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Causes of Back Pain 

Learn about the signs, symptoms and treatments

80% of the adult population will experience back pain in their lifetime. Many people go through life thinking that having back pain is ‘normal’ and they just have to accept it. At the Virginia Spine Institute, our spinal specialists have the experience and knowledge to help our patients understand that they do not have to live this way. We want to build a relationship with our patients and discuss their activity level and goals. Patients can be frustrated when they simply go through physical therapy and take some medications and do not seem to improve. It takes a spinal specialist to be able to interpret a patient’s history, physical examination, and diagnostic images to understand where the back pain is coming from. Let us help you determine the cause of your back pain, and improve your quality of life!

Common Spine Conditions That May Be Causing Your Back Pain

Annular Disc Tear

Most annular disc tears are caused by the natural aging process. Since the neck and back are responsible for bearing most of a person’s body weight, they are susceptible to a great deal of wear over time. In many patients with an annular tear, they will suffer from acute back pain. Some may also have leg symptoms with it. Pain is often worse when sitting compared to standing, and positions that load pressure on the disc (coughing, sneezing, forward bending and lifting) tend to aggravate symptoms.



Many people with arthritic changes will describe stiffness or localized aching at the involved area. People may have difficulty turning or bending their neck. In severe cases, arthritic changes may place pressure on a nerve root, pinching that nerve and causing pain, sensation changes or weakness. With arthritis in the cervical spine (neck) conservative treatment is typically first-line care. Many modalities may be used to promote optimal spine health, improve mobility and strength and reduce pain.


Bertolotti's Syndrome

Bertolotti’s syndrome is an uncommon cause of low back pain, particularly focused along the waistline slightly off to the side, that is often confused with sacroiliitis. Bertolotti’s syndrome is a diagnosis given to someone with symptomatic pain due to a transitional vertebra which is inflamed. Although it is a very rare cause of back pain, Bertolotti’s syndrome is a very treatable diagnosis.


Bone Spurs

Bone spurs in the back are simply an indication that there are increased forces on the joints of the spine. In response to this over time, the body remodels bone. In many cases, bone spurs and other degenerative changes may be considered a normal process of aging. The presence of bone spurs alone does not necessarily mean that they are the actual cause of pain. The diagnosis of bone spurs can be easily made with x-rays.



Bursitis is a painful condition that affects small fluid-filled pads called bursae that act as cushions between bony projections and nearby tendons and muscles. Bursitis is inflammation of the bursa and can be acute or chronic. Bursitis often occurs near joints that perform frequent repetitive motion, most commonly in the shoulders, hips, elbows and knees. Bursitis can be caused by overuse or trauma. Repetitive motion, such as throwing a baseball, repetitive kneeling, or running can lead to chronic bursitis.


Degenerative Disc Disease

Degenerative disc disease in the back is a condition that involves weakening of one or more vertebral discs which normally act as a cushion between the vertebrae. This condition can develop as a natural part of the aging process but may also result from an injury to the back. When the disc degenerates the disc begins to lose many of its properties that make it a good shock absorber. For some people these tears can cause considerable pain and spasms.


Disc Herniation

A herniated disc in the back may occur when too much force is exerted on an otherwise healthy intervertebral disc. Heavy forces on the back may simply be too much for even a healthy disc to absorb. A disc herniation, by definition, is displacement of disc material beyond the normal confines of the disc space. The terms disc protrusion, disc bulge, disc herniation, ruptured disc, and slipped disc all mean the same thing and imply that disc material has left the normal disc space. Treatment of a herniated disc depends on the severity of symptoms and apparent nerve damage. Most disc herniations improve in six weeks to three months from the initial injury.


Facet Syndrome

Pain stemming from the facet joints is termed “facet syndrome.” The facet joints become inflamed and may cause pain, soreness and stiffness. Patients often report increased pain with extension or prolonged periods of inactivity like sitting or standing too long. Changing positions often improves pain. Facet syndrome pain may feel worse in the morning and improve after moving around as the day progresses. However, for those who work sitting all day with poor posture, they may experience pain throughout the day. The lumbar spine has considerable motion and high compressive forces. Facet pain from these joints is quite common. Pain is usually felt directly over the affected joints, but may also be felt in the buttocks, hips, groin, and back of the thighs depending on which facet joint is injured.


Myofascial Pain / Muscle Spasms

Myofascial pain syndrome in the neck is thought to be a form of muscle pain that may result from a single trauma to a muscle or from repetitive minor trauma over time. These painful trigger points in your low back develop in susceptible muscle tissues that are overworked for long periods of time. Stress, poor sleep and physical deconditioning have a significant effect on worsening symptoms. With a spine-specialized physical therapy, symptoms of myofascial pain syndrome typically resolve.


Sacroiliac Joint Pain / Sacroiliitis

Pain from inflammation of the sacroiliac joint is commonly called sacroiliitis. This is often felt as pain on one side of the lower back to the right or left of midline where the joint is located. The inflamed joint can become dislocated, as if the lock and key grooves are in the wrong position.

When SI joint dysfunction is severe, pain can refer to the hip, groin, buttocks, and even down the back of the thigh. Pain may be worse with movements that stress that joint, such as standing up from a seated position, walking up an incline, elliptical exercise, prolonged sitting or walking, or twisting when rolling in bed at night.

Sacroiliac joint (SI) dysfunction or inflammation can mimic pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation, or pinched nerves.


