When Jessica B.’s back pain started, she was almost positive it was from a workout injury or muscle strains from toting around her toddler son. She would feel sharp pains in her lower back mostly when standing or lying down for long periods; bending to empty the dishwasher or give her child a bath became really difficult. At first, she saw a chiropractor and did a few sessions of physical therapy, but after a few months, the pain wasn’t letting up.
It wasn’t until she saw an orthopedist — and got X-rays and MRIs — that she learned her ultimate diagnosis: osteoarthritis. She was surprised — “I was only 40, and I didn’t really hear much about people having arthritis in their back” — but also relieved. And once she started taking a prescription nonsteroidal anti-inflammatory medication (NSAID), her pain was notably better.
“I could actually play tennis with my friends for an hour without wincing in pain,” she says.
Indeed, back pain is one of the most common medical complaints. It’s widely reported that about 80 percent of adults experience low back pain at some point in their lives. Most back pain goes away on its own within a few days to a few weeks and is not due to a chronic disease like arthritis. In fact, most acute (short-term) back pain is due to a musculoskeletal injury like a muscle strain or sprain.
When back pain persists for weeks or months, though, it’s time to start investigating whether a medical condition could be responsible for the symptoms. Unfortunately, many people do not suspect arthritis as a cause of their back pain, even though arthritis in the back is very common. Arthritis in the back can also co-occur with other back pain causes, such as slipped or herniated discs or sciatica, which can make it harder to get the right diagnosis and treatment.
When you think of arthritis, you might think of creaky knees, stiff hips, or painful, swollen fingers. Yes, arthritis commonly attacks joints in the hands, knees, and hips. But it can happen anywhere you have joints — including the spine in the back.
Back arthritis is not one disease; rather, many different types of arthritis may cause back pain and stiffness. Symptoms may be related to issues like wear and tear of the joints in the spine, autoimmune disease and widespread inflammation, or infection. Regardless of the exact location or physiological reason, arthritis in the back can be painful and often becomes chronic.
“As you get older, you’re more likely to develop osteoarthritis of the spine,” Michael Tiso, MD, a physician who specializes in internal medicine and sports medicine at The Ohio State University Wexner Medical Center in Columbus. “Oftentimes, people have arthritis in the back without even having any symptoms. While about 10 percent of people in their thirties have lumbar arthritis that is visible on imaging [like X-rays], more than 80 percent of people over age 80 will have arthritic changes you can see on imaging. The percentage of people who are symptomatic is much less, which is why routine imaging is often not helpful.”
Learn more here about what causes back arthritis, different types of back arthritis, and how arthritis in the back is treated.
Symptoms of Arthritis in the Back
Common symptoms of back arthritis may include:
- Back pain, especially in the lower back
- Limited range of motion
- Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck
- Limitation of function, such as being unable to get out of bed easily, tie shoes, carry laundry, or do physical activity or exercise
- Tenderness of the affected vertebrae
- Feeling grinding when moving the spine
- Tingling, numbness, weakness, or sharp shooting pains in your arms or legs if nerves of the spine are affected
- Headaches (when the upper, or cervical, spine is affected)
- Pain/swelling/stiffness in other joints, such as knees, hands, and feet (common in inflammatory arthritis)
- Pain that is felt in the pelvis, buttocks, or thighs
“I’m in agony most days,” CreakyJoints member Jackie R., who has osteoarthritis in her back, shared on Facebook. “Clicking, crunching, popping are normal sounds now.”
Linda H., who has ankylosing spondylitis, told us that she is “always very stiff in the morning and can take a while to loosen up. Generally bending to pick something up is difficult, but vacuuming is the worst.”
Although back pain is a common symptom, not all people with arthritis in the back have symptoms like pain, even those with advanced back arthritis. On the other hand, some people may experience back pain even before evidence of arthritis can be seen on an X-ray.
Mechanical vs. Inflammatory Back Pain
Though many different types of arthritis can affect the back, they generally fall into two basic categories:
- Mechanical causes (which include osteoarthritis)
- Inflammatory causes (which include rheumatoid arthritis as well as arthritis in the spondyloarthritis family, such as axial spondyloarthritis and psoriatic arthritis)
Mechanical back pain is far more common than inflammatory back pain. However, inflammatory back pain may be treated very differently from mechanical back pain. (Medication options for debilitating symptoms include biologics that target the immune system.) So it’s important to get the right diagnosis if you think inflammatory back pain could be the reason for your symptoms.
The differences between mechanical and inflammatory back pain can sometimes be subtle, but there are often clear differences in the nature of the pain, if you know to look for it.
