The Ultimate Guide to Understanding Back Pain: Causes, Symptoms, and Effective Treatments

Explore comprehensive insights into back pain origins, symptoms, preventive measures, and cutting-edge treatments. Find relief and improve your quality of life today!

Introduction:

If you ask a random stranger off the street, there will be a good chance that they will say that they’ve dealt with back pain at some point in their life. In fact, nearly 65 million Americans, when asked, would report that they’ve experienced a recent episode of back pain (1). Additionally, when it comes to recurrence, globally the prevalence can be seen in numbers as high as 84%. Affecting all ages from childhood to adulthood, back pain is one of the most common reasons that patients seek emergency care. Adults who experience back pain, on average, spend 2.5x more on healthcare expenditures than their pain-free counterparts (2). It’s unfortunate, but it can be difficult to determine without medical intervention, the exact cause of the pain. If left untreated, many conditions causing chronic back pain can be debilitating, getting worse over time, and ultimately cause significant rates of disability.

Anyone who has ever struggled with chronic back pain will likely tell you that it negatively affects their quality of life. Not only does it make things like sleeping and general movement extremely difficult, but it is also one of the leading causes of work limitations, with 86 million days of work, on average, lost due to back pain. These limitations can also cause anxiety, depression, and other comorbid conditions to flare up, further lowering their quality of life. 

Though, despite the commonality, there are still many misconceptions about back pain that can cause misdiagnosis or incorrect treatment long term. Understanding the causes and adopting effective treatments is crucial in managing back pain and restoring quality of life.

Here are some of the most common myths:

• Myth: Lifting heavy objects is the main cause of back pain.
• Myth: Bed rest will make all back pain better (3).
• Myth: Back pain is always due to a serious, underlying condition.
• Myth: Poor posture doesn’t contribute to back pain (4). 
• Myth: Surgery is the only solution for back pain.

For a comprehensive explanation of these myths check out our article here - “The Top 5 Myths About Back Pain That You Should Know”

What types of back pain are there?

The most important first step to determining the cause of back pain, is to distinguish between signs and symptoms of mechanical and neuropathic pain. There are many different ways that practitioners can distinguish between the two including: the intensity and quality of pain and whether or not the pain radiates to other areas. Additionally, alleviating and provoking factors and location can help further differentiate not only between the two major types of symptoms but can also help determine the difference between types of injuries.

However, regardless of the type of pain, back pain will always fall into one of the following categories:

Mechanical: This is typically and most commonly caused by an injury to the spine, disks, or soft tissues in the back. (e.g. disk herniation)

Degenerative: These causes may be made worse by injuries to the back, but will typically happen regardless of prior injury and increase the likelihood of injury in the future. (e.g. osteoarthritis)

Inflammatory: Back pain caused by inflammation can be caused by many different factors, however, most frequently it will be seen as part of an acute inflammatory process. (e.g. ankylosing spondylitis)

Oncologic: Often presenting as a fracture, these types of back pain are caused by damage to the bone caused by cancers either within the bone itself or adjacent areas encroaching upon the bone. (e.g. cancers of the bone marrow)

Infectious: This includes infections of the spine, disks, or muscular or soft tissue of the back. (e.g. epidural abscesses)

Back pain can then be further distinguished by the terms: acute and chronic. 

Acute back pain is defined as short-term pain that lasts between a few days to a few weeks. This sort of pain will typically resolve itself after a few days of self-care with no long-term loss of function (5). Chronic pain, on the other hand, is pain that lasts for 12 weeks or longer. Setting itself apart from its short term counterpart, chronic pain can continue long after the initial injury or cause has been treated and if not treated appropriately can become debilitating over time.

Regardless of the injury type, acute or chronic, pain in the back can occur in a variety of places.

Figure 1 (6)

The back is divided down the midline, by the spine and consists of the space between the neck and gluteal regions. Made up of the spine, scapulae, muscle groups, nerves, vessels, and pre-sacral vertebrae, the back is responsible for flexion/extension, lateral bending, and rotation (6). In addition, it serves as the primary structural support for the torso, allowing flexibility for movement.

Divided into 24 vertebrae, stacked on top of each other, the spine is further divided into three primary sections: the cervical spine (top 7 vertebrae), thoracic spine (12 middle vertebrae), and the lumbar spine (lower 5 or 6 vertebrae). Between each vertebrae is a spongy cushion that absorbs pressure and keeps the bones from rubbing together called a disc. All of this is then further held together by the ligaments and tendons (7).

