Written by Reginald Q. Knight, MD, MHA and Shelby Deering; Reviewed by Reginald Q. Knight, MD, MHA

The Universal Guide to Back Pain: Everything you ever wanted to know, straight from the experts.

 

Back pain is one of the most common reasons people self-treat and seek medical care. It will affect approximately three in four adults during their lifetime.

It’s caused, directly or incidentally, by a huge number of health conditions, which may make teasing out the root cause of back pain exceedingly difficult. Sometimes the cause is obvious and sometimes not even a team of doctors can figure out why your back hurts. Many cases go away on their own, but some stick around for months or even years.

Back pain is a big topic because between the upper back and tailbone, there are 17 vertebral bodies, many joints, the sacrum and tailbone. Photo Source: 123RF.com.

Yes, uncertainty abounds when dealing with back pain, but SpineUniverse is here to help. Below is your guide to everything back pain: Its causes, its complications, how it’s diagnosed, how it’s treated, how to live with it, mitigate it and prevent it. Read on.

What Are the Parts of the Spine?

Learning about spine anatomy can help you understand your back pain on a deeper level.

Reginald Q. Knight, MD, an orthopedic surgeon and Director of the Bassett Spine Care Institute in Cooperstown, NY, breaks down the regions of the spine.

“The cervical spine is a highly mobile segment of the spine prone to degenerative changes,” says Dr. Knight. As you age, pain is more likely to take place in what’s called the “transitional zone” between the flexible cervical vertebrae and the more rigid thoracic portion of the spine.

The thoracic spine is associated with the chest and connects to your ribs. Dr. Knight says that particularly, the elderly can experience compression fractures in this region, a result of losing bone mass.

The lumbar spine is generally known as the lower back. “This is the most common region for back pain,” Dr. Knight says. “Younger patients are more prone to discogenic back pain, whereas older patients are more prone to facet joint issues.”

Discogenic pain means one or more intervertebral discs cause pain while facet joint issues originate from the top and bottom of each vertebra.

Finally, the sacral region is the very bottom of the spine. It consists of the flat, triangle-shaped sacrum bone that connects to the hips, and the coccyx, also known as the tailbone, an evolutionary leftover.

Dr. Knight mentions that degeneration of this area tends to occur in older patients. You can also fracture your sacrum or tailbone by falling hard on your rear.

Understanding the spine–its parts and in whole–can help you understand your back pain.

What Muscles, Bones and Other Tissue Make Up the Spine?

Back pain is a big topic. Between the upper back and tailbone, there are 17 vertebral bodies, many joints, the sacrum and tailbone, plus fibrous and muscular supporting structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but here’s what you need to know about those parts.

Before discussing the muscles, we need to talk about vertebrae. Vertebrae are a series of small bones that make up the backbone to which the muscles attach. A spine typically consists of 33 vertebrae, each separated by an intervertebral disc.

Every vertebra is made up of two parts: an anterior vertebral body that protects the spinal cord and nerve roots and a posterior vertebral arch which accommodates the canal and also safeguards the spinal cord.

Back muscles fall into three groups:

• Intermediate muscles make up something called the erector spinae, which includes the longissimus, iliocostalis, and spinalis muscles. These muscles allow the ribs to move as needed.
• Intrinsic muscles stabilize the vertebral column and are located underneath the erector spinae; also known as the “deep” muscles of the back and control the movement and posture of the vertebral column.
• Superficial muscles are directly underneath the skin and attach to the bones of the shoulder, aiding in neck and shoulder movements along with controlling upper limb movements.

Muscles that support the spine are structured in layers, says Dr. Knight. Some muscles extend from the base of a person’s skull to their pelvis. Other muscle groups cover shorter distances depending on the segment of the spine: cervical, thoracic, or lumbar.

Dr. Knight adds, “These muscle groups function as primary stabilizers of the bony and ligamentous structures. Strains of these muscles affect all age groups.”

There are several other parts of the spine worth considering when you are identifying your back pain. These include:

• Ligaments and tendons. While tendons are part of the muscular structure attaching a muscle to bone, ligaments attach bone to bone with no intervening muscle. Both ligaments and tendons contain elastic fibers.

• Intervertebral discs, which actas miniature shock absorbers that sit between vertebrae and prevent bone-on-bone friction. Discs can naturally degenerate over time.
• Hinge-like facet joints, which connect each of the vertebra to the one above it and the one below it. They provide the optimal combo of mobility and stability: Each vertebra can move independently, but since they’re all connected the spine can act as a whole. There are four facet joints per vertebra—two on top and two on the bottom.

The vertebrae, or backbones, can be more complicated than they first seem. Learn about how they work to understand how they can hurt.

Who Gets Back Pain?

Pretty much anyone, it depends on where it hurts.

Upper Back

Chronic upper back pain affects 15 to 19% of people globally. Those suffering tend to fall into certain age groups. For instance, one study found that postmenopausal women are at greater risk, likely due to the risk of osteoporosis and vertebral compression fractures.

Your career choice may also lead to upper back pain. Those who have to hunch for long periods, such as dentists and eye doctors, report higher incidences of upper back pain. Office workers frequently have upper back pain due to poor ergonomics.

Mid-back 

So, what about pain in the mid-back—low in the thoracic spine and even the top of the lumbar? Adolescents get it a lot. According to a 2016 study, between 13% and 45% of children and adolescents will have mid-back pain in a given four-year period.”

A Danish report, which studied overall spinal pain in 11 and 13-year-olds, reported increased mid-back pain if the kids were more physically active than most. Mid-back pain is also a common result of car accidents.

Lower Back

You’ll often get mid-back pain from pushing your body too hard, but lower back pain can come from not pushing it hard enough. A sedentary lifestyle is a big contributor to low back pain.

One study says that reporting of chronic low back pain has gone from 3.9% in 1992 to 10.2% in 2006. While reasons are unclear for this increase, a couple possible factors include higher rates of obesity and depression.

What Are Some Different Types of Back Pain?

The first thing you should probably know about back pain is that it can last anywhere from a few days to years, and that timeline makes a big difference in how your pain is diagnosed and treated.

• Acute back pain is defined as severe but lasting a short time, usually 7 to 10 days.
• Subacute pain can last from two to six weeks.
• Chronic back pain usually occurs every day and sticks around for longer than six to eight weeks. It can be severe and last months or even years, but may be characterized as mild, deep, achy, burning, or electric-like.

Beyond the when, there’s also the where. Mechanical pain means that the source of your pain may lie in the facet joints, discs, soft tissues, or vertebrae.

Back pain that travels into another part of the body, such as the leg, may be consider radicular pain (because it radiates; get it?), particularly when it radiates below the knee. This scenario is commonly called a lumbar radiculopathy (e.g., sciatica). Fortunately, not all occurrences of back pain include leg pain.

Perhaps you’ve heard of inflammatory pain. While it sounds like it could be a separate type of pain from mechanical and radicular pain, it’s actually an element of both. Dr. Knight explains, “Symptoms of pain, whether mechanical or radicular, share a component of inflammation.”

Simply put, inflammation is when your body knows something isn’t right and “flares up” as a result.