Spinal Pain

Spinal pain affects millions of people worldwide, ranging from mild discomfort to severe disability that impacts everyday activities, work, and quality of life.

Table of contents

• Overview
• How Common Is Spinal Pain
• Affected Areas of the Spine
• Symptoms and How Spinal Pain Feels
• What Causes Spinal Pain
• Types of Spinal Pain by Duration
• When to Seek Medical Care
• How Spinal Pain Is Diagnosed
• Treatment Options
• Prevention Strategies
• Living With Chronic Spinal Pain

Overview

Spinal pain refers to discomfort felt anywhere along the back of the body, from the base of the neck to the top of the buttocks. It is one of the most common reasons people seek medical help or miss work days^[1][2]. The pain can range from a dull, constant ache to sudden, sharp sensations that make movement difficult^[3].

The spine is a complex structure made up of 33 small bones called vertebrae (the individual bones that make up the spine), with cushion-like discs between them. This structure supports the head and upper body, allows movement in multiple directions, and protects the spinal cord (the main nerve pathway connecting the brain to the rest of the body)^[4][7].

• Cervical spine (neck region)
• Thoracic spine (upper and middle back)
• Lumbar spine (lower back)
• Vertebrae
• Intervertebral discs
• Spinal cord
• Facet joints
• Muscles and tendons
• Ligaments

How Common Is Spinal Pain

Spinal pain is remarkably common worldwide. The lifetime prevalence is reported as over 70% in industrialized countries, with a worldwide lifetime prevalence of 84%^[13]. In 2020, low back pain affected 619 million people globally, and this number is estimated to increase to 843 million cases by 2050^[6].

Low back pain is the single leading cause of disability worldwide and represents the condition for which the greatest number of people may benefit from rehabilitation^[6]. Approximately half of adults experience low back pain during any given year, and about two-thirds of the population will have back pain at some time in their lives^[5].

People at any age can experience spinal pain, including children and adolescents. The prevalence increases with age up to 80 years, while the highest number of cases occurs at the age of 50 to 55 years. Spinal pain is more prevalent in women^[6].

Affected Areas of the Spine

Healthcare providers often describe spinal pain according to its location in three main regions^[3]:

Cervical region (neck): This area runs from the base of the skull through the neck. Pain here may spread to the shoulders, arms, hands, or fingers. Symptoms can include dull or sharp pain between the shoulder blades that radiates down the arm, or numbness and tingling in the shoulder or arm. The pain may increase with certain neck positions or movements^[2].

Thoracic region (upper and middle back): This section runs between the base of the neck and the bottom of the rib cage. The thoracic spine is much more rigid than other areas and is less frequently injured^[2]. Pain in this area can radiate around one or both sides of the rib cage and may be triggered by physical exertion or even taking a deep breath^[2].

Lumbar region (lower back): This is the most commonly affected area, located below the ribcage. The lumbar spine bears most of the body’s weight and experiences the most stress when lifting or carrying things, making it especially vulnerable to injury and wear^[3]. Pain from this region frequently results in sciatica (pain that travels from the lower back down through the leg), with sensations of burning, tingling, and numbness radiating from the buttock into the leg and sometimes the foot^[2].

Symptoms and How Spinal Pain Feels

Spinal pain can feel different depending on its cause. People describe their pain in various ways, including burning, aching, dull, sharp, shooting, stabbing, or throbbing sensations^[3]. The discomfort can range from a muscle ache to an intense, stabbing feeling^[1].

Common symptoms associated with spine problems include^[4]:

• Muscle tightness or stiffness
• Limited mobility and reduced range of motion, making it difficult to bend, twist, or perform certain movements without experiencing pain
• Tingling, numbness, or weakness
• Muscle spasms, which can range from mild to extremely painful
• Radiating pain that spreads from the back to other areas like the buttocks, hips, or legs
• Stiffness in the affected area, restricting range of motion
• Inability to maintain normal posture due to stiffness or pain

Certain positions, such as standing up, bending over, or lying down, may worsen or improve symptoms. Pain may come and go and can be worse at certain times of the day, like when first waking up^[3]. The pain can also be affected by activities like bending, twisting, lifting, standing, or walking^[1].