Figure 2 (8)

Unveiling Common Causes of Back Pain

While back pain can affect people of all genders and ages, there are certain factors that can make an individual more prone to it, including:

• Age: The most common age people begin to feel lower back pain is between 30 and 50, becoming more common the older they get.
• Fitness Level: The reason for this is two fold. First of all, individuals who are not in good, physical shape may experience undue strain because their muscles are not be strong enough to support their spine. Secondly, individuals who are more overweight can be more prone to back pain due to the strain of sudden weight gain. This is not to say, however, that being skinny will disclude anyone from back pain. In fact, individuals who are too underweight can have separate problems with bone strength and malnutrition.
• Genetics: Some underlying causes of back pain have a fairly significant genetic component. Conditions such as ankylosing spondylitis can be passed down from parent to child and has been known to run in families.
• Job: On two opposite ends of the spectrum, jobs that require heavy lifting, pushing, pulling, or twisting as well as jobs that require sitting at a desk all day can both cause back pain for different reasons.
• Mental Health: Back pain has a high comorbidity rate with mental health conditions such as major depressive disorder. While having back pain can certainly bring on these depressive episodes, conversely, anxiety, mood, and depression can also influence the level of discomfort experienced.
• Smoking: Smoking isn’t great for you in general, but in regards to back pain specifically, it can restrict blood flow to the disks in the spine, robbing them of oxygen and causing faster degeneration over time.

With all of those factors in mind, understanding that any of them can contribute to or predispose someone to a certain condition, here are some of the most common causes of back pain.

For a more detailed explanation of these causes below, click here “A Closer Look at Back Pain: Causes, Symptoms, and Healing Methods”.

Muscle or Ligament Strain: Repeated Heavy Lifting or Sudden Awkward Movements

One of the common causes of back pain is muscle or ligament strain. This type of injury is defined by sudden lower back pain or spasms in an area of the lower back feeling sore to the touch (9). These injuries are typically able to be managed with non-surgical methods such as heat, ice, and anti-inflammatory medications (10). 

Bulging or Ruptured Disks: A Hidden Culprit

A herniated disk, also known as a bulging, slipped, or ruptured disk, occurs when a fragment of the disk nucleus is pushed out into the spinal canal through a tear or rupture (11). An unpleasant but accurate metaphor for understanding this would be to think about jelly being squeezed out of a jelly donut (12).

These herniations can occur at any part of the spine, but are most common in the lower back or lumbar spine. There are cases of herniations in the neck or cervical spine, but this only tends to occur about 8% of the time. For the most part, pain due to a slipped disk will improve in 6 weeks as the herniation shrinks. However, this depends upon the person and the seriousness of the symptoms.

Arthritis: Not Just Your Grandparent’s Disease

There are many different types of arthritis that can affect different parts of the body, but Osteoarthritis is the most common type of arthritis to affect the spine and back specifically (13). Additionally, while the cause of general spinal arthritis is mostly unknown, Osteoarthritis is known to be caused primarily by wear and tear. Since the vertebrate in the back move so much on a daily basis, the spine is especially susceptible to the kind of wear and tear seen in Osteoarthritis cases (14). 

Most people assume that older individuals are the only ones who experience issues with arthritis. However arthritis, especially Osteoarthritis, can occur in individuals of all ages. While younger people may not have as much natural degeneration, they may experience an onset due to a trauma or injury experienced (15). Additionally, while the condition can occur anywhere along the spine, it is most frequently found in the lower back and the neck. The joints in the lower back tend to carry most of the weight daily, and the neck is the part of the spine that sees the most movement.

Additional types of arthritis that can occur in the back include:

• Rheumatoid arthritis: Caused by an auto-immune disorder.
• Ankylosing spondylitis: May cause inflammation at the base of the spine, causing a hunch in the back in severe cases.
• Psoriatic arthritis: Associated specifically with psoriasis either prior to or after manifestation of arthritis.
• Reactive arthritis: Typically triggered by an infection in the body that has traveled to the spine.
• Enteropathic arthritis: Associated specifically with IBD (Irritable Bowel Disease) and tends to sync with IBD flare ups.
• Other forms of spondyloarthritis include undifferentiated spondyloarthritis (when symptoms don’t match any of the known types) and juvenile spondyloarthritis (when symptoms begin in childhood).

