Back pain is a very common concern and it can be either acute or chronic. If the pain is acute, symptoms are generally sudden. In chronic cases, however, the pain returns regularly, over time, sometimes unpredictably and can make everyday activities difficult.

Back pain can occur in a person due to several reasons, including the following:

  1. Herniated Disc
  2. Overuse or Poor posture
  3. Muscle injury
  4. Pinched/compressed nerves
  5. Narrowing of the spinal canal(Spinal Stenosis)
  6. Vertebral fracture(s)
  7. Osteoporosis
  8. The natural processes of aging
  9. Spondylitis (a spinal infection that creates inflammation. 
  10. Scoliosis
  11. Tumors

Many of the solutions marketed to patients treat back pain as a single diagnosis. In fact, the term “back pain” is not really a diagnosis at all, rather a description of a symptom. Treating all patients that present with back pain the same is like prescribing antibiotics to every patient with abdominal pain. Just as there are many diagnoses that cause abdominal pain, there are several distinct types of back pain

Many structures in back can cause pain

Back is subjected to various strong forces throughout the day, such as from twisting, sudden jerks or jolts, or poor posture when sitting over. During these activities in your spine,  many interconnected and overlapping structures are capable of becoming injured and producing back pain. Common anatomical causes of back pain include:

  • Large muscles that support the spine, they act as a corset around your spine.
  • Spinal nerves that exit the spinal canal and may go to the peripheries(Legs and arms)
  • Facet joints that connect the vertebrae along the back of the spine
  • Intervertebral discs that provide shock-absorption for the bones

It is usually difficult for the brain to distinguish between injuries to one spinal structure versus another nearby. For example, a torn or herniated disc may feel similar to an arthritic facet joint due to their close proximity. In some cases, the same nerve root can be compressed or irritated by different structures, such as a disc or bone spur.

The physician or the physical therapist will take a thorough medical history, discuss your symptoms, and conduct a physical exam in order to accurately diagnose the cause of back pain. Sometimes diagnostic test such as X-rays, MRI scans, or diagnostic injections are needed when trying to locate or confirm the underlying cause of pain.

Description of pain by the patient, its area of distribution, and any related symptoms are important to determine a back pain diagnosis. Three common classifications of back pain include:

  • Axial pain. Also called mechanical pain, axial pain is confined to one spot or region. It may be described a number of ways, such as sharp or dull, comes and goes, constant, or throbbing. A muscle strain is a common cause of axial back pain as are facet joints and annular tears in discs.
  • Referred pain. Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example in the lower back, degenerative disc disease may cause referred pain to the hips and posterior thighs. 
  • Radicular pain. Commonly described as electric shock-like or searing, radicular pain follows the path of the spinal nerve as it exits the spinal canal. This type of pain is caused by compression and/or inflammation to a spinal nerve root. In the lower back (lumbar spine), radicular pain may travel into the leg. Other terms for radicular pain are sciatica or radiculopathy (when accompanied by weakness and/or numbness). It can be caused by conditions such as a herniated disc, spinal stenosis, or spondylolisthesis.


Other factors like psychological factors, such as depression and sleeplessness, can make the pain worse and also need to be included as part of a comprehensive treatment program.

Once your doctor reaches an accurate diagnosis for your back pain, an effective treatment plan can begin. A skilled physiotherapist or a physician can diagnose your issue by identifying the specific type of problem you have, and customize a treatment plan. Accurately matching the diagnosis to the treatment plan is crucial to reducing your back pain. For persistent back pain and/or any neurological symptoms, it is always important to see a doctor for a diagnosis. Understanding your pain is an important element of this process.