Low back and neck pain can arise due to many causes, some of which are complex.  Back pain is rarely the result of a single injury or accident. It is more often the result of the cumulative effect of physical stress on spinal tissues combined with progressive degenerative changes.  The initiating factor may involve a simple movement or action. The physical stressors are often compounded over months or years of poor posture, abnormal body mechanics, harmful work habits, stressful living and deconditioning with a loss of strength and flexibility. The aging process is typically associated with a decline of physical fitness which negatively impacts posture. Additional risk factors include chronic emotional stress, lack of rest, smoking and poor nutrition. For some, there may be genetic or developmental predispositions with structural abnormalities of the spine, which contribute to the development of back pain.  

A degenerative back disorder usually develops long before the onset of symptoms such as pain. The pain develops after tissues of the spine become inflamed from repetitive microinjury to spinal structures. When the inflammation resolves during the healing process the back pain dissipates. The underlying tissue “weak linkâ€? often remains leaving the individual prone to re-injure the area and once again experience pain. Some of the most common causes for back pain include muscle guarding and spasm, postural strains/sprains, joint degeneration, osteoarthritis, abnormal vertebral movement, and acute strains/sprains.  

It is often a challenge for a physician to accurately determine the primary cause of back pain, particularly a physician who does not have extensive experience in the evaluation and care of spine disorders.  This dilemma is due to the complexity of the spine which contains numerous pain sensitive tissues such as muscles, ligaments, tendons and joint membranes/capsules.  There are two primary classifications of back pain, acute and chronic.  Acute pain refers to pain that is less than three months in duration, whereas chronic pain is persistent, lasting more than three months.  Chronic pain can persist throughout an individual’s life.  An individual with chronic pain can also have periods of acute exacerbation, referring to periods where this a temporary increase in the pain level. Pain may be intermittent, persistent or progressive.  Back pain and neck pain may have more than one cause.

Back pain is most commonly experienced at or below the level of the waist.  It may be reported as sudden and sharp or dull and aching. The low back is the most common region of the spine to be affected with a very high prevalence throughout the population.  The most common cause of low back pain is muscle strain associated with heavy physical labor, from lifting or forceful movement. Individuals who have underlying degenerative changes in the low back are more susceptible to suffer a muscular strain/sprain injury.  Muscular strain may also arise from sustaining an awkward position or standing position too long. 

Sometimes neck or low back pain will be accompanied by radiating pain, numbness, tingling and/or weakness involving the extremities. This type of pain indicates a more serious condition.  Low back pain associated with bowel or bladder dysfunction and/or leg weakness requires the immediate attention of a spine specialist.  Neck pain associated with abrupt onset or progressive upper extremity weakness or incoordination also requires the immediate attention of a spine specialist.  Surgery may be required to protect the spinal cord and/or the spinal nerves. Surgery is not required to treat most cases of neck or low back pain.