Common Causes of Back Pain and How to Alleviate It

Despite the prevalence of back pain on millions of Americans, only those who have lived with it truly understand the toll it takes – not just on the body, but on every aspect of daily life. The constant discomfort, the struggle to move freely and the frustration of feeling held back can be overwhelming. 

Back pain can feel isolating, but relief is within reach. By identifying its causes – whether posture, habits or medical condition – and exploring effective treatments, you can move toward a life of less pain and greater mobility.

We speak to C. Shane Hume, D.O., a board-certified and fellowship-trained orthopedic spine surgeon with INTEGRIS Health Medical Group Orthopedics Central, to learn more. 

“At INTEGRIS Health Orthopedics Central, I use a multidisciplinary approach to diagnosing and treating neck and back pain issues,” Hume says.

“I evaluate and treat each patient individually to determine the pain source and use both non-surgical and surgical solutions to address it. By utilizing medications, physical therapy, exercise, lifestyle modifications and interventional pain specialists, I try to avoid surgery if possible. If surgery is necessary, I use state-of-the-art, minimally invasive and motion-sparing techniques to get the patient back to normal work and activities in the most efficient manner possible.”

Why back pain occurs

At a glance: Back pain is often linked to how the spine, muscles, nerves and surrounding tissues function together to support the body. When one or more of these elements is disrupted, pain can occur.

The back is a complex structure that relies on precise coordination between bones, muscles, nerves and ligaments. 

• The spine consists of 33 individual bones (vertebrae) stacked on top of one another that assist with support and movement.
• Located between each vertebra, intervertebral discs act as shock absorbers.
• There are 31 pairs of spinal nerves that help control muscle movement and send sensory information, such as touch and pain, to the brain.
• In addition, the back has more than 40 muscles broken down into three layers – superficial, intermediate and deep – that assist with anything from breathing to posture.
• Tough, fibrous tissues called ligaments connect bone to other bones in the back to limit excessive movement.

Strains

Strains of muscles or ligaments are one of the most common causes of back pain.

• Repeated motions, such as twisting or bending, can fatigue the muscles and ligaments in the back over time and increase the likelihood of small tears.
• Lifting heavy objects without engaging the legs or maintaining proper spinal alignment can place excessive pressure on the back muscles and ligaments, leading to injury.
• Jerky or awkward movements, especially during activities like sports, can cause the muscles or ligaments to overstretch or tear.
• Weak or unconditioned muscles, such as poor core strength, are less capable of supporting the spine and are more susceptible to injury. 

Herniated or bulging discs

Herniated or bulging discs cause pain when they press on nearby nerves.

• Over time, spinal discs naturally lose their elasticity and hydration, becoming less flexible and more prone to tearing (called disc degeneration).
• A sudden impact or high-energy trauma (car accidents, falls or injuries) can cause a disc to rupture.
• Activities that involve repetitive bending, twisting or lifting places strain on the discs, leading to gradual wear and tear.
• Some people inherit structural weaknesses in their spinal discs or a tendency for disc degeneration.
• Lack of regular physical activity weakens the supporting muscles around the spine, leaving the discs under additional strain.
• Consistently sitting or standing in positions that strain the spine contributes to uneven pressure on the discs, leading to degeneration or herniation.

Arthritis

Osteoarthritis, a form of arthritis that causes cartilage breakdown, can affect the spine. 

• It leads to stiffness and pain, particularly in the lower back.
• Spinal stenosis, a related condition, occurs when the spaces within the spine narrow, putting pressure on the nerves.
• Someone with arthritis in their spine may notice worsening pain during cold weather or after physical activity.

Osteoporosis

Osteoporosis weakens bones, making them brittle and susceptible to fractures. 

• Compression fractures in the vertebrae can lead to sudden, severe back pain.
• A person with osteoporosis might experience a fracture after a minor fall, causing long-term discomfort.

Sciatica

Sciatica occurs when the sciatic nerve, which runs from the lower back to the legs, is compressed or irritated, often by a herniated disc. 

• The sciatic nerve is formed by the L4, L5, S1, S2 and S3 nerve roots.
• Any imbalance near these nerve roots can cause pain, tingling or numbness radiating down the leg and into the foot.

