The Complete Guide to Back Pain

Introduction

Back pain is something most people will experience at some point in their lives. Whether it starts suddenly after lifting a heavy object or develops gradually after months of sitting at a desk, it can make even the simplest daily activities difficult.

Pain may be felt anywhere along the spine, from the neck to the lower back. Some people experience a dull ache, while others notice sharp pain, stiffness, muscle spasms or discomfort that radiates into the arms or legs.

Although back pain is common, every person's experience is different. Understanding what may be causing your symptoms is the first step towards finding the right treatment and preventing future episodes.

This guide explains how the spine works, the most common causes of back pain, available treatment options and when it is important to seek professional advice.

What Is Back Pain?

Back pain refers to discomfort felt anywhere along the spine, including the upper, middle or lower back. The pain may develop suddenly following an injury or gradually over weeks, months or even years.

Back pain is not a condition in itself but rather a symptom of an underlying problem affecting the muscles, joints, discs, ligaments, nerves or other structures that support the spine.

The severity can range from mild stiffness that settles within a few days to persistent pain that affects work, exercise, sleep and everyday activities.

Fortunately, many causes of back pain respond well to conservative treatment, particularly when addressed early.

How Common Is Back Pain?

Back pain is one of the leading causes of disability worldwide and affects millions of people every year.

According to the World Health Organization:

• Around 619 million people were living with lower back pain globally in 2020.
• Lower back pain is the leading cause of disability worldwide.
• The number of people affected is expected to continue increasing as populations age and lifestyles become more sedentary.

In South Africa, back pain is also a common reason for visiting healthcare professionals and contributes to time off work, reduced productivity and limitations in everyday life.

The good news is that most cases are not caused by serious disease and can often be managed successfully with appropriate assessment, education, movement and evidence-based treatment.

Understanding Your Spine

Your spine is much more than a stack of bones. It is a remarkable structure that provides strength, flexibility and protection for the spinal cord while allowing you to move freely.

Understanding the main parts of the spine can make it easier to understand why back pain develops.

Vertebrae

The spine is made up of 33 small bones called vertebrae. These bones are stacked on top of one another to create a strong but flexible column that supports the body's weight and protects the spinal cord.

Intervertebral Discs

Between most vertebrae are soft discs that act as shock absorbers. They help cushion the spine during activities such as walking, running, lifting and jumping while allowing smooth movement between the bones.

Facet Joints

Small joints at the back of each vertebra guide spinal movement and help maintain stability. Like any other joint in the body, they can become stiff, irritated or affected by age-related changes.

Muscles

The muscles surrounding the spine provide support, control posture and allow movement. Muscle strain, weakness or prolonged tension are among the most common causes of back pain.

Ligaments

Strong bands of connective tissue called ligaments hold the vertebrae together and help stabilise the spine. Sudden movements or excessive force can overstretch or injure these structures.

Nerves

The spinal cord runs through the centre of the spine, with nerves branching out to different parts of the body. If a nerve becomes irritated or compressed, symptoms such as pain, tingling, numbness or weakness may develop in the arms or legs.

Why Understanding Your Spine Matters

Many people assume that all back pain comes from a "slipped disc" or bones being "out of place". In reality, back pain can arise from several different structures, and identifying the true source of the problem is essential for choosing the most appropriate treatment.

A thorough assessment by a qualified healthcare professional helps determine what may be contributing to your symptoms and guides a treatment plan tailored to your individual needs.

Types of Back Pain

Back pain is not the same for everyone. The location, duration and cause of the pain can vary significantly, which is why a professional assessment is important. Understanding the different types of back pain can help you recognise your symptoms and seek the most appropriate care.

Lower Back Pain

Lower back pain is the most common type of back pain. It affects the lumbar spine, which supports much of the body's weight and is heavily involved in bending, lifting, twisting and walking.

People with lower back pain may experience:

• A dull, persistent ache
• Sharp pain when moving
• Muscle tightness or spasms
• Difficulty standing upright
• Pain when bending or lifting
• Stiffness after sitting for long periods

Lower back pain is often associated with muscle strains, joint irritation, disc injuries or age-related changes, although many cases have no single identifiable cause.

Upper Back Pain

Upper back pain occurs in the thoracic spine, between the neck and lower back. While less common than lower back pain, it can still affect daily activities and quality of life.

Common causes include:

• Poor posture
• Prolonged desk work
• Muscle tension
• Repetitive movements
• Sports injuries
• Joint stiffness

Many office workers notice upper back discomfort after spending long hours looking at a computer screen or working from a poorly designed workstation.

