Back pain: what causes low back pain and when to be alarmed

By Cristiano Antonino Last updated Jun 2, 2023

According to the WHO (World Health Organization), back pain is the leading cause of disability in the world. A very common disorder that, according to estimates, affects 40% of people

However, there is pain and pain: being a multifactorial pathology, due to numerous causes and not dependent on age, back pain (correct name: low back pain) can manifest itself with different degrees of intensity and last from a few days up to whole months .

In fact, we speak of acute low back pain when it ends within 6 weeks, of sub-chronic low back pain when it lasts for 6-12 weeks and of chronic low back pain when it is still felt after 12 weeks.

Often associated with overweight, a sedentary lifestyle and wrong movements, back pain is generally defined by patients as pain confined to a generally large area and usually does not hide any other pathology.

The pain can radiate along the entire length of the spine, sometimes even reaching the buttocks.

In the case instead of acute pain concentrated in a very specific point of the spine, it could hide other problems such as the fracture of a vertebra.

The main difference, when it comes to back pain, lies in the definition of acute or relapsing

Acute back pain

Very often, when suffering from back pain, a specific cause is not identified or researched: this is because, in most cases, the pain is due to excessive efforts, incorrect positions, overweight, poor muscle tone.

Only when conservative treatment does not relieve it and “worrying” symptoms (weight loss, fever) appear, the patient usually goes to the general practitioner to investigate the reasons.

However, the most common back pain is acute back pain, which subsides in a short time and is caused by non-serious factors.

It is a very frequent pain especially in the age group between 20 and 40 years, generated by incorrect movements in terms of lifting, twisting or front flexion of the trunk.

In this case, back pain can appear (even very severely) immediately after the traumatic event or the next morning, and generally worsens with movement (for example when you lift a leg, sit or stand) .

The causes of acute low back pain are many:

Damage to the muscles or ligaments of the back (sprain, contracture, strain)
disc herniation (leakage of the nucleus pulposus from an intervertebral disc)
pregnancy
sciatica (inflammation of the sciatic nerve)
cruralgia (inflammation of the crural nerve)
sacroiliitis (inflammation of the sacroiliac joint)
spinal stenosis (narrowing of the spinal canal)
vertebral fracture (due to a fall or osteoporosis)
scoliosis
hyperkyphosis
arthritis of the spine
spinal infections
diseases of the female genital system
vertebral tumors

Those who practice sports, those who carry out a job that involves frequent lifting of loads, those who suffer a car accident or an accidental fall, but also those who have a very sedentary lifestyle have a greater chance of developing acute back pain.

Chronic back pain

If acute back pain is a very common pathology and generally solvable with rest (or with the elimination of the triggering cause), chronic back pain is instead a relapsing and disabling pathology that can compromise the person’s quality of life .

To be defined as chronic, low back pain must last for at least 12 weeks.

It is generally a less severe pain than that of acute low back pain, but it tends to never disappear or to disappear and then reappear immediately afterwards, and often brings with it other problems, from sleep disturbances to depression.

Sometimes chronic low back pain arises from acute low back pain that does not go away (and the causes are therefore the same), other times it hides a pathology that can also be very serious.

Although it is mostly caused by joint problems, by an aging of the intervertebral disc or by inflammation, in rare cases it can in fact originate from an infection or a tumor.

Back pain: the causes

The causes of back pain are really numerous, and it is for this reason that it is always advisable to consult your doctor if it does not go away within a few days.

By carrying out all the analyzes of the case, it is possible to identify its cause in time.

Generally caused by trauma, incorrect posture and incorrect movements, back pain can also originate in those suffering from specific diseases:

juvenile idiopathic arthritis
psoriatic arthritis
rheumatoid arthritis
arthrosis
brucellosis
cystopyelitis
slipped disc
hydronephrosis
lymphogranuloma venereum
Lyme disease
multiple myeloma
Scheuermann’s disease
osteoporosis
radiculopathy
sacroiliitis
Cauda Equina syndrome
Marfan syndrome
fibromyalgia syndrome
syringomyelia
Ankylosing spondylitis
spondylolisthesis
cervical spondylosis
spinal stenosis
spinal cord tumors

Less frequently, they can involve back pain:

hallux valgus
amyloidosis
reactive arthritis
cervical osteoarthritis
cervical whiplash
hemorrhagic corpus luteum
paroxysmal nocturnal hemoglobinuria
endometriosis
fibrodysplasia ossificans progressive
genital herpes
pelvic inflammatory disease
myasthenia gravis
myelopathy
Paget’s disease
osteitis
osteochondrosis
osteoid osteoma
osteomyelitis
hollow foot
flatfoot
polymyalgia rheumatica
polio
porphyria
decompression syndrome
Ehlers-Danlos syndrome
Reiter’s syndrome
cervical stenosis
lumbar stenosis
adnexal torsion

Back pain: symptoms

The primary symptom of back pain is, of course, lower back pain.

