Back pain isn’t a disease, but rather a symptom of multiple other factors.
It usually lasts a couple of days to a few weeks when the cause is back strain or misuse. However, when it becomes chronic or extremely painful, medical advice is always needed.
Back pain can be felt in the upper, middle or lower back as well as the neck and shoulders, and can even stretch from your hip down to your toes.
If you experience any of the following symptoms, you could have a back problem:
- Pain – a dull ache, or sharp or intermittent (pulsating) pain anywhere along the spine and back
- Restriction of back mobility
- Back pain accompanied by numbness of one or both legs
- Back pain radiating to the foot or knee (possibly sciatica)
- Dizziness or disturbance of vision related to neck posture
- Difficulty standing up after sitting for prolonged periods
- Back pain after standing for a long period of time
- A pins-and-needles sensation
- Prolonged muscle spasms
Symptoms you shouldn’t ignore
The following back-pain scenarios might be medical emergencies.
They don’t necessarily mean that something is seriously wrong, but it’s important to double check with your doctor:
- If you’re under 20 or over 65 and suddenly experience severe back pain, it could be the result of a tumour or another serious cause. Acute back pain in teenagers and elderly individuals generally can’t be ascribed to the usual causes.
- Pain in the upper back without a directly identifiable cause. Lower back pain (LBP) is common, but pain is unusual in the upper back.
- Acute or gradual bladder or bowel dysfunction with or without severe back pain. This could be a sign of cauda equina syndrome, a rare medical emergency in which the spinal nerve roots at the end of the spinal cord are compressed.
- Weakness in the legs. For example, if you suddenly can’t walk, stand up straight or climb stairs.
- Back pain accompanied by other symptoms that indicate illness (e.g. fever or weight loss).
- Back pain that’s worse at night.
- New-onset deformities of the spine, especially a hunched back (kyphosis).
- Pain that persists after 2-4 weeks of conservative treatment.
Symptoms of inflammatory lower back pain
Inflammatory back pain (IBP) is the hallmark symptom of spondyloarthritis, a type of arthritis that attacks the spine.
Look out for these symptoms:
- Insidious onset, i.e. it develops slowly over time
- Age: under 45
- Pain at night
- Alternating referred pain into the buttock or groin area
- Pain with associated early-morning stiffness (osteoarthritis-related stiffness generally lasts less than 30 minutes, whereas rheumatoid arthritis-related stiffness lasts longer than 30 minutes)
- Pain not relieved by rest
- Pain that improves with exercise or activity
Symptoms of sciatica
Sciatica describes the symptoms of the sometimes excruciating leg pain that’s commonly caused by the sciatic nerve being pinched along the spinal canal.
This may occur due to a change in the disc shape, spondylolisthesis (where one vertebrae in the back slides forward over the vertebrae below it), or foraminal stenosis (narrowing of the outflow path of the nerve from the vertebrae to the limbs).
If you have pain that radiates from the leg, buttocks or feet (usually only on the one side) and which feels like a bad leg cramp, or if you experience excruciating, shooting pain that makes it difficult to stand or sit, you could have sciatica.
Other symptoms include weakness, numbness and/or a tingling, pins-and-needles sensation that stretches down your leg and even into your toes.
Speak to your doctor as soon as possible if you believe you may have sciatica.
Reviewed by general practitioners Dr Lienka Botha and Dr Suzette Oelofse, FX Health. April 2018.
- SAMJ, Approach to lower back pain. F Moosajee.