The low back is a fairly complicated structure, so it’s no wonder the majority of people—experts estimate up to 80% of us—experience pain in this area of our bodies at some point in our lives. In fact, back pain is one of the most common reasons for visits to the doctor’s office.
The key to relieving back pain is understanding the cause. But diagnosing the source of a patient’s pain isn’t always a straightforward exercise. It could be muscle, joint, or disc-related; in some cases, it may even arise from issues unrelated to the back. So how can you tell if your back pain is muscle- or disc-related, or attributable to something else entirely? We’ll cover all the possibilities in this post.
Lower Back Pain: How To Tell If It’s Muscle- Or Disc-Related
When a patient visits my office with back pain, it’s my job to uncover the pain generator. We talk through the patient’s history, discuss their symptoms, and make a determination as to next steps. If need be, I prepare their case to be looked at by a surgeon, but generally, my goal is to help patients avoid surgery and find relief with more conservative measures.
Most cases of back pain are not caused by serious conditions. But it’s important to always rule out the possibility that a patient has another internal issue that mimics back pain (a condition that generates pain into the back but isn’t actually back pain). Colitis, kidney stones, gallbladder issues, vascular problems, or an aneurysm are examples of serious conditions that are capable of causing pain to radiate into the back, making it feel like you’re experiencing back pain.
A thorough fact-finding investigation should help determine the cause. When did the pain start? How long did it last? What makes it better or worse? Key to determining the pain generator is the patient’s description of their condition and their medical history. For example, if a patient describes the pain as having come on suddenly (seemingly randomly) and causing nausea, nearly prompting a trip to the emergency room, then disappearing just as suddenly, they may be suffering from a kidney stone rather than back pain from a spinal condition.
More often, patients describe pain that comes on gradually over time and won’t go away; or pain that occurred in connection with a specific movement. Naturally, they want to know, “Is my back pain muscle- or disc-related?” But there are actually three broad types of back pain:
- Muscle pain
- Joint pain
- Disc pain
Let’s take a look at each type in more detail.
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Back Pain: Muscles
The most common type of back pain is muscle pain—also called muscle strain or soft tissue strain. A strain can be an injury to a tendon attachment from muscle to bone. Symptoms of muscle pain include:
- Muscle spasms (contraction or stiffening of the back muscles)
- Muscles that feel tight
- Generally sore back
Aggravating the muscles in your back usually happens as a result of doing a somewhat strenuous activity you’re not used to doing, such as an exercise regimen, yard work, or another project involving a repetitive up and down motion. You may have woken up the next day and couldn’t straighten up. And maybe the pain never really went away but got manageable, then the tight feeling returned again later. This type of stiffness, tightness, or cramping pain is almost always muscle-related.
What To Do For Lower Back Pain That’s Muscle-Related
If muscle pain becomes a nuisance, muscle-strengthening exercises can help. Physical therapy, yoga, or a home exercise program recommended by a chiropractor are extremely beneficial for muscle and core strengthening, and for posture, all of which will help ward off future muscle strains. Muscle pain usually subsides with a combination of exercise, time, and (sometimes) anti-inflammatories.
Back Pain: Joints
Joint pain is also fairly common. This occurs when the facet joints are sprained, injured, or inflamed (inflammation of the joint), causing irritation around the joint. Symptoms of joint pain include:
- Sharp, stabbing pain in the joints of the back
- Pain that becomes worse when you move
Joint pain typically happens as the result of an awkward movement, like lifting something heavy, that puts a strain on the body and stress on the joint. Sometimes it’s difficult to distinguish between a strain and a sprain because they’re very closely related; the good news is they usually respond to the same treatment.
What To Do For Joint Pain
The treatment for joint pain is similar to muscle pain—strengthening exercises, anti-inflammatories, occasional ice compresses, and rest. A chiropractor can be especially helpful for mobilizing joints in a way that promotes healing.
Back Pain: Disc
Lower back disc pain is a third possibility. Disc-related pain presents a more significant problem than muscle or joint pain, and could, in some cases, require further intervention from medical professionals to solve it. Disc problems sometimes put pressure on the nerves that travel through the spine and could be the cause of a number of issues. Lower back disc pain symptoms include:
- Radiating pain that extends into the hip, buttocks, thigh, or down the leg
- Tingling, numbness in the thigh, legs, or feet
- Weakness in the leg
- Impaired ability to do usual daily activities
The above symptoms could indicate the progression of the condition. A “tingling in your toes” is something to watch; depending on the context and the patient’s history it may be enough to do an MRI. A patient experiencing weakness in the leg or toe—maybe they can’t stand flat on their feet and raise up on their toes—is likely suffering from a compressed nerve and should undergo further diagnosis with MRI. Finally, if the weakness has advanced to the point where it’s causing functional loss—for instance, you have to lift your leg up manually to climb stairs or get into a car, or your toes drag when you walk—a neurological component is almost certainly involved. It could be a sign of severe spinal stenosis or a disc herniation, and additional workup and potential surgical intervention may be needed.
The Bottom Line
Whether your back pain is muscle- or disc-related, if it lasts longer than 48 to 72 hours and is not responding to rest, ice, or anti-inflammatories, see a doctor. It’s important to root out the cause of your pain to make sure it’s not serious—and to ensure it doesn’t continue to interfere with your daily life and the activities you love.