Back Pain: Where Does Upper, Middle, and Lower Back Pain Come From?

Back pain is a common health problem. In most cases, a lack of exercise, poor posture or overuse are behind the symptoms. In some cases, however, diseases of the back or organic causes can also be the trigger. This can cause pain in the upper, middle, or lower back. What is behind these different types of back pain, what do accompanying symptoms such as nausea, dizziness, or chest pain indicate, and what helps?

Lower back pain

If the back pain tends to occur below, the lumbar spine is usually affected by the pain. It is, therefore, also referred to as lumbar spine syndrome (LWS syndrome for short). The lumbar spine extends from the sacrum to the lower ribs and includes five lumbar vertebrae. Colloquially, “low back pain” is also used for pain below the back. This is because the symptoms are often located at the transition between the lumbar spine and the sacrum.

Back pain in the lower back is widespread because the spine in this area is susceptible to external influences, and the lumbar vertebrae are relatively small compared to other spine areas. Common causes of lower back pain include:

• Poor posture (poor posture)
• lack of exercise
• jerky lifting of heavy objects
• overweight
• mental stress
• Spinalkanalstenose
• osteoporosis
• scoliosis
• Scheuermann’s disease
• Lumbago  (“lumbago”)
• Iliosacral joint syndrome
• vertebral body damage
• ankylosing spondylitis
• disc prolapse

If the pain radiates from the lower back to the groin or legs and feels stabbing, a herniated disc is often the cause.

In addition, nearby organs such as the kidneys (e.g. in the context of a kidney infection) can also trigger pain that is easily confused with pain in the lower back. Women can also experience abdominal pain, for example, during their period, which radiates down to the lower back.

In sporadic cases, a spinal tumour can also cause lower back pain.

 

Lower back pain in pregnancy

Another cause of back pain in this area is pregnancy. The weight of the fetus causes the pelvis to tilt forward during pregnancy, resulting in a hollow back. This in turn causes pain in the lower back. If the pregnancy is further along, the symptoms can also be caused by contractions of the uterus, pressure from the fetus on nerves or a blockage in the urinary tract.

If back pain occurs in early pregnancy, this is due to hormonal changes that lead to loosening of the muscles in the pelvis and pubic bone as well as the intervertebral discs.

Middle and upper back pain

The thoracic spine is the area between the lower ribs and the shoulders. It consists of twelve thoracic vertebrae. Complaints in the middle and upper back are therefore also referred to as thoracic vertebra syndrome (TWS syndrome) or dorsalgia (“dorsal” = “towards the back”, which refers to the curvature of the thoracic spine).

If pain occurs in the middle and upper back, there can be numerous causes behind it, some of which overlap with the triggers of pain in other areas of the back. Possible causes include:

• long periods of sitting and insufficient exercise
• Obesity
• Scheuermann’s disease
• Scoliosis
• Kostotransversalgelenk-Syndrome
• Osteoporosis
• rheumatoid arthritis
• Fractures of the thoracic vertebrae

A slipped disc in the thoracic spine is very rare – in only about two percent of all cases. Pain in the middle and upper back can also, in very rare cases, be caused by a tumor in the spine or spinal cord. The pain then usually increases at night and when lying down.

 

Back pain with other pain

If back pain occurs in combination with pain in the chest, abdomen or kidney area, there may also be organic causes behind it. Read on to find out what these are.

Chest and back pain – damage to the lungs or heart?

Especially when it comes to pain in the thoracic spine, many sufferers find it difficult to distinguish back pain from chest pain. Lung diseases are also suspected.

In fact, some  lung diseases can  cause symptoms such as back pain. One of these is  chronic obstructive pulmonary disease  (COPD). In this disease, which is characterized by chronic  coughing  and shortness of breath, among other things, the diaphragm is subjected to much greater strain during breathing than is normally the case. As a result, it cannot exert a torso-stabilizing effect and the intervertebral discs are subjected to greater strain. This in turn results in back pain.

But  acute infections  such as  bronchitis , inflammation of the pleura or  pneumonia can also cause pain in the middle back. It is then important to pay attention to characteristic accompanying symptoms such as coughing, general feeling of illness, difficulty breathing or  fever  . In the case of  pleurisy ,  the back pain often gets worse when breathing.

If pain occurs in the back and chest, this can also indicate a  heart condition  in which the pain radiates into the back. But back pain can also be felt in the chest area. One distinguishing feature is that back pain usually increases when at rest, while complaints caused by the heart worsen with activity.

Possible heart diseases that can cause back and chest pain include  myocarditis ,  angina pectoris  or a  heart attack . Depending on the disease, typical accompanying symptoms include a feeling of tightness in the chest, tiredness, nausea, upper abdominal pain or dizziness.

The general rule is: If you experience severe pain and acute accompanying symptoms such as shortness of breath, nausea or fear of death, you should always call the emergency services.

Abdominal pain and back pain at the same time

When abdominal and back pain occur at the same time, a common cause is often suspected. This may or may not be the case. Possible common triggers are gallbladder diseases, particularly gallstones, and pancreatitis. In addition to severe pain, both diseases often cause nausea and vomiting. Gallstones can also cause noticeably light-colored stools.