Skeletal Irregularities: When Your Spine Throws You a Curve

Another reason for back pain to occur, lies in the structure of the spine. “Abnormal curvature in the spine can put it out of alignment” (16) causing pain and spinal deformity. These abnormalities can be seen in a variety of ways across the board. So, they have been categorized into age groups for purposes of diagnosis and treatment. More details on each of these and treatment options are found in this article. "A Closer Look at Back Pain: Causes, Symptoms, and Healing Methods."

Osteoporosis: The Silent Strength Stealer

Osteoporosis is a disease that develops when bone mass decreases; quite literally osteo (bone) porosis (porosity), bones full of holes. This condition occurs when the creation of new bone can no longer keep up with the loss of older bone (17). This can happen for a wide variety of reasons, but some common risk factors include: age, hormone levels, and even smaller body frames. 

Recognizing the Symptoms Associated with Severe Back Pain

Lower back pain is usually not an emergency. However, if you experience any of the red flag symptoms such as: difficulty standing or walking, loss of bowel or bladder control, loss of consciousness, pain that extends from the lower back around to the abdomen, or sudden numbness in the pelvic region or in one or both legs, call 911 immediately or seek emergency medical care (18).

When it comes to statistics, individuals who are more likely to experience a back pain emergency are those younger than 18, older than 50, the immunocompromised, and individuals with osteoporosis or osteoarthritis (19). So, make sure to keep those facts in mind when determining next steps. 

To make the breakdown a little easier, here is a chart to reference with three different options: go to the ER, go to Urgent Care, or Wait for an Appointment, and when each one is appropriate (20).

When You Should Not Ignore Back Pain?

Never ignore back pain.

If you are not experiencing any alarming symptoms, it’s alright to wait to see a doctor until you can get an appointment, or just call a hotline to speak with a nurse practitioner. However, evaluating and treating back pain as quickly as possible can help prevent the problem from becoming chronic. Acute back pain is far easier to treat than chronic back pain.

However, once again, if you experience any red flag symptoms, please seek immediate medical attention.

These Red Flag Symptoms Include:

• Weakness
• Bowel or bladder incontinence
• Pain that awakens patients from sleep
• Sensation changes
• Difficulty with ambulation
• Fever
• Chills
• Unexplained weight loss

How Long Should Back Pain Last?

By definition, acute or short term pain lasts a few days to a few weeks, usually resolving on its own. Whereas chronic back pain is pain that persists for 12 weeks or longer, even after the underlying injury or cause has been treated. However, if the pain lasts longer than 6 weeks after an acute injury, an x-ray or MRI might be needed to identify potential breaks, disc herniation, or spinal stenosis.

Treatment Options for Back Pain Relief

As mentioned previously, most cases of back pain will resolve themselves over time with appropriate self care. However, in the cases where extra treatment is required, those treatments can be divided into two separate categories: conservative treatments and invasive treatments (21). Each of which has a time and a place for appropriate use.

For a more detailed explanation of the following treatment options click to see this article “The 6 Most Common Treatment Options for Back Pain Relief”.

Physical Therapy: Tailored Exercises for Core Strength

While there is no evidence that shows one type of exercise being superior to another, there is evidence that passive methods of recovery for back pain are associated with worsening of the condition. According to a study done in 2018, physical therapy is the first line of treatment that should be considered for chronic back pain (22). 

Medications: Relief and Management

Medications can be helpful in the management of back pain, but don’t necessarily work towards long term relief or overall healing. Here is a list of potential medications that can help manage the pain along with their pros and cons (23).

• Acetaminophen
• NSAIDs
• Muscle Relaxants
• Antidepressants
• Opioids

When taken properly, medications can reduce pain and inflammation, however, they do not do anything to prevent further degeneration. 

Acupuncture: Tapping into Ancient Practices

A variety of integrative treatment options like acupuncture, tai chi, and yoga have been shown to have an effect on the improvement of back pain. Overall, acupuncture has been shown to be effective, safe, and cost effective in ways that other treatments are not. There may be some debate amongst the general public about how effective acupuncture can be, however, studies show that it can make a significant difference.

Electrostimulation: The Body’s Natural Electric Highway

Certain medical devices, such as TENS units have shown some success regarding the delivery of electrical impulses to block pain signals from reaching the brain. This method can be helpful for pain management but not necessarily long-term pain relief. However, other companies, such as ARPwave NeuroTherapy have reported considerable success in utilizing the nervous system to prompt pain lessening and even complete erasure over time.

Chiropractic Adjustments: A Spinal Solution

“Among people seeking back pain relief alternatives, most choose chiropractic treatment” (24). Using manual adjustments and manipulation of the joints, chiropractors attempt to create ideal situations for the body to heal itself without medication or surgery. Typically, chiropractic treatments are most effective for acute back pain, but can be helpful in chronic cases as well. 

