During my 17 years practicing medicine, patients and friends constantly ask me:

"What is the most likely cause of my back pain?"

I've written this simple guide for people who have the same question in mind.

The commonest type of back pain is caused by tears or strains to ligaments, tendons or muscles around the lower spinal cord. The underlying factors are straining, poor posture, incorrect lifting and inactivity. The pain usually appears 36-48 hours after the strain or can be gradual in onset. The symptoms can be mild to moderate depending on the level of injury.

Herniation of a vertebral disc may be associated with back pain and also sciatica...shooting pain down the back of one leg. It is most often seen in people in their 30's and 40's but can also occur in the elderly. The degeneration of the vertebral disc is responsible for this condition. This can lead to a gradual rupturing of the disc and Herniation of the disc contents. This process can be exacerbated by physical straining or exercise. The herniated portion of the vertebral disc compresses the adjacent spinal root nerve resulting in sciatica. The pain, which can be very severe, may be associated with numbness or tingling in the area supplied by that nerve (dermatome).

Facet Joint Syndrome is caused by injury, degeneration or arthritis of the facet joints of the spinal vertebrae. These joints are normally covered with cartilage and lined by synovial membranes. Arthritis leads to wear and tear of the cartilage and inflammation of the membranes. This leads to grating movements between the two facet joints. It is characterized by back pain that is made worse by twisting or extension of the spine. The pain is normally well localized and may spread to the buttocks.

Narrowing of the spinal canal (Spinal Stenosis) is more commonly seen in the elderly. It is secondary to vertebral degeneration. It may also occur with infection, trauma, tumors and arthritis of the spine and with bony spurs and disk herniation. It can progress to severe spinal cord injury. It is associated with back pain as well as pain, numbness and weakness of the buttocks.

Radiculopathy ('a pinched nerve') is associated with back pain and pain, numbness, weakness and tingling of the legs. It occurs when inflammation of a spinal nerve is caused by pressure or friction. The underlying factors can be tumors, bony spurs, disc herniation, and fractures of the vertebrae. The presence of muscle weakness in the legs as well as pain in the back... indicates severe symptoms. In such cases you should seek a doctor's advice immediately.

Tumors of the spine, whether they originate in the spine or spread from distant organs, can cause terrible back pain through pressure on the nerves and spine. Chronic persistent pain despite treatment is suggestive although not diagnostic of a spinal tumor. Be suspicious when such pain is associated with generalized signs of cancer such as weight loss, loss of appetite and tiredness.

Infection of the spinal cord or surrounding tissues causes pressure on the spine and can result in severe back pain and loss of function of the affected spinal nerves. Examples include spinal meningitis and osteomyelitis.

Underlying bony disease of the spinal vertebrae can lead to nerve compression, inflammation and degeneration. Examples include osteoarthritis, osteoporosis and ankylosing spondylitis. Ankylosing spondylitis is characterized by pain in the back and stiffness. This lack of mobility of the back is most noticeable first thing in the morning. It is also not helped by resting. There may also be pain in the shoulders, neck and mid-spine. Osteoporosis ( low bone mass) leads to fractures. Fractures cause sudden severe back pain localized to the area of the fracture. Osteoarthritis, the wear and tear of joints with age, leads to chronic back pain which tends to be poorly localized. This is characterized by pain and decreased movement of the spine. It is not helped by rest.