Middle Back Pain

Pain in the middle of the back is less common but may develop from muscle strain, poor posture, rib joint dysfunction or repetitive physical activity.

People often describe:

• Localised aching
• Tight muscles
• Pain between the shoulder blades
• Discomfort when twisting

Although most cases are mechanical in nature, persistent middle back pain should be professionally assessed to rule out less common causes.

Acute Back Pain

Acute back pain develops suddenly and typically lasts less than six weeks.

It often follows:

• Lifting something heavy
• A sporting injury
• A sudden awkward movement
• A fall
• Muscle strain

Many people recover within a few weeks with appropriate advice, movement and conservative treatment.

Chronic Back Pain

Chronic back pain is pain that continues for more than three months.

It may:

• Come and go
• Persist every day
• Flare up periodically
• Affect sleep and work
• Reduce physical activity

Managing chronic back pain often requires a combination of education, exercise, lifestyle changes and hands-on care where appropriate.

Mechanical Back Pain

Mechanical back pain refers to pain originating from the muscles, joints, ligaments or discs of the spine.

This is the most common category of back pain.

Symptoms often:

• Change with movement
• Improve with certain positions
• Worsen after prolonged sitting
• Respond to physical treatment

Mechanical back pain does not usually involve serious disease.

Nerve-Related Back Pain

Sometimes pain occurs because a spinal nerve becomes irritated or compressed.

This may happen with conditions such as sciatica.

Symptoms can include:

• Burning pain
• Tingling
• Pins and needles
• Numbness
• Pain travelling into the leg
• Muscle weakness

Because nerve-related pain has different causes and treatment considerations, it is important to have these symptoms assessed promptly.

Common Symptoms of Back Pain

Back pain can present in many different ways depending on the underlying cause. Some symptoms develop suddenly, while others build gradually over time.

Common symptoms include:

• A dull ache in the back
• Sharp pain with certain movements
• Muscle stiffness
• Reduced flexibility
• Difficulty standing upright
• Pain when sitting for long periods
• Pain when bending or twisting
• Muscle spasms
• Pain that radiates into the buttock or leg
• Tingling or numbness
• Pain that interrupts sleep
• Fatigue caused by ongoing discomfort

Some people experience only mild stiffness, while others find that pain limits their ability to work, exercise or enjoy everyday activities.

If symptoms persist, worsen or begin to interfere with your daily life, a professional assessment can help determine the underlying cause and appropriate management.

What Causes Back Pain?

Back pain rarely has a single cause. In many cases, several factors contribute over time, placing increased stress on the muscles, joints and other structures of the spine.

Poor Posture

Modern lifestyles often involve prolonged sitting, particularly while working on computers or using mobile devices.

Slouching places additional strain on the muscles and joints of the spine, which may contribute to stiffness and discomfort over time.

Improving posture and taking regular movement breaks (or getting a professional posture assessment) can often reduce this strain.

Prolonged Sitting

Sitting for long periods reduces movement in the spine and may increase pressure on the lower back.

Office workers, students and people who drive for long periods commonly experience:

• Lower back stiffness
• Tight hips
• Reduced spinal mobility
• Muscle fatigue

Regular stretching and changing position throughout the day may help reduce these effects.

Incorrect Lifting

Lifting heavy objects with poor technique can overload the muscles, ligaments and joints of the back.

Common mistakes include:

• Twisting while lifting
• Lifting with a rounded back
• Carrying uneven loads
• Lifting objects that are too heavy

Learning safe lifting techniques is an important part of preventing future injuries.

Muscle Strain

Muscle strains are among the most frequent causes of back pain.

They may occur after:

• Exercise
• Gardening
• DIY projects
• Moving furniture
• Sudden awkward movements

Most muscle strains improve with time, gentle movement and appropriate conservative care.

Disc Injuries

The discs between the vertebrae absorb shock and allow movement.

Sometimes a disc may become irritated or injured, leading to local back pain and, in some cases, nerve irritation.

Not every disc change seen on an MRI causes symptoms, which is why imaging results should always be interpreted alongside a thorough clinical examination.

Sciatica

Sciatica occurs when the sciatic nerve becomes irritated or compressed.

Symptoms often include:

• Pain travelling from the lower back into the buttock and leg
• Tingling
• Numbness
• Burning pain
• Weakness in the leg

Because several different conditions can cause sciatica, an accurate diagnosis is essential.

Sports Injuries

Sports involving running, lifting, twisting or contact can place increased stress on the spine.

