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Back Pain; All You Need to Know About Pain in the Back

As a common type of pain, back pain is categorized into three section of upper, middle, and lower back pain.

Back pain is a general term that refers to any type of pain and discomfort affecting the back. This type of pain in the body can be related to muscle, disk, spinal changes such as scoliosis but can also involve nerve and bony changes of the vertebrae.

Pain in the back can be in three different regions: upper back, middle back and lower back. Because lower back is one of the more common areas of pain, it is given a unique term called lumbago.

What Exactly Is Back Pain?

Back pain consists of any pain, stiffness and/or discomfort in parts of the back ranging from the lower neck to the lower back. Pain in the back can be presented differently based on severity, duration and etiology.

Back pain can be acute or chronic and may present as dull pain or sharp pain or both depending on the cause of the pain. Back pain may also be accompanied by neurological symptoms such as numbness, tingling and/or weakness in some cases.

As a common pain, back pain could hurt and engage the lower, middle and upper parts of the body back.

The back is classically categorized into three regions of upper back, middle back and lower back.

The assessment and treatment of each region can vary based on the presentation and a thorough assessment is required to ensure the best treatment plan is designed to assist in recovery.

Upper Back Pain

Upper back pain can be classified as a dull or sharp pain in between the shoulder blades, along the back or sides of the neck, sometimes going into the shoulders.

That whole region is made up by the cervical and thoracic spine. This type of back pain is usually uncommon with the general population but can be most targeted towards students or individuals with desk jobs.

Middle Back Pain

Middle back pain can be classified as discomfort or pain in between the upper and lower back. With middle back pain, you may feel symptoms during activity or after as that is the case with most individuals.

You may experience the pain or discomfort traveling to the sides of your ribs, up or down along the spine, and perhaps a broader general surface.

Lower Back Pain

Low back pain can be classified as stiffness along the lumbar spine, sacroiliac joint and going into the glutes or hip.

This type of back pain is most common amongst individuals of all ages, most targeted by older age due to the discs which is a soft tissue that cushions the bones in the spin that are thinning out, causing friction with activity.

Your lumbar spine consists of the five bones (vertebra) in your lower back. Your lumbar vertebrae, known as L1 to L5, are the largest of your entire spine. Your lumbar spine is located below your 12 chest (thoracic) vertebra and above the five fused bones that make up your triangular-shaped sacrum bone.

Types of Back Pain

We have two types of back pain in terms of severity:

  • Acute back pain
  • Chronic back pain
Back pain can be acute and chronic in severity and mechanical, muscular, neuropathic and visceral in type.

Acute refers to a recent injury and chronic refers to pain persisting more than 6 months from the onset. There are other types of pain in the back which will be explained below.

Mechanical Back Pain

Mechanical pain refers to structural changes of the vertebrae, discs and surrounding joints.

In mechanical back pain, there is a mechanical issue such as joints jamming into each other or irritation of the discs. Mechanical back pain responds favorably to manual therapy approaches and exercise.

Muscular Pain

Muscular back pain refers to when the pain is related to muscles of the body that are hypertonic (have increased tone) or feeling “tight”.

This type of back pain responds well to manual therapy approaches like chiropractic care, massage therapy, physiotherapy, etc. and the pain changes with stretching and proper body movement.

If the muscular pain has developed in response to a mechanical back pain, the mechanical issue must be resolved in order to also resolve the muscular pain.


Neuropathic pain is caused by a compressed nerve. Following an injury, nerves can become damaged or deteriorated.

This condition is chronic and is usually caused by diabetes or regional pain syndrome. Other causes that are generally uncommon is exposure to toxins, infection, or substance abuse.

Neuropathy is aggravated by constricting the blood vessels that supply nutrients to the peripheral nerves.


Visceral back pain is pain that is referred to the back from our viscera also known as our organs. Organ referral pain is distinct in its pattern of pain referral and does not respond well to manual therapy and movement.

Common Causes of Back Pain

Back pain can have multiple causes and each can present differently in their symptom presentation. Common causes for back pain are:

  • Muscular and ligament dysfunction from sprain/strains
  • Discogenic pain
  • Arthritis and other bony changes
  • Genetic conditions
  • Muscular imbalances
Back pain common causes include sprains, arthritis, disk problems, genetics, muscular issues, etc.

Muscle Strain or Ligament Sprain

Continuously performing heavy lifting or awkward movements all of a sudden can aggravate muscles and cause them to tense up which can lead to low back spasm.

If you are someone in weak physical health, it is easier for you to strain muscles in your body when performing activities.

Bulging Discs

Discs in your spine are a cushion for your bones in your spine. A bulging disc can compress the nerves exiting the vertebrae. A discogenic pain may or may not present with nerve pain

A bulging disk occurs when the inner, jelly like portion of the disks between the bones in the spine bulge out through a tear in the outer (annulus) portion of the disk.


Osteoarthritis refers to bony changes that occur over a long period of time. This can be due to genetics, immobility but it can also be a normal part of aging.