However, the person may also experience:

tingling or burning in the lower back
movement difficulties in the acute phase of pain
lumbar stiffness
lameness

How back pain is diagnosed and what the patient can do about it

To carry out a correct diagnosis of back pain it is necessary to understand its causes in order to undertake the appropriate treatment, thus avoiding chronicity and recurrences.

The doctor will ask the patient about the location of the pain and its duration, so as to distinguish between a widespread condition (which therefore originates from a deeper tissue) and one located in precise points where a lesion has probably been created.

Through the physical examination he will understand if the patient suffers from sciatica (when the pain radiates down the leg) or if it is connected to some other disorder, perhaps at the kidney or intestinal level. Generally, only in the event that it does not pass with rest, or with the prescribed conservative treatments, the specialist will order diagnostic tests such as an X-ray or, in special cases, an MRI.

As a general prevention, the first rule is not to stay too much in bed or in a lying position.

In fact, resuming moderate physical activity as soon as possible helps prevent relapses and calm back pain.

If the pain arises instead after an effort, it is likely that the cause is a “lumbago”, a violent contraction of the muscles located near the vertebrae.

In this case, the patient feels severe pain and remains stuck in the position assumed, given the functional impotence of the muscles involved (the intensity of the pain itself and the fear of making the situation worse can fuel impotence).

In these cases, bending over and trying to reach the sofa or bed can relieve the pain.

Only after having unloaded the weight of the body from the vertebral column can one try to straighten the back through very slow movements and breathing deeply.

The advice is to stay in bed, getting up only if strictly necessary and always with great attention, first sitting up on the bed, then slowly lowering your legs until your feet touch the floor and slowly rising to your feet, supporting yourself with hands on the edge of the bed. Together with the rest, the doctor will prescribe adequate pharmacological treatments.

Instead, in the case of all those other pathologies such as herniated discs or more serious diseases, the symptoms vary according to various factors and cannot be diagnosed except through adequate checks (X-rays, CT scans, magnetic resonance imaging).

It is therefore always better to consult a doctor and carry out periodic checks especially in the situation in which the back pain does not cease after a few weeks.

Back pain: how to prevent it

Assuming and maintaining correct posture is essential in order to improve and prevent the onset of back pain.

Only a correct postural attitude can allow for a more uniform distribution of weight on every part of the column, avoiding stretching of the muscles.

For example, if you are standing you need to keep your head up with your eyes straight and not on the ground, so that the neck can maintain an upright posture and the weight of the head is well distributed throughout the column.

When the back starts to ache after a period spent standing then most likely it is the symptom of something not going as it should: bending the legs can help in these situations, because it helps to decompress the vertebrae, and the back and lumbar muscles can lengthen and stretch.

For women, even wearing shoes with a heel greater than 5cm can contribute to pain, given the poor posture they induce.

For those who have a sedentary lifestyle or, otherwise, an office job, sitting incorrectly can be a source of back pain

For this reason, the desk or work table must not be too high or too low with respect to the torso and shoulders, in order not to force forward or backward inclinations; moreover, the chair must be adjustable in height, to allow the feet to rest well on the ground, and must have a slightly curved backrest at the height of the lumbar region of the spine so as to be able to support the area.

Those who study or read for long periods of time must place the book on a lectern, while those who spend a lot of time in front of a computer must place the monitor at a height such as to be able to keep the head in a comfortable position, and keep the elbows move slightly forward with respect to the center of gravity so as not to put the weight on the shoulders.

In any case, those who maintain the same position for a long time should interrupt the activity they are carrying out at regular intervals by getting up from the table and walking, stretching their arms and stretching their back backwards.

To prevent low back pain or its recurrence, the best thing is to perform appropriate gymnastics, made up of targeted and not too tiring exercises that allow you to strengthen the muscle tone of the back and abdominal area to make them more elastic and more resistant to any efforts. Stretching techniques are also useful in this regard, as are massages.

Although the cause of back pain is generally due to disc degeneration or joint disease, perform a gentle physical activity, such as walking, swimming or performing simple gymnastic exercises, thus giving greater vigor to the muscles and ligaments connected to the vertebrae will prevent the condition from worsening.

Likewise, in case of overweight, it is useful to try to lose the extra pounds through both physical activity and correct and adequate nutrition.

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