What Causes Back Pain…and What Can Back Pain Cause?
Low back pain is the most common cause of disability worldwide and nearly everyone has it at some point in their life. One of the most common things people are worried about when they get back pain is what might be causing it. This is understandable. I’ve had back pain before and I understand how disabling it can be. It hurts to move, you can’t sleep, you can’t bend over the slightest amount, you can’t sit, and on and on (and everyone is different).
In this blog, I’m going to talk about what back pain is, what some of the common causes are, what some uncommon causes are, how to know which one you have, and talk about some of the other symptoms you can have that may be coming from the back.
What is Pain?
First thing’s first, though. Let’s get our language right. Pain itself doesn’t come from your back. Pain is an experience in your brain. Whether you step on a nail or (as happened to me as a kid) your brother hits you with an aluminum baseball bat, or you have a back ache, the experience of pain is always in your brain.
It’s not in one part of your brain, but it’s the result of multiple areas of your brain talking to each other and deciding that you should feel pain after what may or may not have just happened. What happens in the tissue is technically called “nociception,” and involves the stimulation of nerve fibers, but let’s just call them “danger messages.” From now on, when I talk about pain, I mean the experience in your brain (which is kind of complex) and when I talk about danger messages, I mean whatever is happening in the tissue itself.
COMMON CAUSES AND CONTRIBUTORS TO BACK PAIN
- NORMAL STRESS ON AN ABNORMAL STRUCTURE: If you have had previous lower back surgery (particularly a fusion), have a large scoliosis (you’ll know it if you do), have had a previous fracture in your spine, or otherwise had a change in your spine and you KNEW it, your spine is just different. Sometimes this means it just isn’t standing up to the daily stresses placed upon it. The source of the danger message could be the facet joints in your spine, the discs, various ligaments in your spine, and even muscles (I could go into an exhaustive lecture on anatomy, but I don’t want to put you to sleep). Autoimmune conditions could also go in this category or the next, except the stress on the joints of the spine is chemical.
If this sounds like you, here’s the good news: you probably let your back limit you more than you need to. The spine really is inherently resilient and adaptable. Olympic swimmers have competed with the best in the world despite having a large scoliosis, people with fusion surgeries have gone on to play professional golf successfully, and so on. If this seems far-fetched (and sometimes it does), seeing a physical therapist that can understand your situation and provide good advice may be helpful.
Let’s set up an analogy here. Below are two buckets at point #1. If your friend has never had back pain before, he might be able to do more vigorous activities before his back begins to bother him (if it does). Think of this amount or intensity of activity as a bucket. At point #1, his bucket is bigger than yours.
However, if you begin to train your body, through exercise, to begin to accept this amount of activity, your bucket will get bigger. Eventually, you can train your body to meet or exceed the bucket size of your friend. Although this may be hard to believe, remember the Olympic swimmer. The average body would not be able to meet the demands of a rigorous Olympic training schedule, but with dedicated time spent improving her activity tolerance, she has surpassed what most people on Earth could do! This is what happens at Point #2.
- ABNORMAL STRESS ON A NORMAL STRUCTURE: This one’s easy. No matter how great your back feels, abnormal stress can change that. The obvious example is physical trauma such as falling or getting in a car accident. Just like any other part of our body, our back has a limit to what it can tolerate. Another example of this is bending forward for a prolonged period in an awkward position. Think of picking up rocks or weeding for many hours in your yard. What you’re doing is placing a LOAD on your spine that it isn’t used to, and if done for long enough, this can lead to tissues being stressed, danger messages being sent, and pain occurring. Placing stresses on your spine that it isn’t used to leads can make the disc or other structures sensitive, which means they send danger messages more easily. Luckily, our bodies are excellent at healing. Research shows that moving around like you would do on an easy day around the home and community is much better than lying in bed.
- STRESS, ANXIETY, AND DEPRESSION: Most people intuitively know these things are related to pain. Remember where PAIN occurs? It occurs in the brain. It should make sense, then, that things like stress and anxiety can sensitize your brain to the danger messages coming from below. If you feel like these things may be impacting your pain experience, try finding times during the day to be grateful, relax your mind, or exercise. Trying to improve your sleep at night can also be beneficial. Research shows people who are forced not to get a full night’s sleep begin to have more pain.
LESS COMMON CAUSES OF BACK PAIN
What follows is a list of extremely rare things that can cause back pain, because the hypochondriac within you is wondering (we all have them). However, you should rest assured that 98 of 100 people with back pain do NOT have anything on this list.
- Spinal infection (bone or disc)
- Spinal tumor
- Abdominal aortic aneurysm (large blood vessel in your abdomen)
- Kidney stones
- Cauda equina syndrome (extremely rare)
- Pregnancy (Back pain almost always resolves after pregnancy)
SYMPTOMS THAT COULD BE REFERRED FROM THE LOW BACK
- Sudden weakness in the legs
- Numbness in the legs
- Tingling in the legs
- Hip pain
- Knee pain
- Thigh pain
- Calf pain
- Foot pain
- Groin pain
- Clumsiness in the feet
- Stomach pain
Whew! As you can see, there are a lot of conditions that cause back pain — or symptoms that back pain (or problems) can cause. It should become clear that a thorough physical examination is the best approach if you do have any concerns about your back or mysterious pain elsewhere. If you still have questions, feel free to contact us to talk to a physical therapist directly. Physical therapy specialists have advanced training and are able to safely and effectively recognize back pain that can resolve with physical therapy or back pain that requires a more thorough workup. Based on a survey from 2017, most people believe PT is the #1 most effective and #1 safest treatment for back pain.
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