What Causes Back Pain?

There are many risk factors that may contribute to the onset of back pain. The most common pain occurs in the lower back and may be caused by many different reasons.

  • Genetics: some spinal conditions, like ankylosing spondylitis, are genetic; there is research that suggests that lower back pain may also have a genetic component—whether that is a predisposition to disc problems or a marker for lower pain tolerance is not clear.
  • Age: as we age, we lose bone strength as well as muscle elasticity and tone. the discs between the vertebrae also lose flexibility and fluid, which decreases their ability to cushion the vertebra.
  • Weight gain: rapid weight gain, obesity or excess weight may put stress on the back and potentially cause lower back pain.
  • Fitness: when abdominal and back muscles are weak, they cannot properly support the spinal column, which may lead to back pain.
  • Pregnancy: many changes occur to the body when a woman is pregnant, including ligament softening, pelvic changes and weight loading which may contribute to back pain; this pain is usually resolved postpartum.
  • Occupation: jobs that require heavy lifting, moving, pushing and pulling and involve spinal movements, may cause injury or back pain.
  • Mental health: stress, anxiety and depression may affect the body in many ways, causing muscle tension and increased focus on and perceptions of pain.

In most cases, lower back pain is mechanical and not related to serious underlying conditions.1

  • Herniated or ruptured discs
  • Intervertebral disc degeneration
  • Radiculopathy
  • Sciatica
  • Skeletal irregularities
  • Spinal stenosis
  • Spondylolisthesis
  • Sprains and strains
  • Traumatic injury

Although not as common, there are certain conditions where pain in the back, and at times pronounced leg pain, may indicate a more serious condition.1

  • Abdominal aortic aneurysm
  • Age-related bone deterioration like osteoarthritis and spinal stenosis
  • Cancer / tumor
  • Cauda equina syndrome—rare complication of a ruptured disc
  • Cervical spondylosis
  • Cervical, thoracic or lumbar disc herniation
  • Degenerative disc disease
  • Endometriosis
  • Fibromyalgia
  • Infections—osteomyelitis, discitis, sacroiliitis
  • Inflammatory arthritis, e.g., rheumatoid, psoriatic, ankylosing spondylitis, juvenile idiopathic arthritis, systemic lupus erythematosis, polymyalgia, rheumatic
  • Injury, fracture
  • Kidney stones
  • Paget’s disease of the bone
  • Severe spinal deformity, e.g., scoliosis, Scheurmann’s kyphosis
  • Spinal fusion
  • Thoracic outlet syndrome

In all of these conditions, the bones, joints, muscles and ligaments may be damaged or dysfunctional, causing neck, upper or lower back pain and decreased mobility. Fortunately, there are treatment options available to help alleviate many back pain symptoms, lessen stiffness and rigidity and restore spine movement to healthy function.

See How are Spine Disorders Treated for an overview of treatment options.

1 National Institute of Neurological Disorders and Stroke