In addition, certain kidney diseases can also cause back pain.

 

Back pain due to kidney or bladder disease

Pain in the middle or lower back can also be a sign of advanced  bladder infection  (cystitis). In addition, symptoms typical of bladder infection occur, such as burning and pain when urinating, frequent  urination  or  discolored urine  . Back pain usually occurs with cystitis when the infection has spread to the kidneys. In this case, medical advice should be sought urgently.

In the case of kidney diseases, such as kidney stones or pyelonephritis, pain can radiate from the kidneys that feels like back pain. Whether it is kidney pain or back pain can often be determined based on the following criteria: Firstly, kidney pain does not  usually  limit mobility. Secondly, a light blow with the edge of the hand at kidney level (about two to three fingers above the pelvis) usually triggers pain in the case of kidney disease.

Back and neck pain

The uppermost part of the spine is the so-called cervical spine. It lies between the shoulders and the skull and consists of seven cervical vertebrae. Diseases of the cervical spine and the associated complaints, such as arm pain or headaches, are also known as cervical spine syndrome (Cervical spine syndrome) or cervical syndrome.

The following causes, among others, can be behind a cervical spine syndrome:

• poor posture and long periods of sitting
• Wear and tear on intervertebral discs, ligaments or vertebrae
• Block or wedge swivel
• Scheuermann’s disease
• rheumatoide Arthritis
• Inflammation of the cervical vertebrae due to bacterial infections
• Tumor (in rare cases)
• Osteoporosis
• Whiplash

In the case of cervical spine syndrome, the adjacent muscles in the neck are often tense. If the tension is particularly severe, accompanying symptoms such as headaches, dizziness or ringing in the ears can occur. This is probably because the tense muscles press on nerves that emerge from the spine. Constriction of the blood vessels by the muscles could also   promote dizziness and tinnitus .

Depending on whether the problems occur in the lower, middle or upper part of the cervical spine, the pain can radiate to different areas of the body. If the  lower part  of the cervical spine is affected, the symptoms are often felt as pulling pains extending into the arms (cervicobrachialgia). If the problems occur in the  middle area  , the pain occurs in the shoulder blades, whereas if the  upper part occurs, the pain is felt  in the back of the head.

Chronic back pain

Back pain is considered chronic if the symptoms have existed for at least twelve weeks and occur almost daily during this time.

Chronic back pain can be a major burden for those affected. It often leads to a restriction of everyday activities that can no longer be carried out without pain. It is also often the reason for occupational disability or early retirement.

If the symptoms do not improve, chronic back pain can also lead to psychological problems and even  depression  . If the symptoms persist, you should always seek medical advice.

 

Diagnosis of back pain

The first port of call for back pain is usually your GP. From there, depending on the cause of the back pain, you may be referred to an orthopedic, neurological or rheumatological specialist.

An important part of diagnosing back pain is the  doctor-patient conversation  (anamnesis). The doctor will first ask about the type and exact location of the symptoms. For example, if the pain only occurs to the left or right of the spine, it could be caused by a crooked sitting position or a slipped disc if the disc has slipped into the left or right half of the back. Whether the symptoms improve with movement or worsen when lying down can also be an indication of the underlying cause. Living conditions, such as professional activity, are also important for the diagnosis.

This is followed by a  physical examination  in which posture, possible movement restrictions and pain points are checked.

If necessary,  blood tests  or  imaging procedures can  be used for further diagnosis. The latter include X-rays, bone density measurements, magnetic resonance imaging (MRI) or computed tomography (CT).

What helps with back pain?

If you frequently suffer from back pain, different behaviors can help to improve the symptoms.

Stress often leads to muscular tension and thus back pain. Long working hours in desk jobs also put additional strain on the spine. In these cases,  targeted  back exercises  and  relaxation techniques can  help to relieve mental and physical tension and counteract damage caused by poor posture and long periods of sitting.

Unless there is a medical reason not to do so, you should do gentle sports on your back, as sufficient exercise can be a helpful way to combat stress and back pain. Suitable sports include backstroke, yoga or cycling. Even a light walk can help.

Warm baths and massages also contribute to physical and emotional relaxation. A professional masseur should always carry out the latter, at least if an underlying back problem is suspected.

Another option is treatment in the form of physiotherapy, where muscles can be strengthened, or poor posture can be corrected under professional supervision.

In the past, back surgery was widespread in cases of herniated discs. Nowadays, however, conservative treatment with heat, massage or physiotherapy is usually preferred for back pain. Surgery is often the last option only if this approach does not improve the symptoms or if symptoms such as highly severe back pain, paralysis or bladder and bowel problems occur.

Medication for a sore back?

In the case of acute back pain, medication can help relieve it. In particular, taking painkillers can be advisable if the pain is caused by tension or poor posture, as this makes it easier to resolve incorrect protective postures and regain full mobility.

Suitable painkillers are, for example, paracetamol, ibuprofen or acetylsalicylic acid. However, all of these drugs can also have side effects. They are not appropriate for long-term therapy. In the event of prolonged back pain, medical advice should always be sought.