Back Pain: Muscles, Nerves or...?

When you suspect where your back pain originates from--the muscles, tendons, nerves, spine or internal organs--you can better know what to do about it. A stretched tendon will eventually heal on its own in few weeks, but if you have myofascial pain with muscle knots you might need to change the way how you sit or quit some repetitive exercise, for example.

Having an idea of the origin of you back pain can help you easier find an appropriate specialist. A sport doctor can help you with muscle or tendon pain, but for a nerve pain you may want to visit a neurologist.

During my research in recent years, I have collected information about typical causes and symptoms of back pain and I want to present may findings here.

Pain from the back muscles or tendons is usually dull and limited to the back; it does not radiate to the arms or legs. The affected muscle or tendon is tender to touch and can be swollen or bruised.

Pain from the ligaments--which connect bones in the joints--can appear around the shoulders and in the lower neck and is associated with shoulder or neck stiffness.

Pain from the spinal nerves is usually sharp, shooting or burning and associated with tingling or numbness. It tends to radiate to an arm or leg.

Pain from the spine can be felt along the middle vertical line of the back. Tapping over the spine can trigger pain.

Pain from the internal organs--heart, lung, lung membrane, stomach, intestine, gallbladder, pancreas or kidneys can be felt in the chest or upper abdomen but sometimes also between the shoulder blades or at the tip of the shoulder (more often on the right).

Muscle and tendon pain most commonly occurs around the shoulder blades and in the lower back. The affected muscle is tender to touch and the pain is aggravated by moving the torso or arms.

Examples of causes of ACUTE muscle pain in the back:

• Contusion: a hit to a muscle or fall typically result in localized pain, swelling and bruising.
• Muscle strain: reaching for an object on a high shelf or a forced movement during an exercise can cause muscle pain, which is aggravated by moving a torso or lifting the arm(s).
• A tear of various upper back muscles can occur in sports, such as handball. The ruptured muscle is tender to touch and bruised.

Examples of causes of CHRONIC muscle pain in the back:

• Myofascial pain syndrome includes pain and palpable muscle knots in the upper back caused by bad posture during sitting or repetitive movements with arms (assembly workers) or repetitive hard exercise. Applying pressure on muscle knots can trigger pain in the neck, shoulder or arm.
• Fibromyalgia is a chronic pain syndrome with tender points above the shoulder blades and pelvic bones and other parts of the body (see image on the right). Applying pressure on the tender points trigger pain only in the pressed location but not in distant locations.
• Serratus anterior pain syndrome is chronic pain arising from the muscles on one or both sides of the chest (below the armpits) and around the shoulder blades caused by repetitive sprints, lifting heavy objects sideways or chronic coughing. The pain is aggravated by lifting the arms, deep breathing and coughing.

Nerve pain in the UPPER BACK is usually caused by bulging or herniated discs in the neck spine. Symptoms include pain, tingling and numbness in the lower neck and in one or, rarely, in both, shoulders and arms. Pain can be triggered by bending the neck or moving an arm.

Nerve pain in the LOWER BACK is usually caused by bulging or herniated discs in the lumbar spine. Symptoms, known as sciatica, include pain in the lower back, buttock and leg, usually on one side. The pain becomes worse during prolonged sitting and is relieved by walking.

Shingles, which is reactivation of the Herpes zoster virus in one of the spinal nerves, causes pain, followed (after several days or few weeks) by red, itchy and burning rash in the form of a stripe that travels around the chest, usually only on one side. The condition usually heals on its own within a month.

Bone pain in the back can arise from the spine, shoulder blades, ribs and pelvic bones.

Spine pain in the lower back can be due to an inflammation of the spinal joints (ankylosing spondylitis), mostly in younger males. Pain anywhere in the spine can arise from broken vertebra due to an injury or osteoporosis or due to cancer metastases into the spine.

Rib pain which is more likely felt on either side of the chest rather than in the back, occurs in a rib fracture. The pain is severe and aggravated by moving the torso and arms and by deep breathing.

Shoulder blade pain very rarely arises from the actual shoulder blade, for example from broken shoulder blade due to a fall on the back from the height or from rare tumors. What is often refered as shoulder blade pain is usually pain from the surrounding muscle tendons or from the chest or abdominal organs (see below).

Kidney pain can be felt in the middle back, at the bottom of your rib cage, few inches away from the spine on one or both sides. The pain can be triggered by gentle tapping over a kidney with a fist, but usually not by moving.

Examples of causes of acute kidney pain:

• Kidney infection (pyelonephritis) can cause dull pain over one or both kidneys. Typical associated symptoms include fever, nausea, frequent urination and cloudy and smelly urine.
• Kidney expansion (hydronephrosis), for example, due to a stone blocking the ureter can cause severe pain. A palpable lump on one or both sides can appear.
• Obstruction of the ureteropelvic junction (UPJ)--a part of the ureter just below the kidney--can cause pain triggered by drinking a large amount of water.

NOTE: Kidney stone pain usually occurs in the lower back or lower abdomen or in the groin rather than in the kidney area, because kidney stones typically lodge in one of the ureters not in the kidneys.

Examples of causes of chronic kidney pain:

• Kidney inflammation (glomerulonephritis or interstitial nephritis) can be associated with foamy urine.
• Polycystic kidney disease--you may have a lump in one or both flanks.

Pain in coronary heart disease (angina pectoris) typically occurs behind the breastbone in individuals older than 50 years. Sudden severe pain lasts for less than 5 minutes, can radiate to the left shoulder blade or shoulder, jaw and the left arm and hand. In women, pain can radiate into the area between the shoulder blades and rarely toward the right shoulder and arm.

In heart attack, pain can be located in the same areas but is usually much stronger and lasts for more than 15 minutes.

Inflammation of the heart sac (pericarditis) can cause sudden, shooting pain in the chest and between the shoulder blades. The pain can be relieved by leaning forward during sitting. Individuals with pericarditis often have fever.

Bacterial pneumonia can cause pain anywhere in the chest or upper back. Other typical symptoms are high fever, shortness of breath and coughing up mucus.

Inflammation of the lung membranes (pleurisy) in flu, pneumonia or other infection can cause knife-like pain triggered by deep breathing and coughing.

Lung cancer causes chest or back pain only in late stages. The other typical symptom is coughing up blood.

Gallbladder pain due to gallstones or gallbladder inflammation occurs below the right rib cage, it can last for several hours and can radiate to the right shoulder blade or between the shoulder blades. Nausea is the typical associated symptom.

Stomach pain due to stomach inflammation (gastritis) or ulcer can be felt in the upper central abdomen and in the middle of the back. It can be either aggravated or relieved by eating.

Heartburn due to gastric acid reflux is a burning pain behind the breastbone, which can radiate between the shoulder blades. Burning pain in the throat and metallic taste in the mouth are typical.

Acute pancreatitis causes sudden upper central abdominal pain, which can be worse after meals and is associated with nausea. The pin can radiate to the left shoulder blade.

• Muscle and tendon pain are localized.
• Nerve pain tends to radiate to the limbs.
• Bone pain, usually from the spine, usually occurs in the lower back.
• Pain from the chest and abdominal organs can radiate between the shoulder blades or to the right or left shoulder.
• Other symptoms, like nausea, fever or cough can suggest the origin of the pain.