How is the back structured?
The back includes the spinal column and the muscles, ligaments, joints and nerves that surround it. The spine is divided into the cervical spine, thoracic spine, lumbar spine, sacrum and coccyx. Each part has different mobility and load.
Between many of the vertebrae are discs. Small facet joints control movement, while ligaments and muscles provide stability. The spinal cord runs through the spinal canal, and nerve roots exit the canal at various levels.
This explains why back problems can cause local pain, stiffness, radiating pain, numbness or weakness. Read more about back pain.
What does the back do?
The back supports the upper body, protects the nervous system, and allows for flexion, extension, rotation, and side bending. It works with the chest, pelvis, hips, and shoulders to distribute load.
The back needs both stability and variety. Muscles in the back, abdomen and pelvis help control movement. Prolonged sitting can cause stiffness, but even sudden excessive strain can trigger pain.
Pain does not always mean tissue damage. The sensitivity of the nervous system, sleep, stress, previous experiences and physical capacity can affect how the discomfort is experienced.
The natural curves of the spine help the body absorb stress. Mobility is distributed between many small segments, which means that a stiff or painful part can be compensated for by other areas. This can cause secondary problems in the neck, shoulders, hips or legs.
Common back problems
Common back pain is often non-specific, meaning that no single structure can definitely explain the pain. Muscle tension, joints, and discs can contribute. A herniated disc can affect a nerve and radiate to an arm or leg.
Other conditions include spinal stenosis, vertebral compression, inflammatory back disease, and post-traumatic injuries. Pain can also originate from the kidneys, abdominal organs, lungs, or heart.
It is therefore important to describe where the pain is located, how it started, whether it is affected by movement and whether other symptoms have occurred.
When should you seek care for your back?
Contact your healthcare provider if the pain is persistent, severe or recurring, or if it is combined with numbness, weakness, fever, night pain or unexplained weight loss. After major trauma or in cases of osteoporosis, earlier assessment is needed.
Seek emergency care for sudden paralysis, rapidly increasing weakness, numbness in the lower abdomen, or problems with urination and defecation. Severe back pain along with chest pain, difficulty breathing, abdominal pain, or a feeling of fainting should also be evaluated immediately.
In cases of gradually developing problems without warning signs, a health center or physiotherapist can often be a suitable first point of contact.
How are back problems investigated?
The investigation begins with a medical history and clinical examination. Mobility, gait, reflexes, sensation, muscle strength and provocation tests can provide important information. Blood tests may be needed if inflammation, infection or other disease is suspected.
X-rays primarily show the skeleton. CT provides detailed skeletal images and is often used in trauma. MRI shows the spinal cord, nerve roots, discs, bone marrow and soft tissues. The area of examination should be chosen based on the symptoms.
An examination of the entire back is not automatically better than a targeted examination. Correct delimitation increases the chance that the answer will be relevant.
When might MRI of the back be relevant?
MRI full back may be relevant when symptoms or previous findings affect several parts of the spine, but often a targeted MRI of the cervical, thoracic or lumbar spine is sufficient. MRI is used for questions about the spinal cord, nerve roots, discs, spinal canal, inflammation and certain tumor changes.
MRI is not needed for all back pain. In acute skeletal injuries, CT or X-rays are often more appropriate. Furthermore, an MRI finding must be consistent with the symptoms to be clinically significant.
Read also about MRI back and the difference between targeted and more comprehensive investigation.
Limitations and next steps
Imaging can show changes that do not cause discomfort and can miss causes that are primarily related to function or pain control. Therefore, the results need to be interpreted in conjunction with the examination and medical history.
Treatment may consist of gradual activity, physiotherapy, medication, treatment of the underlying disease or in some cases surgery. In the event of new or worsening symptoms, the assessment should be updated.
In long-term back problems, the goal is often to improve function and quality of life, even if all pain does not disappear immediately. Increased exercise, work adaptation, sleep and understanding of the pain may be part of the rehabilitation. If the symptoms change in character, the assessment needs to be reconsidered.