Non-speciﬁc low back pain is the type of back pain that neither you nor your doctor can definitively, accurately trace back to its root. In other words, it is not related to a specific, diagnosable disease. An example is a back muscle strain due to an athletic injury or other trauma.
Nonspecific back pain is typically mechanical in nature, in that it is brought on when the spine moves. Muscle imbalances and wear and tear on joints over time may contribute to mechanical pain.
Because the cause of nonspecific back pain is not known, treatment usually consists of conservative care and waiting it out. Exercise may be recommended, most of the time as a part of your physical therapy.
Surgery and other invasive procedures are generally not used for cases of non-specific low back pain.
On the other end of the spectrum of spine conditions is low back pain that is attributable to a disease process that goes on in your body.
An example is back pain caused by irritation to a spinal nerve root, whether that irritation is arthritis related, due to a herniated disc, or has some other cause.
Irritated spinal nerve roots can result in back pain, but the main thing you’ll likely notice is radiculopathy. Radiculopathy symptoms go down one leg and may express there as pain, electrical sensations, numbness, and/or weakness.
Although a herniated disc is the most common cause of radiculopathy, it is not the only one. Other causes may include spinal stenosis, thickened spinal ligaments, or cysts that press on the delicate nervous tissue that makes up the root.
More rarely, systemic health conditions, for example, an infection or the presence of a tumor, are additional sources of back pain not classified as mechanical or non-specific. For these, pain relief and improving your physical functioning are likely best achieved by working with your doctor, and, depending on the exact cause, your physical therapist, as well.
Non-Specific vs. Serious Pain
Back pain is all but ubiquitous. This means it can happen to almost anyone, including you.
A study published in The Lancet reports that up to 84 percent of all people experience back pain at some point in their lives. Almost 25 percent of people live with chronic back pain, and 11 percent are disabled by it, the authors say.
Given that, it’s important to have a decent understanding of this condition in general. That way, should you or a loved one be affected by symptoms of a spine condition, you may be empowered to take the appropriate action in a timely manner.
The first thing to know about back pain, in general, may in itself provide you with a bit of relief: most cases of low back pain are not serious.
Loren Fishman, M.D., a physical medicine and rehabilitation specialist practicing in New York, distinguishes “serious” back pain (from non-serious) as pain that threatens mobility, causes a loss of control over bowel or bladder, or hurts so much that you simply can’t stand it.
Fishman, who teaches yoga as an adjunct to his medical practice, confirms the data in the Lancet study by saying nearly 90 percent of back pain is musculoskeletal in nature.
Non-specific, or mechanical type back pain is generally musculoskeletal in nature.
It may ruin your weekend, Fishman asserts, but back pain that arises from the musculoskeletal system does not impose the severe effects mentioned above.
Fishman further clarifies the difference between non-specific and serious back pain types by saying a diagnostician needs to figure out if pain is coming from soft tissues and bone, or from nerves. “Nerve pain is usually more serious,” he says. But often doctors either don’t or can’t make this distinction before an invasive procedure is done.
“Take the case of Mr. Jones,” Fishman offers. “This patient had seen 21 physicians and had undergone three back surgeries before seeing me."
After six and a half years of this odyssey, Fishman says, Mr. Jones reported being neither better nor worse than when the whole thing began.
Fishman did a simple test that measured the speed of Mr. Jones's Achilles tendon reflex speed when it was stretched tightly against the sciatic nerve in that area. The Achilles tendon is the tough band of fibrous tissue that connects the calf muscle to the heel of the foot.
The test revealed a dramatic delay in the reflex speed, which suggested to Fishman that a tight calf muscle was the culprit.
Mr. Jones’s treatment consisted of a botox injection into the calf muscle along with advice to be patient for a week while the medicine did its work. “Almost to the day, Mr. Jones had an impressive recovery,” Fishman noted.
Another bit of good news about low back pain is that it tends to go away on its own. Back pain that goes away on its own is called self-limiting.
The problem is, back pain that goes away on its own is likely to return. A 2014 study published in the journal Spine found a first experience with low back pain to be the most consistent risk for future low back pain.
In other words, once you experience low back pain, you’re likely to get it again.
Get Your Red Flags Checked
Even if your back pain gives every indication that it is benign and not serious, your doctor will probably consider checking for the rare likelihood that it is coming from a disease. In this case, she may look for red flags, which are signs that a serious underlying health condition is at the root of your symptoms.
Examples of red flags alerting a doctor that a full diagnostic workup may be appropriate include how old you are when your back pain first comes on, if you’ve sustained significant trauma preceding the onset of pain, if you’ve recently lost weight without dieting or being on a program, and/or if you’ve recently experienced neurological disturbances or impairment.
How to Describe Your Back Pain to Your Doctor
Diagnosable Back Pain
As mentioned above, sometimes serious back pain is related to disease processes that go on in the spine, while other times, the cause is more systemic.
Spine-related serious causes of back pain include the following:
Lumbar fracture, which is a break in a spinal bone in your lower back. Spinal fracture may be due to osteoporosis, but that’s not the only possible cause. Traumas, falls, and/or injury may also lead to this injury. And spinal fractures are not limited to lumbar vertebrae; they can occur in the neck and other parts of the column, as well.
