The Underlying Causes Of Back Pain

The human spine and its soft tissues is basically an organ in the same way we know your skin is an organ. Whatever the ‘work’ is that an organ does, that work is the most likely source of that organ’s complaints. The human gut is concerned with absorption and digestion, when we put crappy food into it that’s when it gets sick most often. The human lung is concerned with the conversion of gases, inhaling toxic gases is the easiest way to make them unwell. The human spine is concerned with weight bearing and movement. This means that when the spine hurts the most common causes are those that relate to issues with weight bearing and movement. ‘Most common’ is not the same as ‘always’ however, it is definitely the case that back pain can be caused by many and complex issues through the body and its other organ systems. 

Back Pain Caused By Muscle Wasting

Muscle wasting from old injuries or bad habits, deep in the core, this is the most common of all factors in back pain and plays a significant role in the majority of back pain cases. The human spine has adapted to lead an upright existence, it is a radical piece of mammalian design that relies massively on strong trunk muscles. Without the supportive action of the trunk and core unnatural strain can occur in the spinal tissues, the exact tissues that get sore when you have back pain. 

Back Pain Caused By Scar Tissue

Scar tissue from old injuries that were never properly resolved or rehabilitated. Scar tissue is a more common cause of back pain than most people realise. Scar tissue can form in relation to injury but it can also build up gradually due to things like bad posture. The presence of scar tissue in the back affects freedom of movement and alignment, both of which may cause back pain. 

Back Pain Caused By Muscle Damage

Muscle damage in the spines supporting muscles, caused by pregnancy, child birth, injury or surgery, leaving the back with improper support. The simple fact is that sometimes if a muscle is cut or torn the function of that muscle is affected, often even after the wound has healed. Many people who have had trauma to their trunk and pelvic muscles suffer from long lasting weakness and dysfunction on the muscles that support the spine, a perfect recipe for back pain.

Back Pain Caused By Foot Problems

Even the most sedentary of us take millions of steps per year on extremely hard surfaces like concrete, tarmac & paving. The forces generated when your heel strikes concrete on your way to work are more significant than you think. If your arches are particularly high or particularly flat the strain of walking on hard ground in fashionable footwear is magnified many times. Not only are these kind of foot issues a major cause of knee pain, ankle pain, foot pain and hip pain, they are also a major cause of back pain. 

Back Pain Caused By Sedentary Work

There is no escaping from the fact that we evolved over millions of years to be a highly active organism. The amount of movement involved in child rearing, nest building, water gathering, foraging, hunting & not getting eaten by vicious packs of honey baggers is what you were made for ….. and now you ‘write code’. Prolonged sitting or even standing at work for more than 30 hours a week can lead to back pain by the weakening of the postural muscle, tightening the fascia and compression of the spinal bones. 

Back Pain Caused By Poor Technique

Poor execution of movement in sports and exercise activities can place unnatural strain on the spinal bones and cause back pain. Improper training methods are a major cause of pain and injury. An extremely common cause of back pain is distance running on hard surfaces like tarmac. Running on hard ground without correct technique & hip strength can place significant strain on delicate spinal joints and cause back pain. Mistakenly thinking that sit-ups & planks are a core exercise is also an ironic & very common cause of exercise related back pain.

Back Pain Caused Lifestyle

There are many lifestyle choices that can inflict forms of repetitive strain on the body. A great example would be the classic ‘supporting a child on your hip while doing things around the house’ on a daily basis. Being forced into slightly unnatural movements and positions by life is perfectly normal and healthy; it’s when these movements are excessively constant and repetitive that they can become a cause of back pain.

Back Pain Caused By Stress  

More often than not people who show up at their chosen healthcare providers office with a fresh case of bad back pain have some kind of increased stress. Occupational, financial and relationship stresses are major triggers for episodes of acute back pain in a percentage of individuals. It is important to use the term ‘trigger’ as opposed to ‘cause’ here because if you have a healthy strong spine it is not at all likely that stress is going to trigger bad back pain. If however, you are suffering from some of the issues listed above, stress can trigger those latent issues into an episode of pain. 

Back Pain From Internal Organs

There are many a complex connections within the human body, more than the minds of the genius level experts can even begin to get their heads around. One area in which their is a great deal of complex connectivity is within the sensory part of the nervous system. You can have pain in your neck and feel it as a headache (cervicogenic headache) , you can have pain in your back and feel it in your leg (sciatica), you can also have pain in an internal organ and feel it in your back. The most common example is the kidney which due to its location is a pretty obvious contender, other organs including the gut and reproductive system can refer pain to the lower back too. 

