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A number of adults complain of back pain at some point in their lives. The good news is that most patients with back symptoms return to normal function with simple treatment, most commonly in the form of rest. Patients always want to know why they have back pain and the causes. Here are some common causes and why.

Back pain usually derives from either the joints (spinal bones), muscle or nerve.

Joints

General low back pain is most commonly caused by degeneration of the lower spine as we age. The spine degenerates with loss of intervertebral disc height due to dehydration (why we all shrink as we age), bone spur development, and facet joint enlargement. Over many decades, the spine begins a process to protect itself by going through its own fusion process to prevent further instability. Bone spur development can lead to nerve root compression or back pain. Facet joint enlargement can be very painful and usually the cause of progressive and worsening low back symptoms.

Muscle

Muscle pain is usually related to the development of joint pain. As one develops joint pain, the muscles become tense to hold your spine into position preventing you from developing further back pain. In doing so, the muscles become very tense and painful. When someone says they “threw out my back”, the most probable cause is aggravation of facet joint with subsequent muscle spasms limiting movement.

Nerves

Nerve pain is the easiest to diagnose because it is unmistakable. Nerve pain begins in the buttock (butt cheek) and radiates to the respective nerve dermatome. A dermatome is the area of skin that the nerve innervates or controls. The most common nerves that present with compression are L5 and S1. The L5 nerve innervates the top of the foot and dysfunction can lead to a “foot drop”. Compression of S1 is the traditional ‘Sciatica” with pain radiating down to the bottom of the foot.

Pain caused by joints or muscle usually respond to a reduction in activity and anti-inflammatory agents. Although activity should be reduced, we recommend that patients stay mobile by constantly changing their position throughout the day to prevent muscle spasms. Nerve pain is treated through rest and a short course of oral steroids.