Structural deformity such as kyphosis, lordosis, and/or scoliosis, may cause back pain. The seriousness of these conditions, and the back pain they may cause depends on a number of factors including your age, the degree of deviation from ideal alignment, and more.
Radiculopathy or radicular syndrome, discussed above. The terms refer to the collection of symptoms that occur when a spinal nerve root is compressed or irritated by a nearby structure. Radiculopathy may be brought on by a herniated disc, spinal stenosis or other condition that affects the column.
Spinal stenosis is often, but not always, related to aging. It may cause back pain, radiculopathy, and/or cramping. Cramping in the legs when upright, called neurogenic claudication, is a common symptom of spinal stenosis.
Facet arthritis is a form of osteoarthritis that affects the back part of the spinal column. In this condition, long-term degeneration of the joint leads to erosion of cartilage. Cartilage is a shock absorbing material that helps make spinal movement pain free. As the cartilage diminishes, bone starts to rub against bone and the joints may become inflamed, thereby causing pain.
Inflammatory arthritis, a chronic, debilitating condition that affects joints, may cause low back pain. In the spine, it may take a number of forms, including ankylosing spondylitis. Spondylitis is also called spondyloarthritis or spondyloarthropathy.
Cauda equina syndrome is a very serious medical condition that affects a bundle of nerves located at the base of the spine. Some of the most common symptoms include loss of bowel or bladder function, leg pain and/or weakness or numbness that keeps getting worse and loss of sensation in the bottom/seat area. If you have these symptoms, seek medical attention immediately. Otherwise, you may sustain permanent nerve damage. Cauda equina syndrome may be caused by a severe disc rupture, spinal stenosis, birth defect, injury or trauma, or a tumor or cyst that presses on the nerves in that area. Infection, inflammation, and fractures are other causes.
Is Surgery Necessary?
While it’s important to work with your medical provider and licensed physical therapist for resolution of symptoms and determination of future treatment, surgery is not always needed.
Dr. Fishman shares another story of a recent patient, a woman with “a nagging little backache.” Her set of complaints looked to him to be garden-variety back pain, in other words, the mechanical, or non-specific type.
But Fishman says the one piece of the diagnostic puzzle that did not fit his assessment of mechanical pain was that the patient’s left big toe was numb.
Dr. Fishman ordered an MRI.
A few hours later, the MRI came back showing a large herniated disc pressing on a spinal nerve root. At about the same time, the patient called the doctor from an ambulance, complaining of unbearable pain. The trip to the emergency room, which consisted mainly of a prescription for weak NSAIDs, did little to relieve this pain, Fishman says.
When faced with similar circumstances, many people opt for discectomy surgery, however studies show that the vast majority of patients with lumbar disc herniations will improve over the first few weeks. In fact, about 90% of people with disc herniations in the lumbar spine get better with just time alone.
After being released from the emergency room, the patient immediately headed back to Dr. Fishman’s office, where he applied a few very specific yoga therapy techniques. While she was still at the appointment, about 60–70 percent of her pain was relieved, according to Fishman.
And within a week the pain was almost completely gone, Fishman reports.
Serious Underlying Problems
Back pain due to a serious underlying health problem is usually just one of several accompanying symptoms. For example, symptoms of kidney stones include not only sharp pain on your right side of your back, but also pain or burning during urination, the urgent need to go, blood in the urine, cloudy or smelly urine, and more.
Other systemic conditions that may have back pain as one of the symptoms include:
Infection that affects any of the spinal structures. Infection of a vertebra is called osteomyelitis; infection of the disc is called discitis. Sacroiliitis is the name given to an infected, or inflamed, sacroiliac, or SI joint. This term is also used in cases of inflammatory arthritis of the SI joint.
Though rare, it’s possible that a tumor may cause serious back pain. Usually they are the result of cancer that has spread to the spine from elsewhere in the body.
As mentioned above, kidney stones may cause right side back pain, along with a number of other symptoms.
Abdominal aortic aneurysms occur when the aorta, which is the largest artery in the body, becomes enlarged. In this case, back pain may be a sign that an aneurysm is getting bigger. In this case, it’s important to see your doctor as soon as you can to assess, and possibly prevent a rupture of the aorta.
Along with spinal and systemic causes of serious back pain, certain conditions may predispose you to serious back pain. These include:
Osteoporosis, a disease in which the bones weaken over time, may lead to spinal fractures and/or contribute to other health complications. Osteopenia is the precursor to osteoporosis.
In women, endometriosis may cause back pain as uterine tissue builds up outside the uterus.
Fibromyalgia, which is a chronic pain condition characterized by fatigue and muscle pain all over the body, is another possible cause of serious back pain.
When it comes to non-spinal serious causes of back pain, it’s important to not delay seeing your doctor and to be sure you thoroughly review all your treatment options before deciding what to do.
A Word From Verywell
While it’s prudent to allow your doctor to check for underlying health issues that may be causing your spinal discomfort, most of the time, back pain is not serious. In fact, non-specific, or mechanical, back pain often goes away without any treatment at all.
Unfortunately, it may come back later, as the first incident of back pain is often grounds for future episodes.
For this reason, keeping your core strong and practicing good body mechanics on a regular basis may help you steer clear of back pain for life.