In about 85% of acute back pain cases the exact cause cannot be identified. There are many different possible causes; the following are some of the more common ones:
Sprains, strains and minor injuries: in most cases the causes of back pain is not serious damage or disease, but having lifted a heavy object or made an abrupt movement. This is often called "simple" back pain.
A strain or tear to the muscles, tendons or ligaments can produce painful muscle tension and spasm. The pain usually lasts only a few days. Although this pain often begins suddenly, and one particular movement can trigger it, the underlying cause may have been developing for some time. Inactivity and improper movements are usually at the root of simple back pain. (See risk factors.)
Intervertebral disc lesion: wear and tear or strain may cause a spinal disc to bulge, tear or rupture (herniate). The disc's gelatinous filling protrudes and presses against sensitive nerves from the spinal cord. This is commonly referred to as a "slipped disc".
Facet joint problems and osteoarthritis: this is the usual cause of recurrent or chronic lower back pain. Spinal movement is made possible by joints between the vertebrae that consist of two flat faces or "facets". If these degenerate, the two halves of the joint grate painfully against each other.
Initially, the disc degenerates or wears down and increases the stress on the facet joints behind it. These joints become inflamed and later wear out (osteoarthritis). The inflamed joints cause backache.
Later, the arthritic joints become big and swollen (like an old lady’s arthritic finger joints) and these enlarged joints protrude into and narrow the spinal canal. This is called spinal stenosis and causes pinching of the nerves that run down the buttocks and legs, resulting in nerve pain (sciatica) and weakness down the legs.
The pain is typically worse when standing and walking (spinal claudication) and relieved by sitting or bending forward. It is often easier to walk in a stooped position, for example when using a shopping trolley.
Pathological back pain can sometimes be due to an infection (spondylodiscitis) and tumours. Back pain may also be referred from problems in other organs, usually near the spine. These conditions include peptic ulcers, kidney problems, pancreatitis, infections, inflammatory bowel disease, pregnancy, menstruation and other gynaecological problems such as ovarian cysts. In older people, low back pain may be a symptom of Paget's disease.
Backache can be caused by an accident or an injury to the spine, degenerative disease, metabolic diseases, infections or a tumour Use this list as a basis for the possible causes of back pain.
It can be one of these diseases
Degenerative (related to ageing)
Discogenic disease; Spinal stenosis; Facet joint arthritis
Traumatic (related to injury or an accident, including motorcycle accidents, diving accidents and rugby injuries)
Vertebral fractures; Lumbar strains and sprains; Ligamentous injuries; Musculoskeletal injuries
Inflammatory (usually a chronic type of inflammation)
Arachnoiditis; Arthritis (e.g. ankylosing spondylitis)
Infective (this can be due to a bacterial or viral infection)
Meningitis; Vertebral osteomyelitis; Epidural abscess; Urinary tract infection; Intervertebral discitis
Congenital (you are born with these)
Tethered cord syndrome
Developmental (becomes more apparent in adolescents)
Scoliosis; Sacral agenesis; Scheuermann's kyphosis
Osteoporosis; Paget's disease; Diabetes
It can either be a benign or malignant tumour. A malignant tumour can be primary or metastatic (in other words, it can originate in the spine or spread to the spine from another part of the body).
Preventing back pain
Diagnosing back pain
Symptoms of Spinal problems
Reviewed by Dr Pradeep Makan, orthopaedic surgeon, Melomed Gatesville and Life Vincent Pallotti Hospital in Cape Town and part-time lecturer in the department of orthopaedic surgery at the University of Cape Town, 2016