In severe cases, spine pain or nerve compression can lead to weakness in the back or extremities, making it difficult to perform tasks requiring coordination or fine motor skills. Notable loss of motor function may occur, such as difficulty walking on tiptoes or heels^[2].

What Causes Spinal Pain

Most spinal pain—about 85% to 90% of cases—is classified as nonspecific, meaning it cannot be attributed to a recognizable specific condition^[5][6][13]. The most common causes of back pain are strains (injuries to muscles or tendons) and sprains (injuries to ligaments)^[3].

Strains can occur from a single event, like lifting a heavy object, or from prolonged repetitive movements, such as constantly bending down at work. Sprains typically occur after a sudden fall, twist, or blunt force injury that stretches a ligament beyond its normal range of motion. With either a strain or sprain, a person might hear a pop or feel a tearing sensation when the injury happens^[3].

The lumbar and cervical spine are particularly prone to strain because they bear weight and are involved in moving, twisting, and bending. When these soft tissues become inflamed, they cause pain and may trigger muscle spasms^[2].

Other factors that can contribute to spinal pain include^[4][5]:

• Aging and degenerative changes: As people age, the discs in the spine naturally lose hydration and elasticity, leading to conditions like osteoarthritis, spinal stenosis, spondylosis, or herniated discs
• Nerve damage from conditions that compress or irritate spinal nerves
• Injuries and trauma from accidents, falls, or sports injuries
• Infection: Bacteria or viruses can infect the bones of the spine
• Congenital or structural abnormalities such as scoliosis or lordosis
• Obesity: Excess weight stresses the spine and can lead to chronic pain
• Poor posture when sitting, standing, or working
• Lack of physical activity leading to weak back muscles
• Smoking, which restricts blood flow to the discs and reduces calcium absorption
• Psychological factors like stress, anxiety, and depression

Specific conditions that can cause spinal pain include^[4]:

• Herniated disc: a rupture of a disc in the neck or lower back
• Spinal stenosis: narrowing of the canal surrounding the spinal cord or nerves
• Radiculopathy: shooting pain down the arm or leg due to nerve compression
• Degenerative disc disease: deterioration of the discs in the neck or lower back
• Cervical myelopathy: damage to the spinal cord in the neck region
• Spondylosis: abnormal wear on the bones and cartilage
• Spondylolysis: a defect in a segment of bone in the lower back
• Spondylolisthesis: slippage or displacement of one vertebra relative to another
• Scoliosis: S- or C-shaped curvature of the spine
• Kyphosis: abnormal rounding of the spine
• Spinal tumors
• Tethered spinal cord syndrome
• Neurofibromatosis

Types of Spinal Pain by Duration

Healthcare providers classify spinal pain according to how long it lasts^[3][5]:

Acute back pain lasts less than four to six weeks. This type of pain often comes on suddenly and is typically related to a specific injury or event. Most acute back pain improves over time with home treatment and self-care, often within a few weeks^[1].

Subacute back pain can last anywhere from four to 12 weeks. This represents a transitional phase where pain persists beyond the typical acute period but has not yet become chronic^[3].

Chronic back pain is defined as pain that lasts more than 12 weeks or three months^[3][13]. This type of pain can significantly impact a person’s quality of life and may require more comprehensive management strategies. Research indicates that 31% of people with low back pain will not fully recover within six months, although most will show some improvement^[13].

Recurrent back pain occurs in 25% to 62% of patients within one to two years after an initial episode, with up to 33% experiencing moderate pain and 15% having severe pain^[13]. This pattern of recurring episodes is a hallmark characteristic of back pain in large studies^[13].