Athletes may develop:

• Muscle strains
• Joint irritation
• Ligament injuries
• Overuse conditions

Appropriate rehabilitation is important to support recovery and reduce the risk of recurrence.

Age-Related Changes

As we age, the spine naturally undergoes changes.

These may include:

• Reduced disc hydration
• Joint wear
• Decreased flexibility
• Muscle weakness

These changes do not always cause pain, and many people with age-related findings on scans experience no symptoms at all.

Pregnancy

Hormonal changes, weight gain and shifting posture during pregnancy can place additional stress on the lower back and pelvis.

Many pregnant women experience back pain, particularly during the second and third trimesters.

Management should always be tailored to the individual's stage of pregnancy and overall health.

Stress

Emotional stress can contribute to increased muscle tension, particularly around the neck, shoulders and upper back.

People experiencing ongoing stress may notice:

• Tight muscles
• Frequent headaches
• Shoulder tension
• Upper back discomfort

Managing stress, staying active and maintaining good sleep habits can play an important role in overall spinal health.

Sedentary Lifestyle

The spine is designed to move.

Spending long periods inactive may contribute to:

• Muscle weakness
• Joint stiffness
• Reduced flexibility
• Poor posture
• Increased risk of recurring back pain

Regular physical activity helps maintain strength and mobility.

Repetitive Movements

Repeated bending, twisting, lifting or reaching can gradually overload the tissues of the back.

Occupations commonly affected include:

• Office workers
• Warehouse employees
• Healthcare workers
• Tradespeople
• Teachers
• Drivers

Taking regular breaks and using proper body mechanics may help reduce the risk of overuse injuries.

Risk Factors for Back Pain

Although anyone can develop back pain, certain factors increase the likelihood of experiencing symptoms.

Common risk factors include:

• Poor posture
• Sedentary lifestyle
• Occupations involving heavy lifting
• Repetitive work tasks
• Prolonged computer use
• Lack of regular exercise
• Excess body weight
• Smoking
• Previous back injuries
• Increasing age
• Reduced core muscle strength
• High levels of physical or emotional stress

Having one or more of these risk factors does not necessarily mean you will develop back pain, but understanding them can help you make informed choices to support long-term spinal health.

When Should You See a Chiropractor?

Many episodes of back pain improve within a few days or weeks, particularly if they are caused by a minor muscle strain or temporary irritation. However, if your symptoms persist or begin to affect your daily life, it may be time to seek a professional assessment.

Consider seeing a chiropractor if you:

• Have back pain lasting longer than one to two weeks
• Experience recurring episodes of back pain
• Notice stiffness that limits your movement
• Have pain that makes work or daily activities difficult
• Feel discomfort when sitting, standing or walking
• Have pain after a sports injury or lifting incident
• Experience pain that radiates into the buttock or leg
• Want to identify the cause of your symptoms rather than simply manage the pain

An assessment aims to identify the structures that may be contributing to your symptoms and determine whether chiropractic care is appropriate or whether another healthcare professional is better suited to your needs.

Warning Signs That Require Urgent Medical Attention

While most back pain is not caused by a serious medical condition, certain symptoms require immediate medical assessment.

Seek urgent medical care if your back pain is accompanied by:

• Loss of bladder or bowel control
• Numbness around the groin or inner thighs (sometimes called "saddle" numbness)
• Significant weakness in one or both legs
• Severe pain following a major fall, vehicle accident or other significant trauma
• Fever, chills or unexplained weight loss alongside back pain
• Pain that is constant, severe and unrelated to movement, particularly if it is worse at night
• A history of cancer together with new, persistent back pain

These symptoms are uncommon but may indicate a condition requiring urgent medical investigation and treatment.

How Is Back Pain Diagnosed?

Effective treatment begins with an accurate diagnosis. Because back pain can have many different causes, a thorough assessment is essential before recommending a treatment plan.

At Bornman Chiropractic, the assessment focuses on understanding your symptoms, identifying possible contributing factors and determining the most appropriate next steps.

Medical History

Your chiropractor will begin by asking questions about your symptoms, including:

• When the pain started
• Where the pain is located
• What the pain feels like
• What makes it better or worse
• Whether the pain spreads into the arms or legs
• Previous injuries or episodes of back pain
• Your work, hobbies and activity levels
• Any relevant medical conditions

This information helps build a clear picture of your condition and guides the physical examination.

Physical Examination

A physical examination allows your chiropractor to assess how your spine and surrounding tissues are functioning.