Lifestyle Modifications: Small Changes, Significant Relief

While it’s always important to see a medical professional when experiencing pain, there is something to be said about allowing the body to heal itself the best it can. Setting your body up for success can be as easy as eating better foods and getting more, high quality sleep (25). Some specific changes that can be integrated into your daily life can be found in this article. “The 6 Most Common Treatment Options for Back Pain Relief”.

Surgery: The Last Resort

Despite every best effort to manage pain, sometimes surgery is necessary. While it should very rarely be a first choice, it is important to recognize the instances where it would be the best option. 

The primary reason that individuals would want to consider back surgery would be if other treatments haven’t worked and the pain is disabling (26). There are pros and cons for every surgery, but the most important part is communicating with your doctor and understanding that there’s always a possibility that the surgery will not work as planned.

For a more detailed explanation of the above treatment options click to see this article “The 6 Most Common Treatment Options for Back Pain Relief”.

How To Get Rid of Back Pain Naturally

An individual’s ability to get rid of their back pain depends greatly upon the cause of the back pain and the resources available. 

Aside from the lifestyle changes mentioned in the section above, there has been some success regarding physical therapy mixed with electrostimulation with programs such as, ARPwave NeuroTherapy. ARPwave’s RxBlack uses electrical waves that are similar to those the nervous system uses to help promote natural healing and encourage a relearning process to occur, allowing the body to revert back to the ways in which it is supposed to move. 

For additional information on daily exercises that can help as well as the full ARPwave NeuroTherapy treatment, click here.

How Can I Treat Back Pain Myself?

When experiencing back pain, the first thing that you should do is to stop normal physical activity for the first few days while applying heat and ice to the painful area. However, don’t stop moving completely, continuing gentle movement will help prevent the injury from getting worse through keeping your muscles strong and preventing spasms (27). 

Additionally, you can always take over the counter pain relievers such as ibuprofen or acetaminophen. A majority of the time, back pain will respond positively to home remedies and lifestyle changes, however sometimes it can be an indicator of something more serious going on (28).

Make sure to seek medical attention if your back pain:

• Comes on suddenly, without an obvious cause
• Is severe or unbearable
• Lasts longer than a couple of days and doesn’t respond to OTC pain killers.
• Comes with other symptoms like fatigue or weightloss
• Comes with any other Red Flag Symptoms

Preventing Back Pain: Tips that Work

When it comes to back pain, prevention will be your best friend. It’s always better to be careful than to be sorry. Employing even one of these tips will likely decrease your potential for back pain in the future.

• Avoiding movements that strain your back.
• Exercise regularly at your level.
• Use of electrostimulation regularly 
• Maintain a healthy weight and diet.
• Utilize furniture designed for ergonomic efficiency.
• Don’t stay sitting or standing for too long, move around.
• Wear comfortable, low-heeled shoes.
• Lift properly, from the knees with a straight back.
• Quit smoking.
• Using good posture.

Success Cases of Overcoming Back Pain

Tim Cristian, 35, Low Back Pain SD

“When I first walked in to see ARPwave NeuroTherapy, I couldn’t sit up straight in a chair. Within three days of ARPwave NeuroTherapy treatment, I haven’t lost a night’s rest because of back problems. It’s been tremendous. I want to look forward to no pain plus a future with no pain. With my use of ARPwave NeuroTherapy, it’s going to look like a pain free future.”

Aaron Oberholster, PGA Tour Player

“Bottom line, I can say conventional therapy did me no good and ARPwave NeuroTherapy absolutely did and continues to do so. I have never been stronger.”

Angie Oberholster - LPGA Golfer Scottsdale, AZ

“I can honestly say that I wouldn’t be playing Professional Golf anymore if it weren’t for Denis Thompson and Jay Schroeder and ARPwave NeuroTherapy. There is just not another program out there that can get your body in the shape that this can.”

Conclusion:

As with many things in life, knowledge is power. Understanding what is causing your pain and what your options are to deal with it will set you up for your best chance at recovery. Your journey to a pain-free life starts with understanding your body and exploring the right treatments for you.

If you’re interested in physical therapy with some additional boosts to the nervous system for quicker recovery, please feel free to reach out. Each treatment with ARPwave is individually tailored for each patient’s experience. 

Book a call with one of our physical therapists today to create a treatment plan and determine if ARPwave NeuroTherapy is the right fit for you.