Segmental Instability

Segmental spinal instability is a term used to describe greater than normal range of motion (or “hypermobility”) between two vertebral segments. This condition often develops when a particular disc or facet joint degenerates to the point that it can no longer support the weight of the body through that segment of the spine. Segmental instability in the spine presents itself as significant back pain or spasms actually caused by nerve irritation as a result of the irregular micro-movements. In addition this pain may be accompanied by a “catch” or locking feeling of sudden sharp pain. Most often this happens when one is mid-way through standing upright from a seated position.


Spinal Fractures

Spinal fractures caused by trauma represent a serious orthopedic injury. Fractures that occur as a result from a high velocity accident are most commonly in the mid to low back. High velocity accidents are associated with trauma from motor vehicle accidents, a fall from height, or sporting accidents. People can also develop spinal fractures unrelated to trauma; they usually have weakened bones from osteoporosis, tumors, or other medical conditions. Fractures that occur during daily activities are most commonly associated with conditions that may weaken the bone including osteoporosis, spinal tumors or spinal infections. For patients with low energy fractures due to osteoporosis these fractures are called a compression fracture.


Spinal Stenosis

Lumbar Spinal Stenosis refers to a narrowing of the spinal canal to a degree where the spinal cord or nerve roots may be compromised. Spinal stenosis may occur throughout the spine but is more common in the low back and in the neck. Symptoms depend on whether narrowing affects the spinal nerve roots, the spinal cord, or both. Spinal stenosis can cause patients to have symptoms in the arms or legs.



Spondylolisthesis means the forward slippage of one lumbar vertebra in relation to the vertebra below. Spondylolisthesis can be caused by several mechanisms. The two main causes are from either a stress fracture in the vertebra or by acquired degenerative changes in the facet joints. This condition is most commonly found in the lumbar spine as these levels bear the most weight.



Spondylolysis is a stress fracture or defect in the pars area of the spine, typically in the lumbar spine. It is a common reason for back pain for our young athletes. It is important to diagnose for the young patient so it can be treated appropriately for symptoms to resolve.



Spondylosis in a general term for degenerative arthritic changes of the cervical spine, or more simply arthritis. While we generally think of arthritis as age related, these changes can occur at any age. Heavy labor jobs, high impact sports, previous neck injuries may all contribute to accelerated arthritis. There appears to be a strong genetic component to arthritis and we know that smoking quickly accelerates the degenerative process in the spine. Specific movements, including physical activity or prolonged positioning may exacerbate pain. Headaches may originate in the neck. Crepitus, or a grinding noise may be heard with movement. Symptoms tend to improve with rest, and are worst in the morning and at the end of the day.


When to Seek Care for Your Back Symptoms

Spine conditions are very common; over a billion people word-wide are affected by back or neck pain. If you have these symptoms, you are advised to schedule an appointment with a spinal specialist as soon as possible. We know that people may be afraid of going to the doctor, and a big part of that is because they are afraid to hear what the doctor has found. Patients are better off figuring out what is happening with their spine, and then being proactive about taking care of their condition sooner than later before it progresses.

There are some more worrisome signs that can be signaling something more dangerous is going on with your spine:

  • Pain that lasts longer than 10 days
  • Pain accompanied by numbness and tingling in the legs or feet
  • Pain with weakness into the legs or feet
  • Pain with loss of bladder control
  • Pain accompanied by a fever

Our Doctors That Treat Back Pain

Dr. Thomas Schuler

Spine Surgeon
Founder of Virginia Spine Institute
Chief Executive Officer

Dr. Christopher Good

Spine Surgeon
President of Virginia Spine Institute

Dr. Colin Haines

Spine Surgeon
Director of Research

Dr. Ehsan Jazini

Spine Surgeon

Dr. Niteesh Bharara

Orthopedic Specialist - Non-Surgical Sports Medicine
Director of Regenerative Medicine

Dr. Thomas Nguyen

Interventional Pain Management Specialist

Hear From Our Patients

“Back pain can be overwhelming but Virginia Spine Institute took the time to listen, help and follow up after my spinal fusion. They are patient and I felt safe.  I feel lucky I found them!”

– Barb F.

“Virginia Spine Institute didn’t tell me what I wouldn’t be able to do, they told me what I could do.”

– Abby B.

“Over 7,000 miles of travel was well worth it to receive the best spine care in the world from Virginia Spine Institute!”

– Omar A.

“In many ways this has given me back my life so I can get back to doing the things I love to do. Pain draws so much away from your consciousness and life…it’s wonderful to not have that.”

– Mira L.

“Nine weeks after surgery, I have hiked over 100 miles, and all of it over 8000 ft!”

– Marc W.

“I am truly grateful for the treatment I received and am happy to recommend Virginia Spine Institute!”

– Mary Ellen G.

“I can’t say enough positive things about my experience with Virginia Spine Institute. This is the last back doctor I will see!”

– Sunny B.

“Being able to return to life, it’s the best thing in the world!”

– Robin S.


– Aaron D.

“After stem cells I was completely pain free for the first time in 15 years.”

– Edwin W.

“You have given me my life back. I am able to do everything I dreamed of doing because of you.”

– Tammy W.

Videos About Back Pain

3 Most Common Causes of Back Pain

Dr. Schuler Provides Hope for Those Suffering With Back or Neck Pain.

When You Should See a Specialist for Back or Neck Pain

Schedule a Back Pain Consultation