What Causes Back Pain?

“Why Does My Back Hurt?”

If there’s one question I get more than any other at Ascent Chiropractic, it’s this. It’s no secret: back pain is an epidemic in the US. In fact, at any given time 1 in every 4 Americans are dealing with some degree of back pain. Only the common cold beats back pain as the number one reason for visiting a healthcare provider.

It’s also the leading cause of disability worldwide, as well as the most common cause of missed work days.

Americans spend $90 billion each year on back pain — more than the annual expenditures on high blood pressure, pregnancy, and depression — and that doesn’t even include the estimated $20 billion in lost productivity related to back pain.

Even worse, back pain is the single condition most commonly associated with opioid addiction, which itself is responsible for over $25 billion annually in healthcare costs.

But let’s make one thing perfectly clear: just because something is common doesn’t mean that it’s normal.

Pain exists for a reason

Your body is incredibly intelligent; it’s not going to send pain signals to your brain just because it wants to ruin your day. Pain is your body’s way of telling you there’s something wrong that needs attention. When our spines are functioning like they were designed to, there’s no reason for pain.

So why do our spines need to have a way to let us know when something’s wrong? It’s a simple answer but an important concept to understand: the longer a problem goes uncorrected, the more widespread the wear and tear suffered by the musculoskeletal system as a whole. Your body sends pain signals to your brain to bring your attention to the problem, where it stands a better chance of being fixed before it becomes an even bigger problem.

Plus, when your spine’s not moving properly, you’re at a physical disadvantage. Even though you might not notice, when you’re off structurally, movements that are usually effortless and automatic require more muscle recruitment and more energy to perform. You tire faster and perform worse.

Subtle muscle strains start to add up, and extra wear and tear on joints that aren’t moving smoothly leads to degeneration of the vertebra, discs and ligaments. You might not be aware of micro-injuries that are accumulating in the structures of your back, but stress on the spine is cumulative. Serious back problems are rarely the result of just one bad move.

Spine Anatomy 101

If you don’t quite remember everything from freshman biology class, here’s a quick refresher.

The spine is a column of 24 segments called vertebra rising up from the pelvis. There are seven vertebrae in the neck (also known as the cervical spine, labeled C1-C7), and beneath them are 12 vertebrae that comprise the mid-back, or thoracic spine (T1-T12). Each of the thoracic vertebrae have ribs coming off both sides that encircle the chest cavity and meet in front at the sternum.

Finally, there are five vertebrae that make up the lower back (or lumbar spine, labeled L1-L5). The base of the spine sits on the sacrum, a triangular-shaped bone that’s made up of five permanently fused vertebrae.

The vertebrae are separated by tough fibro-elastic disks that act as cushions and distribute the effects of weight compressing from above and impact compressing from below.

The sacrum joins with two wing-shaped bones called your ilia on either side to form your sacroiliac joints. The location of the two sacroiliac (or SI) joints are easy to find; just look for the dimples on either side of the pelvis above the buttocks. Together, these joints support the weight of your upper body when you stand or walk, helping to absorb impact and reduce pressure on your spine.

In a perfect state, the upright spine carries itself with all 24 vertebra stacked in three gracefully arched front-to-back curves that are designed to disperse body weight and stress in a balanced, mechanically-advantaged way.

The spine’s most important job is to protect the fragile spinal cord, which is an integral part of the central nervous system. The spinal cord runs down the inside of the vertebra from the brain to the base of the spine through the spinal canal. 31 sets of nerves exit the spine between the vertebral segments and supply the body with motor control, sensation, and other functions.

It’s all about balance

In a perfectly-functioning body, properly balanced muscles and ligaments at the front, back and sides of the spine hold it in correct alignment. Correct alignment is necessary for all the joints in your body to move optimally.

Unfortunately, our modern way of life – especially in the work-from-home world we currently live in – involves more sitting than ever before, whether it’s at a desk during the workday or on the couch at home in front of the tv.

Even when we aren’t sitting, many activities are spent frequently flexed forward or bent over, causing imbalance between the stabilizing muscle groups in the lower back. Certain muscles and ligaments get tighter and shorter, while others get weaker and elongated.

And because stability in the spine starts from the base up, like a skyscraper, instability in the lower back or pelvis translates to instability in everything above it. Eventually these joints, muscles and ligaments stiffen up to help prevent major damage from occurring. It doesn’t take a doctor to tell you this isn’t an ideal way of going about your everyday life.

What happens when things go wrong?

The straw that breaks the camel’s back often comes when we finally get out for some physical activity. We tend to go at it full steam, introducing new strains on top of the chronic ones caused by sitting, muscle imbalances and unnatural movement patterns.

It’s a lethal combination.

It’s unnerving how easy it is to ‘do something’ to a spine that’s been under chronic stress, even if you’re not aware that there was a problem there to begin with. Whether that’s taking a walk on a treadmill or bending down to pick up a pencil, a back that’s biomechanically compromised is eventually going to cause pain. Sometimes it’s just a nuisance, sometimes it’s a nightmare, but the fact is, if the functional problems continue to get worse, so will the pain.