Lifestyle factors

Daily lifestyle choices play a significant role in maintaining – or straining – the health of your back. 

• Excess weight in the form of obesity adds significant pressure to the lower back and spine, eventually putting strain on the discs, joints and muscles.
• Emotional tension from stress can cause muscle tightness in the back, contributing to chronic pain.
• Smoking reduces blood flow to the spine, which is crucial for delivering oxygen and nutrients to the tissues and discs.
• A sedentary lifestyle weakens the core and back muscles, which are essential for supporting your spine. 

Medical conditions 

Medical conditions can cause both acute and long-lasting back pain.

• Fibromyalgia is a chronic condition that causes widespread muscle pain, often including the back.
• Scoliosis is an abnormal spinal curve that can cause uneven wear on vertebrae and muscles.

What causes lower back pain in women?

What to know: While general physical strain can lead to back pain in anyone, specific factors often make women more susceptible to discomfort. 

Hormonal changes that occur during pregnancy, menopause or a woman’s menstrual cycle can all contribute to lower back pain.

• Women may notice back pain during the first few days of their menstrual cycle due to uterine contractions and inflammation.
• The natural weight gain and changes in posture that occur during pregnancy, along with the release of the hormone relaxin, can place extra strain on the lower back in the second or third trimester.
• Decreased estrogen levels during menopause weaken bones, muscles and connective tissues, making lower back pain more likely.

Medical conditions specific to women, such as endometriosis and osteoporosis, make back pain more likely.

• Endometriosis occurs when the tissue lining the uterus grows outside the uterus – often on pelvic organs – and can cause severe pelvic and lower back pain.
• Women are more prone to osteoporosis than men, particularly after menopause, and weakened bones in the spine can result in fractures.

How to treat back pain

Key points: Treatment depends on the severity, underlying causes and the patient's health profile, but ranges from physical therapy to surgery.

Physical therapy combines manual therapy, stretching, posture training and exercises to target the root cause of the pain.

• Stretching routines, such as hamstring and hip flexor stretches, help improve flexibility and reduce muscle tension.
• Strengthening exercises for the core and back muscles (planks and bridges) provide better support for the spine.
• Low-impact aerobic activities like walking or swimming can improve blood flow and promote healing.
• Manual therapy involves massage or spinal manipulation to relieve tight muscles and improve mobility.
• Physical therapists teach proper posture techniques to reduce the likelihood of pain recurrence, especially for people with desk jobs.

Medication plays a central role in managing back pain, especially when the discomfort is acute or debilitating.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, help reduce inflammation and provide pain relief.
• Muscle relaxants are prescribed for muscle spasms that worsen back pain, and nerve pain medications (gabapentin or pregabalin) may be used for conditions like sciatica or nerve compression.

Steroid injections are a minimally invasive, effective way to manage back pain caused by inflammation.

• Typically administered by a pain management specialist, injections work by delivering powerful anti-inflammatory medication directly to the problem area, providing targeted relief.
• However, while they offer temporary pain management, combining injections with lifestyle changes and physical therapy often leads to better outcomes.

Sustainable changes to daily habits can significantly reduce back pain and prevent future discomfort.

• Use ergonomic chairs with lumbar support or add a cushion to improve spinal alignment at work.
• Position monitors at eye level to avoid neck strain, keep feet flat on the floor and take frequent standing breaks.
• Losing excess weight reduces the stress on the spine, particularly in the lower back.
• Engage in activities such as yoga, pilates or swimming to strengthen and stretch muscles essential for back support.
• Lift heavy objects by bending at the knees, keeping the back straight and using leg muscles for power.

Surgery is typically a last resort, reserved for severe or persistent back pain that doesn’t respond to other treatments. 

• A discectomy involves removing part of a herniated or damaged disc that is compressing a nerve.
• A spinal fusion stabilizes areas of the spine where vertebrae have weakened, often due to degeneration.
• A laminectomy removes parts of the vertebrae to relieve pressure on spinal nerves.

Next steps: Contact your doctor if you’re experiencing back pain. Depending on the cause and severity, they can refer you to a physical therapist, pain management specialist or orthopedic surgeon for further evaluation.

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