Back Pain

Understanding Back Pain

Back pain is one of the most common health complaints worldwide, affecting up to 80% of adults at some point in their lives.

Back pain is considered the single leading cause of disability worldwide. It is a major cause of missed work, impacting people of all ages, genders, and activity levels.

While some back pain may be mild and short-lived, chronic back pain can be severe, long lasting, debilitating and significantly reduce quality of life.

Types of Back Pain

Acute Back Pain

Lasts a few days to a few weeks and often improves with self-care. The causes and treatments are different from chronic back pain.

Subacute Back Pain

Persists for 4 to 12 weeks. If back pain is not effectively treated by a back pain specialist during this time, there is a significant risk that the back pain could become long-lasting and chronic.

Chronic Back Pain

Persists for 12 weeks or longer, even after the initial cause has been diagnosed and treated. Chronic back pain affects about 20% of individuals with acute back pain and can be difficult to diagnose and treat. Chronic back pain can cause significant distress and reduce quality of life.

What Causes Back Pain?

The spine is a complex structure of bones, discs, nerves, muscles, tendons and other tissues that reach from the base of the skull to the tailbone (coccyx). The spine encloses and protects the spinal cord and the fluid surrounding the spinal cord. Any disruption to one or more of these components can lead to different medical conditions and cause different types of back pain and referred pain.

Here are some causes of back pain and they may include one or more of the following.

Muscle Strain and Myofascial Pain

There are many muscle complexes surrounding the spine and back. Any of these can cause back pain. These spinal muscles are a common cause of acute back pain.

- Muscle can become tight (tension) or go into spasms or contain tender points within them called trigger points.

- Myofascial pain syndrome is a chronic pain condition caused by sensitive trigger points in the muscles and fascia (covering of muscles), often leading to localized or referred pain, stiffness, and reduced mobility.

- Here are some of the muscles involved in back pain

Iliopsoas
This deep hip flexor muscle is often implicated in lower back pain, especially when tight from prolonged sitting.

Quadratus lumborum
Located on the side of the lower back, this muscle can contribute to pain when it becomes tight or strained.

Multifidus
A deep spinal stabiliser muscle that plays a crucial role in maintaining proper alignment and can be a source of pain when weakened.

Gluteus muscles
Tightness in the glutes can also contribute to lower back pain.

Erector spinae
A group of muscles along the spine that help with extension and can cause pain if strained.  

Piriformis
A small muscle deep in the buttocks that can sometimes irritate the sciatic nerve, leading to radiating pain down the leg.

Inflammatory

This category includes inflammatory conditions not caused by infection or malignancy. Examples, ankylosing spondylitis and sacroiliitis. Chronic inflammation can give rise to spinal arthritis and affect spinal facet joints.

Degenerative

Musculoskeletal structures can weaken over time due to aging, overuse, or pre-existing pathology. Conditions like intervertebral disk herniation and degenerative disk disease fall into this group.

Trauma and injury

Back pain commonly results from direct or indirect contact with an external force. Examples are whiplash injury, strain, and traumatic fractures.

Spondylolisthesis

Misalignment of spinal vertebrae can occur due to trauma or degenerative conditions.

Lumbar Spinal Stenosis

The spinal canal or other area narrows in the back and spine, compressing nerves, causing radiating pain or numbness.

Referred Pain

Referred pain is pain that originates in one area of the body like the spine but is felt in another, such as the legs. For example, facet joint pain in the lower lumbar spine can radiate to distant areas, including the thigh, leg, groin, and even the front of the body.

Visceral organ inflammation can cause more serious forms of referred back pain. Examples are biliary colic, lung disease, and aortic or vertebral artery pathology.

Post-Surgical Pain

Persistent and ongoing pain following any form of back surgery is common. Examples include Post-Laminectomy Pain Syndrome and Persistent Spinal Pain Syndrome, previously known as Failed Back Surgery Syndrome.

This is a complex pain condition with many aspects including multiple causes that to be considered. It’s important to be assessed and managed by experienced back pain specialists.

Metabolic

Calcium and bone metabolism can cause the symptoms. Osteoporosis and osteosclerosis are examples of this.

Neurological Causes

Conditions like sciatica, shingles, multiple sclerosis or spinal infections can cause back pain.

Cancer

Anatomic structures of the back can develop primary or secondary cancers (malignant lesions). Pathologic fractures of the vertebrae and bones of the spine (axial skeleton) can arise as a complication.

Infectious

Infections of the musculoskeletal structures in this region can arise from direct inoculation or spread from another source and location in the body.

Who is at Risk of Back Pain?

While anyone can experience back pain, certain factors increase the risk:

Age
Most first incidents occur between ages 20 and 40. The older you get the more likely you are to develop chronic back pain.

Sedentary Lifestyle
Weak back muscles due to lack of activity.

