Back pain may be mild or extreme, quick or constant. What raises your risk -- and what can you do about it? Learn about back pain's causes, risks, and prevention.

Back pain may be mild or extreme, quick or constant. What raises your risk -- and what can you do about it? Learn about back pain's causes, risks, and prevention.

What Is Back Pain?

Spine Anatomy and Back Pain

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

Cervical vertebrae: the seven vertebrae forming the upper part of the spine
Thoracic vertebrae: the 12 bones between the neck and the lower back
Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips
The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.

Causes

What Are the Causes of Back Pain?

Back pain is a symptom. Pain arising from other organs may be felt in the back. This is called referred pain. Many intra-abdominal disorders -- such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others -- can cause pain referred to the back. Your doctor will have this in mind when evaluating your pain.

Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is touched), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, in one spot, and associated with numbness in the area of the leg that the affected nerve supplies.
Herniated discs are produced as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in a third of adults older than 20. Only 3% of these, however, produce symptoms of nerve impingement.
Spinal stenosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc spaces. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.
Spinal degeneration is caused by alterations in the disc that progress to degeneration. This coupled with disease in joints of the low back, causes spinal canal narrowing. These changes in the disc and the joints produce symptoms and can be seen on an x-ray. A person with spinal degeneration may have morning stiffness or pain while standing for a long time or walking even short distances.
Cauda equina syndrome is a medical emergency. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence, or the inability to begin urination.
Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.
Fibromyalgia results in pain and tenderness on 11 of 18 trigger points when touched, one of which is the low back area, as classified by the American College of Rheumatology. Generalized stiffness, fatigue, and muscle ache are reported.
Other skeletal causes of low back pain include osteomyelitis or sacroiliitis (infections of the bones of the spine). This pain is usually worse at night and is worse when sitting or standing for a long time.
Tumors, possibly cancerous, can be a source of skeletal pain.

Are You at Risk?

What Are the Risk Factors for Back Pain?

A risk factor is something that increases your chances of having back pain. Having more risk factors means you have a higher chance of having back pain.

Risk factors that you can't change

These include:

Being male.
Having a family history of back pain.
Having had a back injury before.
Being pregnant. A woman's back is significantly stressed by carrying a baby.
Having had compression fractures of the spine.
Having had back surgery before.
Having spine problems since birth.

Risk factors you can change with lifestyle changes

These include:

Not getting regular exercise.
Doing a job or other activity that requires long periods of sitting, heavy lifting, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment.
Smoking. People who smoke are more likely than people who don't smoke to have low back pain.
Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proven. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility. These can lead to low back pain.
Having poor posture. Slumping or slouching on its own may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse.
Being under stress. Stress and other emotional factors are believed to play a major role in low back pain, particularly chronic low back pain. Many people unconsciously tighten their back muscles when they are under stress.

Risk factors you might change with medical treatment

These include:

Having long periods of depression.
Using medicines long-term weakens bones, such as corticosteroids.
Having an illness or disease that causes chronic coughing.

Related Guide: Back Pain during Pregnancy

Most women develop back pain at some point during pregnancy. As the size and weight of your growing belly place more strain on your back, you may notice your posture changing. To protect your back from poor posture, unnecessary strains, and painful injury, follow these guidelines:

Avoid standing with your belly forward and your shoulders back. Do the opposite.
When standing, rest one foot on a small box, brick, or stool. Try not to stand for long periods of time.
Sit with a back support or pillow against your lower back. If you must sit for prolonged periods, take a break every hour.
Avoid heavy lifting. Lift only by rising from a squat, keeping your waist and back straight.
Avoid stretching to reach something, such as on a high shelf or across a table.
Sleep on a firm mattress (plywood under a mattress helps). Lie on your side, with a pillow between your knees.
Stay active, and do simple back exercises.

You can help reduce back pain by wearing supportive, low-heeled shoes and avoiding flat or high-heeled shoes. A pregnancy support belt that rests under your abdomen can also help take the strain off of your back.

Soak in a warm tub, or apply heat or cold to your tired or achy back. Massage can help relieve muscle strain and tension.

Simple back exercises

See the following pictures of stretching and strengthening exercises. These are well suited to pregnancy, and they can help your back handle the demands of pregnancy:

Back press
Backward stretch
Diagonal curl
Forward bend
Leg lift crawl
Pelvic rocking
Pelvic tilt
Tailor press
Tailor sitting
Tailor stretching
Trunk twist
Upper body bends