You can take this quiz to see if your back pain is more likely inflammatory or mechanical, but generally inflammatory back pain:
- Strikes at a younger age (generally before age 40-45, and often first in the teens and twenties)
- Feels better with exercise and movement and worse with rest and inactivity
- Lasts for three months or more, but can come and go
- Feels stiff first thing in the morning for 30 minutes or more
- Can wake you in the middle of the night in severe pain
Types of Arthritis that Affect the Back
If you have arthritis in your back, it’s important to understand the type of arthritis that might be causing it. Different types of arthritis have specific medications and treatments. Here are some of the more common types of arthritis that affect the back.
It is common for people with back pain to have more than one cause, which could include arthritis as well as other causes (more on those below).
Osteoarthritis (OA) is by far the most common form of back arthritis; risk increases with age. Osteoarthritis is a degenerative joint disease where the cartilage cushioning the ends of a joint wears away gradually. In the back, OA commonly affects the facet joints, which are found at the back part of the vertebrae in the spine. As the cartilage wears away between the facet joints, it can cause pain and stiffness in the back. Patients with OA tend to have mechanical pain such as minimal pain in the morning, worse pain with activity, and improvement with rest, says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.
OA in the back usually coincides with disc changes in the back that become more common with age.
The vertebrae in the spine are cushioned with discs that have a jelly-like center. These discs are what give the spine its flexibility. Over time, the discs lose their cushioning and height. This causes the spaces between the vertebrae to compress, which can make them rub against each other. In response to this stress, the body starts to make bony growths called osteophytes (bone spurs), which can pinch the nearby nerves and cause weakness or numbness. This is part of a process known as spondylosis, and includes degenerative disc and facet arthritis. Sometimes this can lead to other issues like spinal stenosis (narrowing of the spinal canal) as well, says Dr. Kirschner.
Osteoarthritis often affects the lower back (lumbar spine) and neck (cervical spine) and develops through wear and tear, though it has a strong genetic component, too, says Jonathan S. Kirschner, MD, RMSK, physiatrist at Hospital for Special Surgery in New York City.
OA pain is typically more noticeable when you bend backward or twist your back or when you’re standing for a while, says. Dr. Kirschner.
Spondyloarthritis (SpA) is an umbrella term for several different types of arthritis that have certain traits and symptoms in common; namely, that they cause inflammation in the spine. Arthritis types in this category includes axial spondyloarthritis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, and undifferentiated spondyloarthritis.
There are two main kinds of SpA: axial (in which symptoms predominantly affect the back, though other joints can be involved) and peripheral (where other joints in the body, like the hands, feet, or knees, are predominantly affected, though the back may be as well).
Axial spondyloarthritis (axSpA) is the most well-known type of inflammatory arthritis for causing back pain. It is generally broken down into two types: non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Non-radiographic axial spondyloarthritis means inflammation is occurring in the spine and sacroiliac joints (which connect the spine to the pelvis) but damage to the joints is not visible on X-rays. With AS, damage to the joints can be seen on X-rays. AS, too, causes bony growths on the spine, but these are different from those that occur in osteoarthritis.
In AS, the hallmark bony growth is called a syndesmophyte, which originate in the low lumbar spine and work their way up the spine and do not project out, says Dr. Smith. They are calcifications of the ligaments, says Dr. Kirschner.
AxSpA occurs because the body’s immune system is overactive, releasing chemicals into the blood and joints that cause pain, stiffness, and eventually joint damage. Over time, the bony growths around the vertebrae can cause parts of the spine to fuse together, leading to limitations in flexibility and mobility.
Psoriatic arthritis (PsA) is another type of spondyloarthritis. It can cause back pain, but it more commonly affects the peripheral joints, such as those in the fingers, toes, and knees. However, research shows up to half of patients with PsA also have inflammation in the spine that causes inflammatory back pain-like symptoms.
Psoriatic arthritis is linked to psoriasis, an autoimmune skin disease that causes red, silver, scaly rashes on the skin. The majority of PsA patients have both psoriasis plaques as well as pain, stiffness, and swelling in various joints. However, in some patients, joint symptoms precede skin symptoms or skin symptoms can be very subtle, so people may not necessarily think to connect psoriasis and PsA.
Adding to the confusion: People with axial spondyloarthritis are at greater risk of also having psoriasis. For some patients who have both psoriasis and inflammatory back pain, it may not be entirely clear whether they have psoriasis and axial spondyloarthritis or psoriatic arthritis with back pain. Learn more here about how doctors distinguish axSpA from PsA.