This may include evaluating:

• Your posture
• Spinal alignment
• Range of movement
• Areas of tenderness
• Muscle strength
• Joint mobility
• Muscle tightness

The goal is to understand how your body moves and identify structures that may be contributing to your pain.

Movement Assessment

Observing how you move provides valuable information that cannot always be seen on imaging.

Your chiropractor may ask you to:

• Bend forwards
• Lean backwards
• Twist your torso
• Walk
• Perform simple functional movements

Restricted or painful movements can provide clues about the source of your symptoms.

Neurological Assessment

If nerve involvement is suspected, a neurological examination may be performed.

This can include checking:

• Reflexes
• Muscle strength
• Sensation
• Balance
• Coordination

These tests help determine whether a spinal nerve may be irritated or compressed.

Imaging

Most people with uncomplicated back pain do not need X-rays or MRI scans straight away.

Imaging may be recommended when:

• Serious underlying conditions are suspected
• Symptoms persist despite appropriate care
• Significant trauma has occurred
• Progressive neurological symptoms are present
• Surgery or specialist referral is being considered

Imaging is most useful when combined with a thorough clinical assessment, as many people without back pain have age-related changes visible on scans.

How Can Chiropractic Care Help?

Chiropractic care focuses on assessing, diagnosing and managing conditions affecting the muscles, joints and nervous system, with the aim of improving movement and reducing pain where appropriate.

Treatment is tailored to the individual and based on clinical findings rather than a one-size-fits-all approach.

Comprehensive Assessment

Every treatment plan begins with a detailed assessment.

Understanding the cause of your symptoms allows your chiropractor to recommend the most appropriate management strategy and determine whether chiropractic care is suitable.

Personalised Treatment Plan

No two patients are the same.

Your treatment plan may be influenced by factors such as:

• Your diagnosis
• Age
• General health
• Activity level
• Occupation
• Lifestyle
• Personal goals

Some people require only short-term care, while others benefit from a structured rehabilitation programme.

Spinal Manipulation

Where clinically appropriate, your chiropractor may recommend spinal manipulation.

This hands-on technique is designed to improve joint movement and may help reduce pain and stiffness in some patients with mechanical back pain.

Not every patient requires spinal manipulation, and alternative techniques may be more suitable depending on the diagnosis and individual circumstances.

Joint Mobilisation

Joint mobilisation uses slower, gentler movements to improve joint mobility.

This technique may be appropriate for patients who:

• Prefer a gentler approach
• Have significant stiffness
• Are older adults
• Have certain medical considerations

Soft Tissue Therapy

Muscles and connective tissues often contribute to back pain.

Treatment may include techniques designed to reduce muscle tension, improve flexibility and support normal movement.

Exercise Prescription

Research consistently shows that staying active and performing appropriate exercises plays an important role in managing many forms of back pain.

Depending on your condition, your chiropractor may recommend exercises to:

• Improve flexibility
• Strengthen core muscles
• Increase spinal mobility
• Improve balance
• Reduce the risk of future episodes

Exercises are tailored to your individual needs and adjusted as your recovery progresses.

Posture and Ergonomic Advice

Small changes to your daily habits can make a significant difference over time.

You may receive guidance on:

• Sitting posture
• Desk setup
• Monitor height
• Safe lifting techniques
• Sleep positions
• Driving posture
• Movement breaks during the workday

These practical strategies can help reduce unnecessary strain on your spine.

Rehabilitation

Recovery doesn't end when the pain improves.

Rehabilitation focuses on restoring strength, mobility and confidence so that you can return to normal activities while reducing the likelihood of future flare-ups.

A rehabilitation programme may include:

• Progressive strengthening
• Mobility exercises
• Functional movement training
• Return-to-sport guidance
• Long-term self-management strategies

Other Treatment Options for Back Pain

The most appropriate treatment depends on the underlying cause of your symptoms. In many cases, a combination of approaches provides the best results.

Medication

Pain-relieving medications and anti-inflammatory medicines may help manage symptoms during the early stages of back pain.

These medications can provide short-term relief but do not address the underlying cause of mechanical back pain. They should be used according to the advice of your doctor or pharmacist.

Physiotherapy

Physiotherapists play an important role in the management of back pain, particularly through exercise programmes, rehabilitation and movement retraining.

Depending on your condition, physiotherapy and chiropractic care may complement one another as part of a broader treatment plan.

Exercise

For most people, remaining active is one of the most effective ways to support recovery.

Activities such as walking, swimming and prescribed strengthening exercises can improve flexibility, build muscle support and help prevent future episodes.

Prolonged bed rest is generally no longer recommended for uncomplicated back pain, as it may slow recovery.