If we want to actually fix the problem, we can’t ignore the fact that the spine simply isn’t working like it’s supposed to biomechanically. And swallowing pills or strapping yourself into a brace is simply covering up the symptoms without addressing the cause.

That’s why our modern-day habit of simply taking pain-killers, anti-inflammatories or muscle relaxers to hide the pain is so dangerous. It lets us go about our normal activities, causing more damage without actually taking care of the root problem your body is desperately trying to get you to correct.

It’s the same reason it’s backwards to think that surgery is the end-all be-all of back pain treatment. Sure, surgery is sometimes necessary to clean up a severely damaged disc or repair a torn tendon or ligament, but a scalpel can’t cut out stiffness or correct movement between vertebrae. The fact is, there’s rarely something that needs to be removed.

So why does it hurt?

Sick of my Anatomy & Physiology lecture? All good, because we’re about to jump into the real reason you came here: figuring out what’s causing your back pain.

Nearly every back pain sufferer has the same two complaints: 1.) No one listens to what they’re saying (or worse, doesn’t believe them) and 2.) They’ve never been told what exactly is wrong with them. Patients want to know what’s wrong, and most doctors can only make an educated guess.

Studies have shown that in 85-90% of cases primary care physicians are unable to identify an exact diagnosis of back pain. More often than not, this results in prescribing pain-killers, anti-inflammatories or muscle relaxers to nullify the pain, or scheduling a cortisone injection and sending the patient on their way.

No wonder only 17% of patients report ever getting significant relief of their back pain through their primary care provider.

The spine is an extremely complicated piece of machinery, and, especially with patients who have been dealing with pain for an extended period of time, there are usually multiple problems that need to be addressed.

Even so, as mysterious and frightening as back pain might be, diagnosing the problem is usually not rocket science if you know what you’re looking for. So what’s causing your pain? Let’s explore the most common problems…

Disclaimer: The information provided here is not intended to diagnose or treat any condition. Please consult a doctor or healthcare professional to get a medical diagnosis and advice on a treatment plan for your particular condition.

Facet Joint Pain

• Usually felt directly in the middle of the spine, most often where your spine meets your tailbone, but can occur anywhere in your back or neck.
• It may not hurt to bend or lean forward, but doing it backward produces a definite “ouch!”
• Facet joint inflammation in the low back can send nerve pain down into the buttocks and the back of the upper leg.
• Usually a stiff, persistent ache that’s worse in the morning and after sitting.

Facet joints are the most common cause of back pain, with studies suggesting that it’s responsible for anywhere from 45-60% of back pain complaints.

Facet joints are where vertebra meet in the back of the spine. They’re surrounded by a joint capsule made of ligaments, and cartilage and synovial fluid allow them to glide smoothly. In a normal spine, these joints aren’t weight-bearing, but when things get out of balance the compressive load can shift to the facets.

Facet joint capsules are filled with a dense network of nerves that keep your brain constantly updated about their condition – if they’re stressed and swollen, you can bet these nerve fibers are sending out pain signals.

While aging is the leading cause of facet joint problems, trauma from a sports injury or auto accident can cause facet joint pain, too.

Disk Pain & Nerve Pain

• Most often found in the lower back, but can occur anywhere in the spine.
• Sudden lower back pain, tingling or numbness that gets worse with activity or prolonged sitting.
• If a nerve root is affected in the lower back, the pain can travel into one buttock and down one leg all the way to the foot (a condition known as sciatica).
• Aggravated by coughing, sneezing, lifting or bearing down.

The intervertebral disks, located between the vertebral bodies of your spine, act to cushion the spine against stress. Disks are pretty tough, but through a combination of spinal or pelvic misalignment and the natural processes of aging, the outside layer of a disk may bulge (or herniate). In more severe cases, the jelly-like center of the disk leaks, irritating the nearby nerves and causing back and leg pain. This condition is called a slipped, ruptured, or herniated disk.

Slipped disks only happen when the disk’s walls have been broken down over years of degeneration. The process is accelerated by repetitive bending, twisting and lifting. But disk bulges rarely occur quickly – they’re the cumulative result of long-term stress.

Similarly, spinal stenosis is a narrowing of the spaces between the vertebra of your spine, which can put pressure on the nerves that travel through and out from the spine.

Sacroiliac (SI) Pain

• SI joint pain can range from dull and achy to sharp and stabbing.
• Usually felt on either side of your pelvis at the ‘dimples’, but it can spread to your buttocks, hips and to your thighs and groin.
• Aggravated by transitional movements such as getting up from a chair, climbing stairs, or turning in bed.

If your lower back or butt hurts when you get up from a chair or climb a set of stairs, your sacroiliac (SI) joints may be to blame. In fact, studies suggest the SI joint is the source of pain in 15–30% of people with chronic low back pain.

The two sacroiliac joints normally work together in coordination, but dysfunction can occur when one of the sacroiliac joints becomes either too stiff or too loose.

