Knowing what causes back pain is a big step towards preventing back pain and controlling back pain when it occurs.
we now know that psychological and even social factors play an important role
Back pain can originate from various structures in the back. Sometimes the exact location of where the pain comes from can be found while in other cases it is less clear where the pain originates.
Irrespective of where in your back the pain is coming from, the question is what actually caused this pain and what can I do to prevent the pain from becoming worse or re-appearing. The list of factors that may contribute to back pain is long. Not all these factors are physical factors and we now know that psychological and even social factors also play an important role. Some of these possible causes may be surprising, but are nevertheless important if we want to understand and control back pain.
This section will give an answer to the following questions:
Where does my pain come from?
As explained in ‘About your back’ your back consists of many different structures that all have to work together. You may think that any abnormalities in the structure or functioning of your back result in pain, but this is not necessarily true. People have very different backs and it is difficult to define a ‘normal’ structure. Some people with severe deformities may not experience any back pain while others who appear to have ‘normal’ backs experience severe pain.
In most cases scans, such as X-rays and MRI's, cannot show where back pain comes from
This is why medical imaging such as an X-ray, MRI scan or CT scan is not necessarily an appropriate method of assessing back pain. Nowadays your GP or consultant will only use these scans when he or she thinks that your back pain is associated with a certain structural abnormality in your spine. This is only the case in a minority of the people with back pain. In most cases scans and test show no clear explanations for the pain. It should be noted though that even although the exact cause of the pain may be difficult to identify, the pain is real and fortunately there are a number of options when treating this type of back pain.
In some cases the back pain can be traced to a specific cause, for example:
- Muscle sprain: sometimes you can ‘pull a muscle’ in your back, resulting in a small tear or sprain in your muscle.
- Disc protrusion: sometimes the discs between the vertebrae may become weaker and bulge out. In an extreme case this may lead to a prolapsed disc.
- Prolapsed disc (‘slipped disc’ or ‘herniated disc): Sometimes a disc bulges so far out that it puts pressure on the spinal nerves running in your back. You may feel this as pain in your legs (sciatica) since these nerves in your lower back run all the way down to your legs.
- Spinal stenosis: the spinal column runs through a narrow opening in your vertebrae. If this opening becomes too narrow the nerves may become trapped, which causes pain.
- Collapsed vertebra: the vertebrae give much of the structural support to the spine but these may become damaged as a result of disease or injury. Severe osteoporosis may result in a vertebra collapsing and by doing so disturb the surrounding structures.
The above causes may explain where the pain originates, but may not necessarily explain the degree of pain. This is where the risk factors that are discussed below may play a role.
Risk factors for back pain
One of the most important risk factors for back pain is a previous history of back pain. This suggests that if you have experienced back pain in the past, you are more likely to have back pain re-occurring. This makes it even more important for those people with a history of back pain to take good care of their back and know what to do when back pain strikes (Information sheet). Furthermore, it also seems that genetic factors play a role in back pain. The fact that many of your relatives experience back pain may not mean that you will be affected by back pain, but it does imply that you probably will have to take good care of your back.
Physical risk factors
Most people associate back pain with physical risk factors such as heavy lifting, twisting and bending and awkward postures. These can indeed contribute to back pain or exacerbate existing pain. Therefore you should pay attention to controlling these factors by, for example, using manual handling aids (lift, carts etc) and ergonomically assessed workstations.
Other risk factors of a physical nature include vibration (for example the vibrations that a driver experiences when driving a car or truck), repetitive work and static postures.
Psychological risk factors
It may seem strange to think that psychology plays a role when the problem seems to be in the back. However as explained in the ‘About your back’ section, pain signals can be interfered with by many factors. You may all know an example from yourself or someone around you who had to endure much pain and discomfort in order to achieve something they really wanted to achieve. Think about a marathon runner who ‘forgets’ about the pain once the finish line gets closer and the crowd starts cheering. This may be an extreme example of how your mind can alter your pain sensation, but it plays a role in our everyday life.
Fact: Stress and work satisfaction can influence back pain
Mental stress, dissatisfaction at work, depression and distress can all play a role in back pain. These factors may re-enforce relatively minor pain signals resulting in a much more present pain sensation. By no account does this mean that people with back pain are mad, it merely shows that our mind and our psychological well-being plays a very important role in any pain experience. When treating back pain it is therefore very important to address all of these factors.
Social risk factors
After physical and psychological risk factors, there is a third category; social risk factors. Again you may wonder how can these impact on my back pain? Social factors do not necessarily impact on your back, but have an important role to play in how we respond to pain. Over the past decades, the medical profession has made great progress and we can now treat many conditions that were previously untreatable. The same expectation that everything can be treated exists for pain. However it has also become clear that a (back) pain free society does not exist. But this does not mean we should accept the burden that pain gives us. It has become clear that by showing people how to respond to pain, we can control pain and live a life that is not restricted by pain.
There are cultural differences in how back pain is perceived
A famous example of this is from Australia; the aboriginals in Australia seek very little medical help for back pain compared to the other groups of the Australian population. However if you ask them, many will tell you that they have back pain. This shows a fundamental difference in how people respond to pain. Pain itself may be manageable but it becomes a much bigger problem when it impacts on our daily life and people become disabled as a result of back pain. This is when action is needed.
Hopefully you now understand that back pain is a complex symptom that can be caused by a range of different factors and in most cases it is a combination of these factors that result in back pain becoming a real problem. Any attempt to control back pain should therefore address those factors that are important and relevant to you.