Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.”
Lumbar herniated disc. The jelly-like center of a lumbar disc can break through the tough outer layer and irritate a nearby nerve root. The herniated portion of the disc is full of proteins that cause inflammation when they reach a nerve root, and inflammation as well as nerve compression cause nerve root pain. The disc wall is also richly supplied by nerve fibers, and a tear through the wall can cause severe pain.
There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
Enthoven WT, Geuze J, Scheele J, et al. Prevalence and "Red Flags" Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice. Phys Ther. 2016 Mar;96(3):305–12. PubMed #26183589. How many cases of back pain in older adults have a serious underlying cause? Only about 6% … but 5% of those are fractures (which are serious, but they aren’t cancer either). The 1% is divided amongst all other serious causes. In this study of 669 patients, a vertebral fracture was found in 33 of them, and the chances of this diagnosis was higher in older patients with more intense pain in the upper back, and (duh) trauma. BACK TO TEXT
Some of these red flags are much less red than others, especially depending on the circumstances. For instance, “weight loss” is common and often the sign of successful diet! (Well, at least temporarily successful, anyway. 😃) Obviously, if you know of a harmless reason why you have a red flag symptom, it isn’t really a red flag (duh!). But every single actual red flag — in combination with severe low back pain that’s been going on for several weeks — is definitely a good reason to get yourself checked out.
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At the very least, the tension and/or spasm in muscles that cross over the hip and attach onto the pelvis can contribute to imbalance, in terms of how strong and flexible each muscle group is in relation to the others. But muscle imbalance in the hips and the spine may make for pain, limitation and/or posture problems. It can also increase the healing challenge put to you by an existing injury or condition, for example, scoliosis.
In diagnosing the causes of hip pain, it’s important to understand hip anatomy. The hip is basically a ball-and-socket joint similar to the shoulder joint and the arms. The hip joint is impressive in that it serves two factors, it is a support structure and also very flexible. Because it is a strong support structure, it tends to get injured. Because it’s very flexible, it similarly can be susceptible to injuries.
When hip pain comes from muscles, tendons, or ligament injuries, it typically come from overuse syndromes. This can come from overusing the strongest hip muscles in the body such as iliopsoas tendinitis; it can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome. It can come from within the joint, which is more characteristic of hip osteoarthritis. Each of these types of pain present in slightly different ways, which is then the most important part in diagnosing what the cause is by doing a good physical examination.
Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping its progression.
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
If you develop a sudden onset of low back pain, a visit to your physical therapist can help you determine the correct things to do to manage your acute pain. Your physical therapist should be able to analyze your lifestyle, movements, and overall medical history to help determine the likely cause of your pain. By focusing on these mechanical causes of back pain, you can make a change that may give you relief.
Back pain can be confusing enough as it is. Sometimes it may be difficult deciphering if the pain is even coming from your back, and trying to figure out what causes it can be mind-boggling. And many experts recommend focusing on mechanical sources of your back pain rather than anatomical sources of your pain. Is it a herniated disc, bulging disc, or facet joint arthritis causing your problem? It can be hard to decide, so focusing on what you are doing and the positions you put your back in may be the best way to determine the cause of your back pain.
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
The side of the pain on its own doesn’t tell us much, and most of the one-sided sources of pain are viscera that usually cause abdominal pain instead of back pain, or in addition to it. In other words, the only reason to worry about right or left lower back pain is if it is otherwise worrisome: if you have other red flags or significant non-back symptoms.

Some of these red flags are much less red than others, especially depending on the circumstances. For instance, “weight loss” is common and often the sign of successful diet! (Well, at least temporarily successful, anyway. 😃) Obviously, if you know of a harmless reason why you have a red flag symptom, it isn’t really a red flag (duh!). But every single actual red flag — in combination with severe low back pain that’s been going on for several weeks — is definitely a good reason to get yourself checked out.
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