Reactive arthritis is considered a type of peripheral spondyloarthritis that happens in reaction to an infection in your body. Common causes include gastrointestinal illnesses like Shigella, E. coli, or campylobacter. Additional causes include sexually transmitted infections, such as gonorrhea or chlamydia, or urinary tract infections. Conjunctivitis (inflammation of the eyelids) commonly accompanies the arthritis, says Adam Kilian, MD, a rheumatologist and assistant professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, D.C. This arthritis is more common in smaller joints, but it affects the spine in about half of cases, he says.
Enteropathic arthritis, also known as inflammatory bowel disease-associated (IBD-associated) arthritis, is a peripheral spondyloarthritis that occurs in about 10 percent of people with inflammatory bowel disease (ulcerative colitis or Crohn’s disease), says Dr. Kilian. It commonly affects the sacroiliac joints, causing inflammatory lower back pain.
This is a type of peripheral spondyloarthritis when it’s not entirely clear which type of peripheral spondyloarthritis is the most fitting diagnosis, says Dr. Kilian. Since the different types of spondyloarthritis have many common features, it may be difficult to differentiate them early in the course of disease when symptoms may be mild.
Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the body’s immune system attacks itself, causing inflammation and pain in various joints. RA most commonly affects the joints of the limbs — and notably often first strikes in the hands and feet — but it can also affect the spine. When RA affects the back, the cervical spine (the neck) is affected, which may cause neck pain or sharp-shooting pains down the arms if the nerves are compressed, says Dr. Kilian.
Other Possible Causes of Back Pain
Lumbar Muscle Strain
Sometimes the muscles of the lower back become strained or spasm. This accounts for most cases of short-term (acute) back pain. These kind of back problems can occur from an injury, like lifting something improperly or overdoing it during physical activity. This can cause low back pain and stiffness, but it generally goes away within a few days to a few weeks.
The sciatic nerve is the largest nerve in the body, running from the lower part of the spinal cord, through the buttock, and down the back of the leg to the foot. Sciatica refers to pain that radiates from your lower back to your buttock and down the back of your leg. It is often accompanied by low back pain. It most commonly occurs when a herniated disc or narrowing of the space between the vertebrae compresses part of the nerves that go to the leg, says Dr. Kilian.
You may never have realized it, but your spine may be curved to the side instead of straight, either in an “S”- or “C”-like shape. This condition is known as scoliosis. The physical changes of scoliosis often start in childhood or adolescence, but the condition might not start causing back pain until middle or older age. Scoliosis usually causes back pain from muscle imbalance or because it leads to other conditions (like spine arthritis or disc disease), but it in and of itself doesn’t cause pain, says Dr. Kirschner.
Fibromyalgia is a chronic pain disorder that is thought to be due to how the brain processes pain, rather than due to a mechanical or inflammatory trigger of pain. In patients with fibromyalgia, pain processing centers may be on “high alert” so things that ordinarily wouldn’t be painful to someone without the condition — say, gently brushing against someone — can be very painful to them. The condition is known for causing widespread muscle pain and extreme tenderness in many areas of the body, says Dr. Kilian. Many people also experience sleep problems, debilitating fatigue, headaches, and mood disturbances like depression and anxiety. The lower back is a common site of fibromyalgia pain.
A herniated disc is a problem with one of the rubbery cushions (discs) that sit between the individual bones (vertebrae) that stack to make your spine. A spinal disc has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). A herniated disc occurs when some of the nucleus pushes out through a tear in the annulus. It can happen in any part of the spine and can irritate a nearby nerve. Depending on the herniated disc’s location, it can result in pain, numbness, or weakness in an arm or leg.
Degenerative Disc Disease
Degenerative disc disease is a condition where pain is caused from an unhealthy disc. Normally, discs don’t have much feeling, says Dr. Kirschner. But after a disc injury, new nerves grow into the area that can transmit pain signals, he says. Several factors can cause discs to degenerate, including age; smoking, disc herniations (injuries that cause tears in the outer lining of the disc leading to the inner core of the disc), and drying out of the disc. Degenerative disc disease is a separate but related process from osteoarthritis of the spine, as it can lead to bone spurs and joint degeneration.
Lumbar Spinal Stenosis
Lumbar spinal stenosis is a narrowing of the spinal canal through where the spinal cord and nerve roots run through within the spine, says Dr. Kirschner. This compresses the nerves that branch out from the spinal cord, causing symptoms such as tingling, numbness, or weakness. You may have sharp shooting pains that radiate down a leg. Or, pain can be dull, burning, tearing, or feel like a muscle pull, says Dr. Kirschner. These symptoms are often exacerbated by extending the back backward (such as when walking down the stairs) and relieved with flexing the back forward.