Obesity
Excess weight strains the structures of the spine.

Occupational Risks
Jobs involving heavy lifting or prolonged sitting.

Poor Posture
Incorrect sitting or standing positions.

How is Back Pain Diagnosed

A thorough evaluation by an experienced medical professional is essential for diagnosing back pain. The assessment of back pain should not be rushed and needs to be done by a trained expert.

This evaluation process may include:
- Medical History and Physical Examination: To understand the pain’s cause and impact.
- Blood tests and nerve conduction tests; To understand what could be causing the back pain.
- Imaging Tests: Such as X-rays, CTS or MRI scans to identify structural issues.

A quick note on scans and images:

Spinal imaging scans like MRIs often reveals degenerative changes, such as disc bulges or protrusions, even in people without back pain, particularly as they age. These findings are often a normal part of aging and may not be linked to causes of back pain, highlighting the importance of interpreting scans in the context of a patient’s clinical symptoms. This takes training and expertise.

What are the Best Treatments for Back Pain

Treatment depends on whether the pain is acute or chronic and can depend on which medical professional you consult.  

Acute Back Pain Treatments

1. Use Heat or Cold Packs for Relief
Applying a cold pack can reduce swelling and numb acute pain, while heat packs help relax tense muscles and improve blood flow to the area.

2. Physical Therapy and Gentle Exercises
Supervised physiotherapy or light exercises like walking or stretching can strengthen muscles, improve flexibility, and promote healing without aggravating pain. 

3. Over-the-Counter Pain Medications
Non-prescription anti-inflammatories can reduce inflammation and provide temporary pain relief.

4. Stretches and exercises for acute back pain
Some stretches and gentle exercises can be an important part of the recovery and even prevention process. Here are some stretches to consider. We’ll put a link to our block post on them below.  

• Knee to Chest Stretch

• Rotational stretch – Seated

• Cat Cow Stretch

• Bridge exercise

• Rotational Stretch – Lying

Chronic Back Pain Treatments

Through years of experience, we’ve figured out that good and long-lasting chronic back pain relief doesn’t work unless all bases are covered. There is no one best treatment for back pain and the best outcomes are where multiple treatments are considered in a step-wise approach or concurrently.

Optimal back pain management should initially focuse on non-surgical back pain treatments that utilise a multidisciplinary approach that combines pain-reducing treatments like medications and spinal injections with selected therapies like physical and psychological rehabilitation treatment.

Medications 

Medications can be helpful to ease pain. They may include;
- Prescribed muscle relaxants.
- Medications targeting nerve pain.
- Topical analgesics are pain creams, sometimes bought over the counter or prescribed by pain specialists.

Pain Interventions

Interventional spine and back pain management injections can be used to locate, diagnose, and treat chronic back pain.  

- Joint blocks might include facet joint blocks, sacroiliac joint blocks.
- Nerve blocks might target the dorsal root ganglion/nerve roots, the cluneal nerve, the lumbar plexus, the sciatic nerves or combination thereof.  
- Epidural injections can be used for some forms of stenosis.
- Intradiscal therapies can also be delivered.
- Radiofrequency ablation (RFA) of certain joints and nerves are a more advanced pain management technique and can provide longer durations of pain reduction.

Nerve Stimulation (Neuromodulation):

Peripheral nerve stimulation or spinal cord stimulation (neuromodulation) are advanced pain management techniques that use small amounts of electrical current delivered directly to the target or source of pain. Types of therapy might include closed-loop, BurstDR, multi-wave stimulation, or HF10.

They are used to effectively manage chronic pain by targeting specific nerve(s) and nerve pathways. This treat the pain at its source.

Rehabilitation

Rehabilitation involves specialised tailored physical and psychological therapies designed to improve mobility, strengthen the body, and address the mental impact of chronic pain.

Surgery

Surgery is generally recommended when tests show structural issues or changes, which need corrective surgery. These might include herniated discs or worsening stenosis.  

When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression.

These are performed by a neurosurgeon or a spinal surgeon. Types of surgery might include decompression surgery (laminotomy, laminectomy, discectomy) and or stabilisation surgery (fusion).

Why Choose Us for Back Pain Treatment in Melbourne?

At Pain Specialists Australia, we combine cutting-edge treatments with compassionate care.

We’re proactive and get things done. We are back pain specialists in Melbourne and offer advanced care and treatment. We don’t give up.

Our experienced specialists create personalised treatment plans to target the cause of your pain, offering advanced interventions and holistic therapies to improve your quality of life.

Our aim is to get you on that planned holiday or social event, you are worried about missing out on.

FAQs About Back Pain

1. What is the most common cause of back pain?

Back pain often results from muscle strain or mechanical issues like degenerative disc disease or facet joint arthritis.  

