Back pain afflicts an estimated 70 to 80 percent of adults at some point during their lives.  During any given year, approximately ten percent of adults will experience back or neck pain.  It remains one of the most common reasons for an individual to visit their primary care physician.  Approximately 80 percent of individuals who have back pain achieve relief within two to three months of care. Most back pain arises from the spinal muscles and/or tissues of the spine although pain can be referred to the back from internal organs.  For example, bladder infections and kidney stones can cause back pain.  Stomach pathology can refer pain or discomfort to the mid-back region. Pelvic disorders can refer pain to the low back. Atypical angina pectoris secondary to coronary artery disease may be associated with referred pain to the midback (thoracic) region.  Cancer can also spread to the spine from a tumor arising in another area of the body.  Tumors which have predilection to spread or metastasize to the spine include breast cancer, prostate cancer, and lung cancer.  It is rare for tumors to originate in the spine, but it does occur.   

The spine or vertebral column is a stack of more than 25 vertebrae.  Together the stacked vertebrae create a bony column with a canal that which surrounds and protects the spinal cord and exiting spinal nerve roots.  The vertebrae are held together by muscles, tendons and ligaments.  There is an intervertebral disc which lies in between the vertebrae serving as a shock absorber and spacer.  The intervertebral disc and pair of spinal (facet) joints at each level of the spine allow mobility to occur at each spinal segment allowing an individual to twist, bend, flex and extend.   

The low back carries the majority of the weight of the spine.  For this reason it is the frequent site of low back pain.  Strains/sprains can occur due to a variety of reasons, including improper lifting, excessive body weight and habitual poor posture.  Awkward movements or lifting something heavy at a vulnerable angle can lead to muscular and ligamentous injury.  Pain associated with strain or sprain of the back is generally felt immediately after the injurious event.  Pain arising from the spine can lead to unconscious muscle spasm or guarding of the spine, which is the body’s attempt to reduce further movement and injury.   

Another common cause of neck and back pain is spondylosis which may involve osteoarthritis.  The pain is from degeneration of the joints of the spine (facet joints). Spondylosis refers to degenerative changes involving the spine particularly the disc and   facet joints.  Osteoarthritis is often referred to as a wear-and-tear arthritis because it develops slowly over a long period of time.  Chronic loading stress, injury and obesity are known risk factors for the development of osteoarthritis.   

Back pain may occur as a consequence of the loss of integrity of the intervertebral disc.  Age-related changes, as well as normal wear and tear or exceptional strain, can cause an intervertebral disc to herniate.  Some physicians and individuals refer to this as “slipped disc.â€?  The disc is not truly slipped, but the gelatinous central portion of the intervertebral disc migrates away form its central location in the disc through compromised disc (annular) fibers. This is referred to as a “herniationâ€?.  A herniated disc can result in nerve compression leading to symptoms in the arms and legs, such as radiating pain, numbness, and weakness.  A more centralized herniated disc in the cervical or thoracic spine can cause spinal cord compression.