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Where Does Back Pain Come From?

Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. Sometimes, an irritation in a joint or soft tissue, not necessarily located in the area of the perceived pain, is another cause. Also inflammation in internal organs can manifest in severe back pain. It is rare, but cancer in the spine can be mistaken with mechanical back pain.

Most of us have suffered from back pain at one time or another. It often occurs after over-doing a physical task, like fall yard work, winter snow shoveling, working on the car, cleaning the house, and so on. But there are times when identifying the cause of back pain can be difficult or impossible. Let us take a deeper look at where back pain can come from!

Back Pain – Types, Symptoms And Causes

Activity Related Back Pain

Though activity-related back pain is common, many times a direct link to over-use is not clear. Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. (Think of the old adage – “The straw that broke the camel’s back.”)

Referred Pain

There are other less well-identified causes of back pain. One is called “referred pain”. This can be caused by an irritated joint or soft tissue not necessarily located in the immediate area of the perceived pain.

For example, pain in the leg can result from an injured facet joint, sacroiliac joint, and/or a disk tear (without nerve root pinch). This is called “sclertogenous pain”.

Viscerosomatic Pain

Internal organs can also cause back pain. This is called a “viscerosomatic response” (VSR). A classic example of this is when the right shoulder blade seems to be the source of pain, when the gall bladder is inflamed.

This pain can be located at or below the scapula next to the spine and the muscles in the area are in spasm and sensitive or painful to the touch. Also, VSR is often not worsened or changed by bending in different directions (unlike musculoskeletal / MSK pain).

Without further testing, it is easy to confuse this with a MSK or a “typical” back ache. Ultimately, a final diagnosis may require an abdominal ultrasound (CT, MRI scan, and other diagnostics are less frequently used).

Visceral pathology in the back pain patient presenting to chiropractors is reportedly rare, and according to one survey, only 5.3% of patients present with non-musculoskeletal complaints.

Other common VSR pain patterns are as follows:

  1. Heart – left chest to left arm, mid-upper back, left jaw.
  2. Liver – right upper shoulder (front and back), right middle to low back, and just below the sternum.
  3. Appendix – right lower abdomen (may start as stomach pain).
  4. Small intestine – either side of the umbilicus and/or between it and the breast bone.
  5. Kidney – small of the back, upper tailbone, and/or groin area.
  6. Bladder – just above the pubic bone and/or bilateral buttocks.
  7. Ovaries – groin and/or umbilical area.
  8. Colon – mid-abdominal and/or lower quadrants.

Primary Or Metastatic Spinal Cancer

Another challenge to diagnosis is cancer in the spine, which can be primary or metastatic (from a different location). Thankfully, this is very rare. A history of unexplained weight loss, a past history of cancer, over age 50, night-time sleep interruptions, and no response to usual back care may lead a doctor to recommend tests to determine if cancer is present in the spine.

When patients present with back pain, chiropractors have been trained to look for these less common, but important causes of back pain.

They get “suspicious” when the “usual” orthopedic tests do not convey the usual responses seen with mechanical back pain. In these cases, they work with primary care doctors to coordinate care to obtain prompt diagnostic testing and treatment.

Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Dr. Blake Kalkstein DC, MS, CCSP, TPI, ART

While earning his D.C. degree, Dr. Blake worked as a chiropractic intern at the Walter Reed National Military Medical Hospital in Bethesda, MD where he had the privilege to work in the amputee rehabilitation center. Dr. Blake’s post graduate sports medicine internship with John’s Hopkins Sports Medicine orthopedic surgeons allowed him to observe all types of injuries. Guidance from Dr. John Wilckens, team orthopedist for the Baltimore Orioles and his internship supervisor, led Dr. Blake to better understand advanced orthopedic and sports injuries and ways to appropriately manage each condition.

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