In our experience and according to research articles, the spinal facet joints are by far the most common cause of chronic back pain. Spinal facet joint pain requires experts and specialists to make the diagnosis and set up a treatment plan of action. Facet joint pain can be effectively managed.

Remember people use these terms interchangeably; backache is the same as lumbar pain, is the same as spinal pain.

2. When should I see a doctor for back pain?

Seek medical attention if your pain persists for more than a few weeks, if it worsens over time, is accompanied by symptoms like numbness, weakness, or fever or if early treatments are not helpful.  

If you have any doubts about when to seek medical attention, just ask your doctor.

3. What is sciatica?

Sciatica is a general term or condition that describes pain radiating along the sciatic nerve, running from the lower back through the hips, buttocks, and down the legs.  

There is no single cause of sciatica. Sciatica has many causes which might include nerve compression from a herniated disc, spinal stenosis, or even piriformis muscle problems.

Symptoms include sharp pain, numbness, or weakness in the leg, and treatments range from physical therapy and injections to advanced pain management techniques.

If you are getting pain radiating down your legs, the best option is to seek medical advice.

4. Can chronic back pain be cured?

While, in some circumstances, chronic back pain may not always be fully cured, effective treatments are available which can significantly reduce pain, and improve function and quality of life.

One of the treatment principles is that earlier the back pain is diagnosed and the earlier the right treatment(s) are provided, the better the chances of a full recovery. 

It is possible to live a full life despite chronic back pain.  

5. What non-surgical back pain treatments are available? 

There are many non-surgical options for treating back pain. Options include physiotherapy, exercises, rehabilitation, joint blocks, nerve blocks and radiofrequency ablation.

6. How can I prevent back pain?

Prevent back pain by maintain a healthy weight, stay active, focus on strength activities and exercises, practice good posture, and use ergonomic furniture.

7. What are exercises I can do at home, without equipment, to relieve my back pain?  

Here are some of the most highly recommended stretches for back pain.

• Knee to Chest Stretch (Knee Bent)

• Seated back rotational stretch

• Cat Cow Stretch

• Bridge exercise

• Lower back rotational stretch

Here is an article with more details on some of these exercises. (LINK TO BLOG)

8. What is radiofrequency ablation (RFA) for back pain?

Radiofrequency ablation (RFA) is a minimally invasive spinal injection procedure used to treat chronic back pain by using heat generated from radio waves, through expertly placed needles to target and disable specific nerves responsible for transmitting pain signals.  

RFA is often recommended for conditions like facet joint pain, sacroiliac joint dysfunction, or nerve-related back pain. RFA can provide long-lasting relief for many patients without the need for surgery.

9. How do I book an appointment with a back pain specialist in Melbourne?

Make sure you are not kept waiting for long periods of time before you get in to consult a Back Pain Specialist.

At Pain Specialists Australia, our experienced Pain Specialists will see 85% of referrals with the month of referral.

Contact Pain Specialists Australia today to schedule a consultation and start your journey to relief.

References

If you’re interested in more, here are some references for your perusal.

WHO Fact Sheet on Back Pain

https://www.who.int/news-room/fact-sheets/detail/low-back-pain

Back pain

Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK538173/

Muscles and Back Pain

Noonan AM, Brown SHM. Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR Spine. 2021 Sep 15;4(3):e1171.

https://pubmed.ncbi.nlm.nih.gov/34611593/

Multifidus muscle and Back Pain

Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010 Feb;2(2):142-6; quiz 1 p following 167.

https://pubmed.ncbi.nlm.nih.gov/20193941/

Back Muscles and Back Pain

Matheve T, Hodges P, Danneels L. The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med. 2023 Aug 24;12(17):5510.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10487902/

MRIs and Back Pain

Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM. 1994:331;69-73.

https://pubmed.ncbi.nlm.nih.gov/8208267/

Scans and imaging and Back Pain

Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4464797/

Stretches to Relieve Back Pain

Link to our blog on Stretches for Back Pain

Best stretches for back pain relief

Radiofrequency Ablation and Back Pain

Leggett LE, Soril LJ, Lorenzetti DL, Noseworthy T, Steadman R, Tiwana S, Clement F. Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials. Pain Res Manag. 2014 Sep-Oct;19(5):e146-53.

https://pubmed.ncbi.nlm.nih.gov/25068973/

Spinal Cord Stimulation and Back Pain

Eckermann JM, Pilitsis JG, Vannaboutathong C, Wagner BJ, Province-Azalde R, Bendel MA. Systematic Literature Review of Spinal Cord Stimulation in Patients With Chronic Back Pain Without Prior Spine Surgery. Neuromodulation. 2021 Aug 18. doi: 10.1111/ner.13519. Epub ahead of print. PMID: 34407288.

https://pubmed.ncbi.nlm.nih.gov/34407288/