When to Seek Medical Care

Most back pain improves over time with home treatment and self-care. However, certain warning signs, called “red flags,” indicate the need for immediate or prompt medical attention^[1][12].

Seek immediate medical care if spinal pain^[1]:

• Causes new bowel or bladder problems, including incontinence or urinary retention
• Is accompanied by a fever
• Follows a fall, blow to the back, or other injury
• Is associated with loss of anal sphincter tone or saddle anesthesia (numbness in the area that would contact a saddle)

Contact a healthcare professional for back pain that^[1][4]:

• Lasts longer than a few weeks without improvement
• Is severe and doesn’t improve with rest
• Spreads down one or both legs, especially below the knee
• Causes weakness, numbness, or tingling in one or both legs
• Is paired with unexplained weight loss
• Is accompanied by major or progressive motor or sensory deficit
• Involves a history of cancer that can spread to bone
• Occurs with suspected spinal infection

It’s important to note that while red flags are common in patients with acute low back pain, they do not necessarily indicate serious conditions. Healthcare professionals rely on a comprehensive clinical approach to evaluating these warning signs^[12].

How Spinal Pain Is Diagnosed

Diagnosing spinal pain begins with a healthcare professional examining the back and assessing the ability to sit, stand, walk, and lift legs. The provider will ask about pain levels on a scale of zero to 10 and how the pain affects daily activities. These assessments help determine where the pain originates and how much movement is possible before pain or muscle spasms occur^[8].

The diagnosis often starts with a thorough medical history and physical examination. The doctor may ask questions about when the pain started, what triggers it, and the specific location and nature of the pain^[12].

Without findings suggesting serious conditions, imaging is not typically indicated in patients with acute low back pain^[12]. However, when necessary, diagnostic tests may include^[8]:

X-rays can show arthritis or broken bones but cannot detect conditions affecting the spinal cord, muscles, nerves, or discs.

MRI or CT scans generate images that can reveal herniated discs or problems with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels.

Blood tests can help determine whether an infection or other condition might be causing pain.

Nerve studies, such as electromyography (a test that measures electrical signals from nerves to muscles), can confirm pressure on nerves caused by herniated discs or spinal stenosis.

Treatment Options

Fortunately, many effective treatments exist for spinal pain, and most patients don’t need surgery^[4]. Most back pain improves within a month using home treatment^[8]. Treatment approaches can be divided into several categories.

Medications

Nonsteroidal anti-inflammatory drugs (medicines that reduce inflammation and pain, often called NSAIDs) and acetaminophen are effective for nonspecific acute low back pain^[12][13]. These over-the-counter pain relievers can help manage symptoms while the body heals^[1].

Muscle relaxants are beneficial for reducing painful muscle spasms^[12]. For some individuals, prescription-strength pain medications or opioid medications may be necessary^[8].

Antidepressant medications may be prescribed even for people who are not depressed, as they can help with chronic pain. These medications affect chemical messengers in the body that may influence pain signals^[11].

Physical Therapy and Exercise

Physical therapy is essential for most patients with spinal pain. Physical therapists teach proper body mechanics for sitting, standing, and moving in ways that keep the spine properly aligned. They also provide specialized exercises that strengthen core muscles supporting the back^[11]. A strong core is one of the best ways to prevent future back pain^[11].

Specific methods include the McKenzie method and spine stabilization exercises, which may decrease recurrent pain and reduce the need for healthcare services^[12][13]. Regular exercise has been found to be one of the most effective ways to relieve back pain quickly^[11].

Staying active is crucial. Doctors no longer prescribe bed rest for back pain, as lying still can actually make the condition worse. Rest should not exceed one to two days^[11][12]. Low-impact activities like swimming, walking, or yoga can help^[1].

Heat and Cold Therapy

Regular applications of ice to painful areas may help reduce pain and inflammation from an injury. This should be done several times a day for up to 20 minutes each time, with the ice pack wrapped in a thin towel to protect the skin. After a few days, switching to heat can help relax muscles and increase blood flow to the affected area. Warm baths can also aid relaxation^[11].

