Seven (Really Twelve) Reasons You May Have Back Pain

Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

1. You smoke or vape (yes, marijuana counts) – smoking cuts blood flow by constricting blood vessels and arteries and reducing the amount of oxygen and nutrients carried to and from the spinal discs, tissues, muscles, bones, etc. Lack of blood, oxygen and nutrients = poor healing, growth, repair, and regeneration.  You can do the math and figure out why your back hurts if you smoke, whatever you smoke.
2. You’re overweight or obese – carrying around excess weight hurts your back.  Pick up a 10-pound bag of sugar and carry it around for an hour.  You’ll quickly understand why extra weight is troublesome for your back.
3. You eat processed, sugary (junk) food – eating sugary foods increases the production of insulin and stress hormones, including prostaglandins, a key factor in inflammation and pain. Cut sugar and watch pain decrease!
4. You are older in age – Disc degeneration begins around age 30 and continues.  Most people will have some form of back pain in their lives, and it is the reason 80% of people seek medical care in their lives.  Yes, this is true for me too!
5. You have arthritis – Not everyone has arthritis in the spine, but the lower back and neck are the most common sites.  Stiffness, pain, and loss of range of motion are common symptoms.
6. You have an injury to:
   a. Spinal Bones – this could be a fracture or dislocation, both of which can be very painful and may require surgery to repair
   b. Spinal Discs – you could have a bulging, herniated pressing on a nerve or desiccated (dried out) disc that is flat and provides no cushion for your spinal bones
   c. Tendon(s) in the Back – tendons in the back can get strained or sprained just like they can in your ankle or wrist, from playing sports, a fall or car accident
   d. Muscle(s) in the Back – a pulled muscle is a very common reason for back pain.  Typically, a person has a lot of little muscle tears until suddenly the muscle spasms and causes a lot of pain and demands that you rest and pay attention to healing and changing your behavior.
7. Mechanical Issue in the Spine (Bone Spurs, Instability, Stenosis)
   a. Bone Spurs – When arthritis is severe and the cartilage in the joint has worn away, the bone in the joint will often grow larger to give the joint more surface area upon which to glide.  This would be great if the bone grew perfectly flat, smooth and in just the right place, but it is often irregular, lumpy and presses on a nerve or the spinal cord.
   b. Instability – You could have a slippage of the vertebral bones, called a spondylolisthesis, which means the bones are unstable in their stack upon one another.  One or more will “slip” forward causing pain and instability.
   c. Spinal Stenosis – You could have stenosis, which means the spinal canal that houses the spinal cord is narrowing and pressing on either the spinal cord or the nerve roots causing pain and/or dysfunction.  In both of these cases, the only remedy may be a surgical fix to address the mechanical issue, if the pain becomes severe.