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Why Your Back Hurts

  • Decoding Back Pain

  • Back pain is one of the most common physical complaints – with eight out of 10 human beings saying their back hurts at some point in their lives. But what is back pain, really, and what might your body be saying when your back hurts?

    The back is a complex system consisting of the bones of your spine and pelvis – along with the muscles, tendons and ligaments that hold them together. A web of major nerves runs through the spine. And in the same space we think of as our “back” lie our internal organs. So when your back first hurts, how do you know what’s going on?

    Modesto orthopedist Jerry Crooks, MD, of Sutter Gould Medical FoundationOpens new window gave us some interesting information on sources of back pain symptoms that may – or may not - be the back.

    MyLifeStages also talked with Jennifer Lehr, a physical therapist with Novato Community Hospital, to find out what types of situations bring patients to her office for physical therapy – and what can be done to keep your back as healthy as possible.

    Where does your back hurt?

    When a patient comes to the doctor with back pain, the first clue may be location. “I ask the patient to point to where it hurts,” says Dr. Crooks. That finger may point to the side, the hip, the buttocks, the groin, or the upper or lower part of the torso. Each location provides some clues as to what might be happening.

    How is your back pain affecting you?

    Dr. Crooks notes that generally, patients hurting from a spinal disk problem will not want to move. They will tend to hold still to avoid the pain.

    This is quite different from someone with a kidney stone – the pain of which may be experienced in the back. “These patients are antsy, always moving to try to find a more comfortable position.” It is also important to note if the pain comes and goes – just how and when it is experienced – and if other symptoms are present.

    What were you doing before your back started hurting?

    It is common to experience “back pain” after a bout of new physical activity – or overexertion at a common task. If you have pulled weeds for an entire day, and now your back hurts, it’s likely muscle strain that will heal with a little rest, and ice on the painful location. (See more on back pain relief and treatment.)

    When back pain is the spine

    Several conditions of the spine itself will cause your back to hurt. Treatments options for each are different, so a good evaluation is necessary.

    A herniated disk occurs when the liquid that cushions the space between your vertebrae pushes out of its normal location, pressing on nerves. This condition is more likely in younger patients with back pain, commonly from ages 20 to 40. This type of pain may be experienced in the hip, buttocks or back of the leg, since the nerve being pressed on in the spine travels down the leg.

    As we age, the vertebra in the spine may began to suffer wear and tear, resulting in degenerated discs or spinal stenosis. The collapse of the disc itself, or narrowing of the canal around the nerves, can press on nerves and cause the back to hurt. These conditions typically affect those 40 and older. (Wondering if something like this is causing your pain? See our short video, Is Spinal Stenosis Causing Your Back Pain?)

    Inflammatory diseases of the spine – similar to rheumatoid arthritis -- will cause stiffness, difficulty moving and pain in the back. And of course injuries to the spine may result in back pain – at the time of the injury or later in life.

    When your back hurts but it’s not the spine

    The following conditions are other potential sources of back pain. Note that many are extremely rare, or occur in conjunction with other obvious symptoms. As always, check in with your doctor about any new experience of severe back pain.

    • Kidney stones. When hard deposits are moving in or from the kidney, the intense pain may be felt in the back. It is more likely to rise and fall than to be experienced steadily or with certain movements.
    • Gynecological issues, such as uterine fibroids, endometriosis and pelvic inflammatory disease. A physical exam should help determine if the pelvic organs are the reason your back hurts.
    • Pregnancy. Many pregnant women will experience their first back pain at this time, as ligaments loosen in preparation for delivery. Carefully tending the back during pregnancy can prevent any future problems.
    • Muscle tightness or imbalances. Interestingly, athletes who work to keep their bodies in shape may be the ones who experience this type of back pain. Runners, who do most of their training using one set of muscles, can ignore the opposing set (think quads vs. hamstrings), eventually pulling the spine out of ideal alignment. While cyclists may need to pay extra attention to stretching hip flexors, the shoulder girdle and chest – all of which can become shortened in avid cyclists and cause back pain.
    • Sitting too much. Sedentary day jobs and long commutes pitch the body forward, causing hip flexors to become tight and weak. The solution: get up and move. It’s essential not just for your back but your overall health. (See our article on the dangers of sitting too much.)
    • Shingles. The appearance of shingles – the eruption of a virus stored in the nerves – can first show up as severe pain along one side of the body. Shingles will quickly reveal itself with the appearance of small, red blisters along the path of the affected nerve, within three days of feeling the pain.
    • Hip problems. Problems with the hip joint can be identified as back pain or hip pain, when the source is actually the ball and socket joint where the leg meets the pelvic bones.
    • Cancer. Back pain as an initial symptom of cancer is not likely, but a cancer that presses on the spine – or has spread to the bones of the spine – will cause pain.
    • Stomach ulcer at the back of the stomach. Again, this symptom is rarely the first indication of the problem, as stomach pain and GERD or acid reflux will have likely been occurring for some time.
    • Abdominal aneurysm. The pain of a dilated, bulging aorta is “catastrophic” pain that comes with other severe symptoms like weakness and fainting.

    See when to see a doctor for back pain if you’re in doubt about whether or not to go to the doctor. Some back pain symptoms may indicate a serious emergency.

    Keeping a healthy back

    So how do you maintain your (hopefully) pain-free back – or work with a back problem to avoid as much pain as possible?

    Keep your body strong and limber

    Lehr reminds us that the spine and its web of nerves are contained in a ring of muscles. Keeping those muscles strong, limber and balanced will go far in protecting your back.

    “Many know that the back is supported by strong abdominal muscles in the front,” says Lehr. “But it’s important to make sure all sides of the body are strong and supple.” She notes that the gluts – the muscles of the buttocks that we usually just sit on – also have an important role to play.

    If you don’t exercise much, at least move around – take frequent walks.

    If you are a serious athlete, consider cross training – alternating your usual activity with a very different activity a few days a week. This can keep more of your muscles stretched and strengthened, to protect your back.

    If you do stretching exercises, pay attention to your form. “You may dilute all your benefits by doing your stretches in the wrong way,“ says Lehr. “And don’t rush – or bounce – in the stretch. Hold for a full minute to achieve the benefits. Breathe – while you stretch. This can help slow you down.”

Download our lower back exercises and stretches.