Alternative and Complementary Approaches

Several alternative therapies may provide relief^[9][13]:

Massage therapy can improve pain and functioning for people with chronic back pain, with benefits lasting about six months^[11].

Acupuncture is an alternative therapy that has shown moderate improvement in back pain^[5].

Spinal manipulation and chiropractic techniques are no more beneficial than established treatments for nonspecific acute low back pain, and adding them to established treatments does not improve outcomes^[12].

Injections and Procedures

For some patients, spinal injections or radiofrequency neurotomy (a procedure that uses heat to interrupt pain signals) may be recommended^[9].

Surgery

Surgery is reserved for cases where symptoms are accompanied by severe nerve dysfunction or are due to serious causes like malignancy. Most patients with neck and back pain do not need surgery, as targeted therapy can improve their condition^[5][9].

Patient Education

Patient education that includes advice to stay active, avoid aggravating movements, and return to normal activity as soon as possible is effective. Discussing the often benign nature of acute low back pain helps reduce anxiety and supports recovery^[12][13].

Prevention Strategies

One of the best ways to prevent back pain is to keep back muscles strong and maintain good overall health^[1][17].

Exercise and Strengthening

Do muscle-strengthening and stretching exercises at least two days a week. Regular physical activity can help keep back muscles strong. Aim for at least 150 minutes per week of moderate-intensity aerobic activity. Activities like yoga can help stretch and strengthen muscles and improve posture^[17].

Posture and Body Mechanics

Stand and sit up straight. Avoid slouching when standing or sitting. When sitting, use a back support at the curve of the back and keep hips and knees at a right angle with feet flat on the floor. Legs should not be crossed^[18][19].

Avoid standing or sitting in the same position for long periods. If possible, switch between standing and sitting. When standing for extended periods, try elevating one foot by resting it on a stool or box, switching feet every few minutes^[18].

Proper Lifting Techniques

Lift correctly by using leg muscles, not the back. Keep the back straight and bend at the knees. Stand close to the object being lifted with a wide stance and feet firmly on the ground. Tighten stomach muscles and lift using leg muscles in a steady motion without jerking. Avoid lifting objects that are awkward or heavier than 30 pounds without help^[18].

Weight Management

Aim for a healthy weight. Being overweight can strain the back. Getting regular physical activity and choosing healthy foods can help achieve and maintain a healthy weight. Extra weight puts additional stress on the spine and can lead to chronic pain^[1][4].

Bone Health

Get enough calcium and vitamin D to keep bones strong and prevent osteoporosis, which can lead to fractures and back pain^[17].

Lifestyle Factors

Quit smoking. Smoking restricts blood flow to the discs that cushion vertebrae, leading to quicker disc degeneration. It also reduces calcium absorption and new bone growth, increasing the risk of fractures^[16].

Living With Chronic Spinal Pain

Chronic back pain is characterized by persistent discomfort lasting more than three months. This condition can significantly impact quality of life, making it difficult to perform daily activities and enjoy normal routines^[20].

Managing chronic spinal pain often requires a combination of lifestyle modifications and self-care strategies. Maintaining the normal curve of the spine is key to managing symptoms^[18].

Sleep can be challenging with back pain. Try lying on the side with a pillow between the knees to keep the spine in a neutral position and relieve strain. If sleeping on the back, place a pillow under the knees. Use a comfortably firm mattress^[11].

Psychological treatment can help. Different coping, relaxation, and distraction skills can help patients better manage chronic low back pain^[9]. Long-term pain can lead to depression and psychological distress, so addressing mental health is an important part of comprehensive care^[9].

Work with healthcare providers to develop a personalized management plan. Most cases of chronic back pain can be treated without surgery through a combination of approaches^[4][13].

Rehabilitation is essential at all stages of back pain to help people make sense of their pain, return to enjoyable activities, and identify strategies to support recovery and improve function^[6].