developing long-term (chronic) pain. Alternatively, back pain can lead to developing depression.

For further detailed information, read our topic about depression. And to find out more about emotions and pain, see our topic about psychological support for back pain.

Fibromyalgia

Fibromyalgia (pronounced fye-bro-my-al-ja) is a long-term (chronic) condition that causes pain in different parts in your body. You might have pain all over or it might be in different parts of your body at different times. Pain is often described as tenderness, stiffness and aching, but how this feels to you will be individual to you. Fibromyalgia often affects the muscles in your back leading to tender spots, called trigger spots. It can also affect your neck and shoulders. If you have fibromyalgia, you may also have other symptoms or conditions such as depression and anxiety, headaches and tiredness.

For further detailed information, read our topic about fibromyalgia.


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Related information

    • Thoracic back pain. PatientPlus. Patient.info/patientplus, last checked 29 September 2016
    • Musculoskeletal lower back pain. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Spine basics. OrthoInfo, American Academy of Orthopaedic Surgeons. www.orthoinfo.org, last reviewed December 2013
    • Osteoarthritis. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Osteoarthritis. Medscape. emedicine.medscape.com, updated 14 March 2018
    • Degenerative disk disease. Medscape. emedicine.medscape.com, updated 6 February 2017
    • Degenerative disc disease. Arthritis Foundation. www.arthritis.org, accessed May 2018
    • Lumbar disc disease. Medscape. emedicine.medscape.com, updated 12 December 2017
    • Osteoporosis. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Spinal stenosis. BMJ Best Practice. bestpractice.bmj.com, last updated April 2018
    • Spondylolithesis, spondylolysis, and spondylosis. Medscape. emedicine.medscape.com, updated 3 February 2017
    • Ankylosing spondylitis. PatientPlus. Patient.info/patientplus, last checked 26 March 2018
    • Symptoms of depression. Mind. www.mind.org.uk, published June 2016
    • Low back pain (without radiculopathy). NICE Clinical Knowledge Summaries. cks.nice.org, last revised April 2017
  • Produced by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, July 2018
    Expert reviewer, Sundeept Bhalara, Consultant Rheumatologist and Physician
    Next review due July 2021



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