This can occur as the result of a fall, sports injury, arthritis, pregnancy and childbirth, or hip or spine surgery.

SI joint pain usually starts in the lower back and buttock, and can radiate out to the hip, groin or upper thigh – but not past the knee. While the pain is usually one sided, it can occur on both sides.

Costovertebral (Rib) Pain

• A dull ache with intermittent sharp, stabbing pain where the ribs connect with the vertebra in the upper back.
• Usually felt between the shoulder blades and to one side of the spine.
• Aggravated by deep breathing, coughing or rotation movements of the upper back and rib cage.

Costovertebral pain happens in your upper or mid-back, between the spine and one of shoulder blades. It’s usually a constant dull, nagging ache, but it can become sharp and localized pain when taking a deep breath.

It often radiates out underneath the shoulder blade, to the armpit, and can even wrap around the torso to where the ribs meet the sternum. Muscle spasms and stiffness are commonly associated with rib pain.

Costovertebral problems occur most commonly when there’s a sudden twisting through the thoracic spine or when there’s an impact that forces the joint through a greater range of movement than normal, such as a sports injury or auto accident.

These are all symptoms of what has been referred to as a ‘slipped rib’ or ‘slipped rib syndrome’, and they’re often mistaken for muscle knots.

Piriformis Pain

• Literally a pain in the butt that can cause sciatica-like pain down the back of the thigh, calf and foot.
• Can be caused by trauma, such as falling on your bottom, or from overuse in activities like running.
• Aggravated by sitting for a long time, climbing stairs, walking, or running.

The piriformis muscle is a flat, band-like muscle that connects the tailbone to the femur. It stabilizes the hip joint and enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs – it’s involved in pretty much every motion of the hips and legs.

The sciatic nerve either passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet.

Irritation or spasm in the piriformis muscle can cause sciatica-like symptoms like pain, numbness and tingling down the back of the leg and into the foot.

Muscle Pain

• Strained (or pulled) muscles may spasm, feel tender to the touch, or cramp and contract tightly, causing intense pain.
• Aggravated by certain movements, such as bending forward, backward, or getting out of bed.
• Pain is most intense in the first few days, followed by dull, achy pain and stiffness for 1 to 2 weeks as the muscle heals.
• Muscle strains usually resolve within 4 to 6 weeks.

The muscles of the back, along with the hip, pelvis, buttock, and hamstring muscles, provide support for the lumbar spine and pelvis.

When any of these muscles are injured, usually from physical activity, pain or tightness will usually be felt across the back and into the hips or buttocks.

When soft tissues in the low back are stretched or torn, the surrounding area will typically become inflamed. Inflammation, or local swelling, is part of the body’s natural response to injury, in which blood is rushed to an injured tissue in order to start the healing process.

Muscle spasms and cramps can cause intense pain and temporarily limit mobility, as the affected area in the lower back may be swollen for a few days.

Ischial Bursa Pain

• A dull, nagging ache felt at the crease of the buttock over the ‘sit bones’, sometimes radiating down the back of the thigh.
• Aggravated by prolonged sitting, as well as activities such as walking, running, or stair climbing.
• Caused by inflammation of the ischial bursa, the fluid-filled sacs that reduce friction between the hamstring muscles and the bony ischia they attach to.

The ischial bursa sits between the ischial tuberosity (the lower part of the V-shaped bone that helps form the pelvis) and the tendon that attaches the hamstring muscle to the bone. It’s the part of your body that bears most of the pressure when sitting in a saddle.

Injury or overuse can cause the bursa to become inflamed, swollen, and painful — a condition called ischial bursitis. Ischial bursitis can result from sitting for long periods on a hard surface, from direct trauma to the area, or from injury to the hamstring muscle or tendon through activities such as running or bicycling.

Ischial bursitis causes pain at the center of the buttock that may radiate down the back of the hamstring to the knee. It’s often confused with sciatica, but there’s an easy way to tell the difference: sciatic nerve pain will run down the entire leg and foot; musculoskeletal pain like ischial bursitis won’t go past the knee.

The Bottom Line

The good news? All of these problems are biomechanical problems, and rarely (if ever) require drugs or surgery to fix.

While there’s no doubt a time and a place for medication and surgical intervention, at Ascent Chiropractic we aim to provide relief from pain by correcting the underlying cause and restoring optimal function of the body naturally.

When the cause is addressed, the effects disappear. Pain is an effect. We’re not here just to address pain or put a band-aid on it, instead we recognize it as a signal of an underlying problem that needs to be corrected.

Part of being smart with your healthcare is being knowledgable about what’s actually happening in your body, and then weighing the risks and benefits of treatment options. Thanks for being smart and sharing this with the people you care about.

If you’re reading this, you probably already know that the results we get at Ascent Chiropractic are second to none. If you have friends or family who are dealing with back pain and could benefit from what we do, we truly appreciate the trust you put in us! To make an appointment at Ascent Chiropractic, call 262-345-4166 or schedule an appointment with our online scheduling app.