As many as 54 million American adults age 50 and older have osteoporosis and low bone mass, according to the National Osteoporosis Foundation. Osteoporosis happens when your body creates new bone more slowly than it breaks down old bone tissue, resulting in weak and brittle bones that are abnormally porous and compressible, like a sponge. As bones weaken and become more brittle, a fall or even a mild stress event like coughing can cause bones to break. Fractures caused by osteoporosis often occur in the spine.
“Osteoporosis does not cause back pain unless a fracture is present,” says Dr. Kirschner. “But not all fractures are painful.” He says that because people don’t “feel” osteoporosis, people at an increased risk of osteoporosis should have regular bone density screenings and get appropriate treatment to reduce the risk of fractures, such as getting enough calcium and vitamin D, doing weight-bearing exercises, and taking bone-building medications if necessary.
Check out this osteoporosis risk calculator from the non-profit American Bone Health.
Other serious, though rare, conditions can also cause back pain, including infections, tumors, kidney stones, female reproductive problems like endometriosis or fibroids, or abdominal aortic aneurysm.
This is not a complete list of back pain causes and it’s important to see a health care provider to understand what might be causing your back pain.
How Arthritis in the Back Is Diagnosed
Diagnosing arthritis in the back begins with taking your medical history and doing a physical exam of your back and legs to assess your mobility/flexibility and make sure your nerves are working properly. The doctor will ask questions about:
- Where the pain is occurring
- How long the pain has lasted
- What the pain feels like/how severe it is
- What situations/activities make the pain feel better or worse
- How the pain is affecting/limiting your daily function
Imaging tests are usually needed to help confirm a diagnosis of arthritis. X-rays are typically the first imaging test ordered. They can joint damage/bone spurs, but cannot show damage to soft tissues such as muscles, ligaments, or bulging discs. Other tests may be ordered to look for changes or damage that is not visible on X-rays. These may include MRI, CT, ultrasound, bone scans, or other tests as needed. The gold standard to diagnose arthritis in the back is actually an injection called a medial branch block, but it’s not often necessary, says Dr. Kirschner.
If your doctor suspects you could have a type of inflammatory arthritis, they may order blood tests to look for signs of inflammation, such as C-reactive protein or erythrocyte sedimentation rate.
Other blood tests may look for genetic markers associated with axial spondyloarthritis, such as HLA-B27, or antibodies associated with rheumatoid arthritis (such as rheumatoid factor or anti-CCP).
How Arthritis in the Back Is Treated
Treatment for back arthritis depends on many factors, including your age, level of pain, type and severity of arthritis, other medical conditions and medications, and personal health goals. Because joint damage caused by arthritis is irreversible, treatment usually focuses on managing pain and preventing further damage.
Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Analgesics (such as acetaminophen) can help with mild to moderate pain and are considered a first-line medication for osteoarthritis, says Dr. Tiso. Over-the-counter NSAIDs like ibuprofen (Advil) and naproxen (Aleve), as well as prescription NSAIDs, can help relieve pain and swelling in the joints. However, though many NSAIDs are available over the counter, they can cause side effects (such as stomach ulcers, increased heart attack risk, and kidney problems), especially when taken for the long term and/or in high doses. NSAIDs are a first-line of treatment in OA as well as axial spondyloarthritis to reduce pain and stiffness. In inflammatory arthritis, they can be used along with other kinds of medication to treat inflammation, pain, and swelling.
Steroids are anti-inflammatory medications that may be used when there is an inflammatory cause of back pain. Your doctor may initially prescribe a steroid if you have a systemic inflammatory type of arthritis, says Dr. Kilian. However, if you don’t have inflammatory arthritis, steroids are typically not recommended.
Although not technically medication, another option for treating osteoarthritis in the back is radiofrequency ablation, an outpatient procedure in which the nerves to the facet joint are burned with a needle. The treatment can provide longer-term pain relief for some patients; pain can be eased for one to two years, says Dr. Kirschner. However, it may not work in all patients and recent osteoarthritis treatment guidelines say there is only limited evidence for its effectiveness. It has limited effectiveness in knee OA, but guidelines don’t comment on spine OA, says Dr. Kirschner. Other studies show that radiofrequency ablation of the spine is highly effective, he says. Read more here about radiofrequency ablation for arthritis pain.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
Disease-modifying anti-rheumatic drugs include conventional immune-modifying drugs, such as methotrexate, as well as biologic medications, which are more targeted to certain immune system pathways. DMARDs reduce immune system activity to stop inflammation and they are only used to treat certain kinds of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis.