Arthritis does not always cause pain and the pain from arthritis is significantly manageable using manual therapy techniques, yoga and therapeutic stretching and exercising.

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Genetic Conditions

There are certain genetic conditions such as scoliosis, ankylosing spondylitis, narrow spinal canal or spondylolisthesis that can cause lower back pain.

These conditions respond well to manual therapy as a therapeutic approach and can provide more comfort and ease from the pain to the patient.

Muscular Imbalance

Oftentimes, the demands of our work duties or sports we play may cause muscular imbalances in the body which may lead to compensatory patterns of movement.

We as humans are very good at creating compensatory movement patterns to still achieve a particular goal and strength.

However, muscular imbalances, especially when repeated over time, can be a cause of back pain. Another condition that causes muscle imbalances is scoliosis.

Diagnosing Back Pain

Back pain can be diagnosed by trained professionals such as physical therapists, medical doctors, chiropractors, and more.

A thorough assessment is done by our team of experts at Fulcrum Therapy, so you get a proper treatment for your back pain health issue.

In most cases, an accurate diagnosis can be attained by asking the right questions and performing appropriate orthopedic tests by your healthcare practitioners.

In some cases, the practitioner may request further imaging in cases where the pain presentation is atypical or they would like further insight before reaching a diagnosis.

Examples of imaging techniques that assists in diagnosing back pain are:

  • CT Scan
  • Discography
  • EMG
  • NCS
  • MRI
  • Myelogram
  • Selective Nerve Root Block
  • X-Ray

Treatments for Back Pain

Different approaches are available for back pain treatment and each one is suitable for certain types of people with certain conditions.

Some of the treatment approaches are discussed below:

Conservative Care

When dealing with back pain, therapies such as massage therapy, physiotherapy, or chiropractic care are extremely beneficial.

These practitioners are trained in diagnosing back pain and design individualized treatment plans that are unique to you and your symptom presentation.

They are also trained to rule out any risk factors and recommend imaging if appropriate.

At Fulcrum Clinic, we co treat alongside medical doctors and are open to communicating with your medical clinic to ensure you are receiving the best care for your back pain.


Exercise is one of the most beneficial tools to assist in back pain recovery and is anything that helps your body move better and more efficiently.

It is important to note the benefits of exercise multiply when you incorporate different types of exercise into your routine. For example, a combination of stretching and strengthening works better than just stretching and just strengthening.

Our practitioners at Fulcrum Therapy Body Wellness Clinic are experts in helping you design an exercise program unique for your needs and ensuring that you are exercising safely and effectively.


In some cases of acute pain, medications can be a great alternative to create symptom relief. There are over-the- counter (OTC) medications for pain relief and there are stronger options available through prescription drugs to assist in pain that is more severe.

Medication can be used to assist in better movement and sleep and sometimes is a necessary tool to allow improved quality of life when suffering from an acute injury.

However, it is not recommended to use medication for long term relief due to adverse side effects.


The purpose of injections is to provide the patient with some relief and reduce inflammation. Injections are often used as a last resort for conditions that have not responded well to manual therapy and medication.

Injections can provide pain relief and give patients a window to further focus on their exercise routine and manual therapy approaches.

However, injections are not recommended as a stand alone treatment as pain can often return once the effects of the injection wear off.


If surgery is recommended for back pain, neurosurgeons have many approaches and options they are able to perform to help alleviate the pressure on the nerve roots.

For instance, if there is several nerve roots and discs associated with the pain or if degeneration is present in the spine, your surgeon may choose a non-invasive technique, a more open decompression, or fuse the vertebrae together with bone grafts and stabilize with screws, rods, plates and more.

Post surgical patients may regain mobility in the spine and perhaps even need rehab. Surgery is dependent on the severity of each case.

How to Prevent Back Pain?

One of the most effective ways to prevent back pain is through staying active.

Exercise in the form of cardio, strength training, mobility and stretching is proven to be the most effective way to keep back pain away.

Furthermore, maintenance therapy such as attending chiropractic, massage therapy, physiotherapy and kinesiology sessions on a routine basis can help identify movement dysfunctions and tightness that may be building up as a result of daily life, work and sports.

Maintenance therapy is a fantastic way to work with trained professionals that can help guide you towards improving your overall wellness and fine tuning your exercise routine.

Learning how to move efficiently and effectively while keeping your joints mobile and muscle flexible is the best way to prevent lower back pain.

It is important to know that seeing therapists is not only for when you are in pain. In fact, you get significant benefits from seeing them when you are not in pain as preventative therapy.

Never Ignore Your Back Pain

Back pain is a sign that your body is not functioning optimally and there is hindrance to your overall wellness and health.

This type of pain may go away on its own but can also return and sometimes, the pain can get progressively more over time. It is imperative to not ignore back pain, have it checked by a trained professional to ensure your optimal health and wellbeing.

Our practitioners are here to help you understand your back pain, refer you when appropriate and provide education and home care to ensure your back pain never gets in the way of doing the things you love to do.

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