Lifestyle Changes

Healthy lifestyle habits can make a meaningful difference to spinal health.

These include:

• Maintaining a healthy body weight
• Exercising regularly
• Improving posture
• Taking movement breaks throughout the day
• Managing stress
• Getting adequate sleep
• Stopping smoking, where applicable

Making gradual, sustainable changes often has a greater long-term impact than relying on any single treatment.

Surgery

Only a small percentage of people with back pain require surgery.

Surgical treatment is generally reserved for specific conditions, such as certain spinal fractures, severe nerve compression or structural problems that have not responded to appropriate conservative management.

If surgery is indicated, your chiropractor will refer you to the appropriate medical specialist for further assessment.

Back Pain in Specific Groups

Back Pain During Pregnancy

Back pain is common during pregnancy, particularly in the second and third trimesters. As your baby grows, your centre of gravity shifts, hormones loosen the ligaments around the pelvis, and extra weight places greater demand on the spine and surrounding muscles.

Common symptoms include:

• Lower back pain
• Pelvic discomfort
• Hip pain
• Stiffness after sitting or standing
• Pain when turning in bed

Many pregnant women find relief through gentle exercise, good posture, supportive footwear and appropriate manual therapy. If you are pregnant, any treatment should be tailored to your stage of pregnancy and your individual health needs.

Always discuss new or severe symptoms with your obstetrician, midwife or healthcare provider.

Back Pain in Office Workers

Spending long hours at a desk can place considerable strain on the spine. Poor workstation setup, prolonged sitting and limited movement often contribute to stiffness and discomfort.

To reduce your risk:

• Sit with both feet flat on the floor.
• Keep your screen at eye level.
• Position your keyboard and mouse within comfortable reach.
• Support your lower back with an ergonomic chair or lumbar support.
• Stand up and move every 30 to 60 minutes.
• Stretch regularly throughout the day.

Small adjustments to your workspace and daily routine can make a significant difference over time.

Back Pain in Athletes

Whether you enjoy running, golf, cycling, CrossFit or team sports, your spine is exposed to repetitive forces during training and competition.

Common causes of back pain in athletes include:

• Overuse injuries
• Poor lifting technique
• Muscle imbalance
• Inadequate recovery
• Limited mobility
• Sudden increases in training intensity

Returning to sport too soon after an injury may increase the risk of recurrence. A structured rehabilitation programme can help restore strength, mobility and confidence before returning to full activity.

Can Back Pain Be Prevented?

While not every episode of back pain can be avoided, healthy habits can significantly reduce your risk.

Stay Active

Regular physical activity keeps the muscles supporting your spine strong and flexible.

Aim to include:

• Walking
• Swimming
• Cycling
• Strength training
• Stretching
• Core stability exercises

Improve Your Posture

Good posture reduces unnecessary stress on your spine.

Remember to:

• Sit upright without slouching.
• Keep your shoulders relaxed.
• Avoid looking down at your phone for long periods.
• Change position regularly.

Lift Correctly

When lifting:

• Bend your knees.
• Keep the load close to your body.
• Avoid twisting while lifting.
• Lift with your legs rather than your back.
• Ask for help with heavy objects.

Strengthen Your Core

Strong abdominal, back and hip muscles provide stability for the spine and support everyday movements.

A balanced exercise programme should include exercises that improve both strength and flexibility.

Maintain a Healthy Lifestyle

Overall health influences spinal health.

Helpful habits include:

• Maintaining a healthy body weight
• Eating a balanced diet
• Staying hydrated
• Getting enough sleep
• Managing stress
• Avoiding smoking

These lifestyle choices support your body's ability to recover and remain active.

Frequently Asked Questions

Conclusion

Back pain is a common condition, but it doesn't have to become a permanent part of your life. Understanding how your spine works, recognising the factors that contribute to pain and seeking timely professional advice can make a significant difference to your recovery.

Whether your symptoms are new or ongoing, the right combination of education, movement, lifestyle changes and evidence-based treatment can help you move with greater confidence and improve your quality of life.

At Bornman Chiropractic, your local chiropractor in Pretoria East, we're committed to helping patients understand their condition and make informed decisions about their spinal health through compassionate, personalised care.

Recommended Internal Links

• The Complete Guide to Neck Pain
• The Complete Guide to Back Pain
• The Complete Guide to Lower Back Pain
• The Complete Guide to Headaches
• Back Pain Exercises
• Sports Chiropractic
• First Visit
• About Dr Jaco Bornman
• Contact
• Chiropractor Pretoria East