Many different types of DMARDs are available and some are more appropriate for certain types of arthritis than others. The type of DMARD that is recommended for you will depend on the type of inflammatory arthritis that you have, says Dr. Kilian, as well as other factors, like your insurance coverage.
The spine wasn’t meant to carry large amounts of excess weight. Maintaining a healthy weight helps reduce stress and pressure on the joints and losing excess pounds can lead to less pain and better function. One study published in the journal Arthritis & Rheumatology found that people who were overweight or obese had significantly more disc degeneration in the lumbar spine, for example.
Aim to eat an array of anti-inflammatory foods, which may help reduce inflammation. Choose colorful fruits and vegetables, legumes and nuts, olive oil, fish, and whole grains, says Dr. Kilian. Avoid heavily processed foods and simple carbs like breads, pastas, and foods high in added sugar.
“Maintaining a healthy weight minimizes excess force on the joints and is one of the most important aspects of joint health,” says Dr. Kilian.
When your back is causing agony, exercise may be the last thing you can fathom. But exercise is a critical part of managing arthritis in the back, regardless of the type of arthritis. Check with your doctor before starting any new exercise plan; you may also want to work with a physical therapist or trainer who can show you how to modify exercises so they won’t exacerbate your pain.
For inflammatory types of arthritis like axial spondyloarthritis, gentle exercise, including stretching moves in yoga and Pilates, may actually make acute back pain feel better because it helps fight the stiffness that comes from revved-up inflammation.
For osteoarthritis, regular strength training and flexibility exercises are important to help strengthen core and back muscles, which support a healthy spine and may help prevent further joint degeneration.
Cardiovascular exercise, such as walking, swimming, or cycling, is also important to promote good circulation in the spine and help with maintaining a healthy weight.
Physical therapy has been shown to help with most types of back pain. Your doctor may send you for physical therapy to help improve your range of motion and strengthen the muscles in your back and core, which play a role in a large amount of back pain, says Dr. Smith.
Smoking typically makes arthritis more resistant to treatment and more difficult to control. It affects all tissues of the body and reduces the body’s ability to heal itself. “Smoking is awful for your bone health and impairs bone healing,” says Dr. Kilian. Talk to your doctor about strategies to help you quit, he says.
A physical therapist can provide postural training to make sure the way you naturally sit and stand doesn’t further contribute to your back pain. Your posture should be straight and upright with little to no slouching, says Dr. Tiso.
Avoid Being Sedentary
Also important: getting up at regular intervals if you have a job that keeps you sedentary. Sitting for prolonged periods isn’t good for the low back, he says. Take frequent breaks or try using a standing desk for periods of time throughout the day. It’s also a good idea to look at your work station and make adjustments if necessary. You may want to use an ergonomic chair that gives proper lumbar support or tools such as an ergonomic computer mouse or computer stand.
Surgery for Back Arthritis
Surgery is a last resort when it comes to arthritis in the back. “Know that 95 percent of people with back pain will not need surgery, and 75 percent will fully recover within three months,” says Dr. Tiso.
Doctors recommend that you try medications, physical therapy, and weight loss (if necessary) before considering surgery, says Dr. Kilian. “The best surgical outcomes often occur in patients who are actively involved in physical therapy and have a healthy body weight,” he says.
The type of surgery depends on the type of arthritis and region of the back that is affected. Depending on the procedure performed, surgery aims to decompress any pinched nerves and free up the nerve roots from bone spurs and other tissues that may be pressing on them.
Spine surgery may be performed if there is a danger to the nerves or as a last resort for severe disabling back pain, says Dr. Kilian. It’s most beneficial when nerve roots are severely compressed, he says. A spinal fusion, for example, fuses two or more vertebrae together in your spine permanently. Here, they won’t move. They’re typically done for severe spinal arthritis causing deformity or for scoliosis, says Dr. Kirschner.
Lumbar disc replacements
In a lumbar disc replacement, you replace a worn or degenerated disc in the lower part of your spine with an artificial disc. This disc is made of metal or metal and plastic. Not everyone is a good candidate for this type of surgery. You may be a good candidate if you’re not overweight or haven’t had spinal surgery, and your back pain mainly comes from one or two discs in your lower spine.
Just remember that arthritis in the back pain doesn’t have to get in your way of living a healthy and active life. “It shouldn’t be a crippling, life-ending problem,” says Jonathan Hersch, MD, FAAOS, an orthopedic surgeon and sport medicine physician at West Boca Medical Center in Boca Raton, Florida. “Most people can live a healthy and functional life with minimal pain if they seek the right medical attention.”
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