Common Causes of Back and Neck Pain

Causes of back and neck pain can include anything from a sudden injury to age-related changes over time. Spine-related pain is very common, with low back pain affecting up to 80% of people at some time in their lives. Low back pain is about twice as common as neck pain.

Pain, stiffness, muscle spasms, and other symptoms can last for a short time after you pull a muscle playing sports or lifting a heavy object. However, chronic back and neck pain can be related to a more serious condition, and managing pain can require pain medication or even surgery.

This article presents some of the reasons why your back and neck may hurt. It explains how your healthcare provider may diagnose these back and neck pain conditions, and why some people may be more at risk for back and neck pain.

Back and Neck Pain Symptoms

There are many ways to describe back or neck pain, and the description often involves specific sensations, timing, and exacerbating or relieving factors.

Some common ones include:

• Muscle pain (myalgia)
• Muscle spasm
• Shooting pains
• Pain radiating down your leg (referred pain)
• Pins and needles sensations
• Numbness in your leg
• Neck or back dysfunction (i.e., can't stand straight or twist neck)
• Pain gets worse with activity
• Pain gets better when lying down
• Stiffness of back or neck
• Loss of bowel or bladder control (urinary incontinence)

Location

The location of back and neck pain depends on the specific area of the spine that is affected.

Back pain can occur in the following areas:

• The neck is made up of seven cervical vertebrae. It is defined as the part of the spine extending from just below the base of your skull (which is approximately at the level of the bottom of your earlobe) down to the top of the first thoracic vertebrae.
• The mid and upper back extends from just below the seventh cervical vertebra down to the bottom of the 12th thoracic vertebra, which lines up approximately with the tenth rib (the third from the bottom).
• The low back is the area corresponding to the lumbar spine, which starts below the 12th thoracic vertebra and extends down to the top of the sacrum, which is almost mid-way down between the two halves of the pelvis.
• Sacroiliac and coccyx pain mainly takes the form of sacroiliac joint dysfunction. The coccyx bone is your tailbone. It is the last bone of the spine and attaches down at the bottom of the sacrum.

Why Does My Neck and Back Hurt?

There are many causes of back and neck pain. Sometimes, you can have more than one cause.

Habits and Aging

Degenerative, changes in spinal structures occur due to age, repetitive use, and wear and tear over time. This is a common cause of chronic back and neck pain. These may lead to spinal osteoarthritis, foraminal stenosis, and possibly spinal stenosis.

Osteoporosis is a disease that occurs due to thinning of the bones, and it can lead to compression fractures of the vertebrae.

Trauma or Strain

An accident or trauma can lead to severe neck and back pain, due to a herniated disc, muscle sprain, ligament strain, spinal fracture, or spinal cord injury.

Up to 20% of all sports injuries involve a neck or lower back injury. These sudden, acute injuries can lead to chronic back problems due to repetitive stress over time.

Structural Problems

The disks that cushion your vertebrae can rupture or bulge (herniate) and may press on the spinal nerves. Irritation of a spinal nerve is called radiculopathy and can result in pain, weakness, numbness, and/or electrical type sensation that goes down one arm or one leg.

Arthritic (degenerative) changes in the spine, such as facet joint hypertrophy, spinal stenosis, and bone spurs may also cause these symptoms.

Genetic and Congenital Conditions

Genetic and congenital causes can cause neck and back pain as well. One example of a congenital spine condition is Spina bifida is one example of a congenital spine condition.

Scheuermann's kyphosis, a deformity that affects some teenagers, is another example of a genetic spinal condition.

Systemic Problems

More rarely, neck or back pain is caused by systemic problems such as inflammatory diseases, infections, tumors, or cysts. Your diagnostic workup may include screenings to identify signs of a systemic problem, especially if you have risk factors for these conditions.

Who's at Risk for Back and Neck Pain?

You may be at a higher risk for neck or back pain if any of the following apply:

• You are female.
• You're overweight or obese.
• You smoke.
• You have osteoporosis.
• You exercise too much or not enough.

Other risk factors can include income and education level, an urban location, high stress levels, and emotional difficulties (anxiety or depression).

On-the-job factors play a big role in neck and back pain risk, too. If you're dissatisfied with your job, you lack support from your co-workers or bosses, or your job involves subjecting your body to vibration (for example, operating a jackhammer), you may have a higher likelihood of neck- or back-related pain. Office workers tend to get more neck pain than other types of workers.

Diagnosing Back and Neck Pain

During your evaluation for neck pain, your healthcare provider will look at your medical history and do a physical exam.

Diagnostic imaging such as X-rays and sometimes magnetic resonance imaging (MRI) may be needed. However, this full workup may be an unnecessary expense if it isn't warranted.

Interestingly, a 2016 study published in The Permanente Journal found that people with public insurance got spine MRIs more frequently than those with either no insurance or private insurance.

Blood tests may be done to look for evidence of systemic disease.

Electromyography (EMG) nerve studies might be done if there's concern about muscle or nerve disease.

Bone scans may be done to look for suspected compression fractures or tumors.

Back and Neck Pain Treatment

For acute back pain, the general guidelines are to continue your normal activities as much as you can. Over-the-counter pain relievers and placing heat on the back (such as a heating pad) may help with relief. If it doesn't get better in a few weeks, or if the type of back pain warrants it, your healthcare provider may advise other forms of treatment.

Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) or a muscle relaxant might be suggested. There are also topical pain relievers that you can put on the location where you feel the pain.

A short course of narcotic pain relievers might be tried for severe acute pain, but these don't work well for chronic pain. This type of medication comes with a risk of addiction. Before consenting to the prescription or taking the drug, it's important to consider the potential for addiction as well as other side effects (such as constipation).

Antidepressants have been shown to help relieve some types of chronic back pain.

Cortisone injections near the area of pain can help reduce inflammation around the nerve roots or the area of inflammation, which may provide relief.

Back surgery is rarely necessary to treat back pain and has a poor track record of success when done for treating back pain. It is mostly used to correct severe spinal stenosis or a herniated disk that hasn't had effective treatment by other means. Generally, other treatments are tried first.

Summary

Back and neck pain have a wide range of causes, from a sudden (acute) injury to chronic pain that develops over time. Risk factors can include age, obesity, and sports or repetitive work injuries.

Symptoms of back and neck pain also vary widely, and their presentation often can help with a diagnosis of the precise cause (lower back pain affecting the coccyx, for example). Treatment can help most people who experience back and neck pain. Work with your healthcare provider to ensure you are getting the physical therapy and treatment that is right for you.