Going to the source: How back pain begins

Knowledge is power!  The more you know about back pain, the better you can manage it.  In this article, you will learn:

  • The three major categories of back pain
  • The most common causes of back pain
  • The symptoms used to diagnose the source of your pain.

A closer look at the spine

Your back extends from the top of your neck down to your tailbone, and you can have pain anywhere along that long stretch of spine.  Sometimes, the pain might even radiate into your arms and legs.

The spine is a collection of bony rings, called vertebrae, whose major function is to provide support for the body and protection for the spinal cord.  The vertebrae are stacked on one another, separated by firm, pliable “cushions” called discs.  The stack of bones and discs is held together by ligaments and moved by muscles.  The vertebrae form a kind of “tunnel” that houses the spinal cord—a collection of nerves that form a “communications center,” sending and receiving messages from your brain, and branching off to the rest of your body.

Categories of back pain

All back pain originates in one or more of three places in the back.

  • The bones of the spine, the vertebrae
  • The muscles, tendons and ligaments attached to these bones
  • The nerves that come from the spinal cord that weave in and out of the spine

Structural changes in bones or soft tissue can press on nerves, which results in pain.  In some conditions, the nerves themselves become inflamed, and this causes the pain.  The conditions and symptoms described below fall into one or more of these three categories.

Muscle strain or sprain

This is the most common cause of back pain.  The muscles supporting your back never get to rest, even when you are lying down.  No matter what your position, they are always working to hold your spine in alignment.  And the muscles of your neck—at the top of your spine—must hold up your head, which weighs between 8 and 12 pounds.  Muscle injury causes inflammation and swelling of the soft tissue, which may press on nearby nerves, resulting in pain.  With commonsense treatments, most muscle strains and sprains resolve on their own.  Some muscle strains come from poor posture or changes in posture.  This can happen during pregnancy, or by wearing high-heeled shoes, both of which can throw the spine out of alignment, causing pain.

Wear and tear

As we get older, the bones, muscles and ligaments of the spine are subjected to wear and tear, especially if you participate (or participated in younger years) in contact sports or other activities that subject the spine to impact.  By contrast, moderate exercise—such as walking, jogging, or stretching—is actually beneficial, because it promotes blood flow to the spine.

Wear and tear cause symptoms in the bones and nerves of the spine.  These include arthritis of the spine, which is called spondylosis.  Spinal stenosis, is one form of arthritis where there is narrowing of the space within the spinal canal.  Both of these conditions can cause pain by compressing or “pinching” spinal nerves.


As the body ages, bones tend to become thinner and more brittle, especially in women after menopause.  Osteoporosis can be treated by diet, weight-bearing exercise and medications, but still has the potential to cause pain.  Thinner, more fragile vertebrae weaken the strength of the spine, and may fracture, either because of activity or simply due to the effects of gravity on the spine.

Herniated (slipped) disc

“Discogenic” back pain occurs when the cushioning, shock-absorbing discs between the vertebrae malfunction or break, slipping out of position and pinching spinal nerves.


This condition occurs when one vertebra in the spinal column slips forward over another.  This disrupts the whole integrity of the spine, destabilizing it.  When the spine is destabilized, the vertebrae pull on muscles, ligaments and other discs, compressing nerves and causing pain.


The sciatic nerve is actually a collection of spinal nerves joined together at the lower part of the spine.  At the end of the spine, the sciatic nerve splits in two, sending branches through the buttocks and down the back of each leg all the way to the feet.  When any one nerve in this group gets irritated or compressed, it sends pain signals to all of the other nerves, and this pain can extend all the way down the leg.

Pain symptoms

The conditions described above can cause pain aching, stiffness, burning, “crackling”, shooting, stabbing or throbbing.  It is important to describe the pain accurately to your health care provider, including its location.  Back pain is not only felt in the back, but may radiate outward to arms and legs, and appropriate treatment depends on a correct diagnosis.


The AGS Foundation for Health and Aging. Aging in the Know: Your Gateway to Health and Aging Resources on theWeb. (2005) Back pain. Retrieved June 19, 2008 from http://www.healthinaging.org 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (2005). Handout on health: back pain. Retrieved June 19, 1008.http://www.niams.nih.gov