Back Pain Caused By Osteoarthritis

In many ways osteoarthritis is an extension of the movement & weightbearing problem our spines face, hence the term‘wear & tear’. All the years of weight bearing and compression when combined with certain other factors causes some degree of  arthritic change in the spine of essentially all of us over the age of 60. While there can in some cases be a connection between back pain and osteoarthritis there is often none. It is a completely myth that all arthritic joints hurt, it is also a myth that osteoarthritis and back pain are strongly connected. A clue to this fact is that people over 60 get severe back pain episodes far less than those in their 40’s and 50’s.

Back Pain Caused By Inflammatory Arthritis

Rheumatoid arthritis is just one example of an inflammatory arthritic condition that is a body-wide condition with the capacity to cause back pain. These types of arthritic conditions include other more obscure forms of arthritis-like psoriatic arthritis and anylosing spondylitis. These forms of arthritis are not common causes of back pain but they do nonetheless show up. We have most probably yet to even begin to identify the full complexity and subtlety of many of these conditions, some of which we are now being told maybe more to do with the health of the gut than anything else.  

Back Pain Caused By Bone Disease

On occasions back pain can be caused by a focus of disease within one or more of the spinal bones. In older people with osteoporosis, if a vertebra becomes seriously undermined and weakened it can become susceptible to fractures. Osteoporosis is a condition that causes the bone matrix to degrade and become weakened. Other instances where the bone becomes weakened by systematic disease include cancer, kidney disease and endocrine disease, if the bone is sufficiently affected any of these can turn into back pain. Often these type of issues will not make themselves known until they have caused a bone fracture. 

Thankfully it is not that likely that your back pain is being caused by a disease process. If you are sweating profusely and getting a lot of pain at night, losing weight without any change of diet or exercise or feeling increasingly unwell in combination with back pain, get yourself checked out ASAP. 

Back Pain Caused By Major Injuries

It probably goes without saying that significant injuries to the spine and it’s associated tissues can cause bad pain. Serious injuries to the spine are not that common and usually only occur under more extreme accidents. Probably the most common are spinal fractures in contact sports and vehicle accidents. If you badly injure your spine in a sporting context or in a serious accident you will almost certainly know all about it in the form of serious amounts of  back pain. Hospitals do an excellent job is screening and x ray-ing for these type of injuries so very few of them slip through the net these days. 

Back Pain Caused By Infections

Spinal infections are another less common cause of back pain that nonetheless should be considered.  Infection should be considered if there is a ‘hot spot’ on in the spine of someone who hasn’t injured themselves or had any previous instances of back pain, or whom has other symptoms of infection like fever. There are basically 2 kinds of spinal infection. There is a slow creeping kind that can behave a lot like normal back pain and is often misdiagnosed as a result, and there is also a far more aggressive kind of acute infection that makes people very sore and very sick very fast. There are numerous possible causes of spinal infection which require medical investigation to be identified. 

Back Pain Caused By Cauda Equina/Cord Compression

If your spinal cord or it’s root become compressed you can most certainly get back pain as a result. Some if that issues we have discussed above including fractures, tumors and large disc protrusions can all potentially compress the spinal canal and cause serious issues. Compression within the spinal canal generally causes pain or loss of sensation around the saddle region and down both legs in combination with some loss of bowel/bladder control. These issues are a very definite indicator that it’s an emergency hospital visit that you need as opposed to a trip to your osteopath or chiropractor. 

Closing Thoughts

Most back pain is mechanical in nature, it relates to movement issues. Human beings are prone to mechanical back pain in a big way, this isn’t a new thing either. There are pieces of Egyptian text that describe treatment being given for back pain. The biggest single reason for this weakness is probably our transition to an upright, 2 legged posture. A large mammal like us standing upright and walking on 2 legs is a very biomechanically unstable arrangement compared to all of our known ancestors and to all our living relatives in the mammal kingdom. 

Biped ( 2 legged ) design places greatly increased compression and force on delicate tissues of the lower spine & pelvis over a lifetime. Your dogs lower back only bears weight when she rears up on hind legs to deposit mud on your jacket or look up a tree. Your lower back bears the weight of your entire upper body all day every day. Yet, your lower back is essentially only fractionally differently from a dogs spine. You have all the same bones as a dogs spine in all the same places. Hopefully this gives you a glimpse on what an ambitious and unstable thing it is for us to be upright all the time, and that it puts radical strain on our lower backs. 

Setting aside the big picture it is still true that we don’t all get back pain, this is where the individual causes of back pain become more complex.