Back Pain | Causes, Symptoms, Prevention & Treatment

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Your back is out of your line of sight most of the time. So you may not think about it much — until it hurts. But your back is central to your ability to work, play, relax, be intimate, and generally live a high-quality life. When back pain steals that from you, you need a plan to stop the pain and reclaim your life.

There’s no one-size-fits-all solution. Everyone is different, so in this complete guide to back pain, we’ll take a deep dive into it. First, what is back pain? Then…

  • Back pain causes
  • Back pain symptoms
  • Home remedies that work
  • Effective ways to prevent back pain
  • Back pain treatments. We’ll include both holistic and conventional medical treatments.

What Is Back Pain?

Back pain usually refers to generalized pain in the back. It’s one of the main reasons people seek medical treatment. It’s also the most common cause of disability not just in San Francisco, not just in the United States, but around the world.

The causes of back pain are many. And we’ll take an in-depth look at each of them. But regardless, back pain affects the muscles, bones, joints, discs, and ligaments. Back pain is always a symptom of dysfunction within these structures. 

Localized vs. Radiating Back Pain

Some people experience back pain in one area, and always that area. We call this localized back pain. For example, you may have:

  • Lower back pain
  • Back pain middle
  • Back pain lower left side
  • Back pain lower right side
  • Back pain upper middle
  • Back pain in the middle of the back

But it can also radiate from a source (or root cause) of the pain. This radiating back pain (also called traveling pain) can move around, so you may be unsure what you’ve done to cause it.

It can even make its way down your legs and into your feet. In fact, a lot of people experience stress first in their lower back.

What happens is the pain causes the joints and the muscles to stiffen up. Then inflammation forms around it. And that constant inflammation irritates the body. This is actually what causes low back pain—most of the time. 

Ultimately, back pain is more mechanical that anything else. It starts with misalignments in joints and muscles. Fortunately, this is what chiropractors help with, and with excellent results. 

To get to the root cause of pain and discomfort, schedule an initial consultation, including a comprehensive evaluation and first treatment.

Back Pain Symptoms

What does back pain feel like? It may seem like a silly question since you may be experiencing it right now.

But back pain can feel like a lot of things:

  • Soreness
  • Sharp pain
  • Dull achy pain
  • Stiffness
  • Sharp shooting pain

Take our Back Pain Quiz to see which treatment works best for your kind of pain.

Back Pain Causes in San Francisco

What is back pain caused by here in San Francisco? Back pain has several causes that impact people across the nation and the world, but they tend to be interrelated. In San Francisco, a lot of us work desk jobs with long hours and often struggle to maintain a healthy work-life balance.

But more generally, it could be related to age, activity levels, weight, and other physiological conditions. You might be surprised to learn that psychological factors can also cause back pain. 

If you’re in your 20s or 30s, you’re more likely to have a disc issue while those 60s, 70s & older could be at a higher risk for things like degenerative disease or osteoporosis. Below, we’ve created an extensive list of common back pain causes.

Dysfunction/Misalignment in the Musculoskeletal System

Back pain is caused by dysfunction in the musculoskeletal system (muscles, tendons, ligaments, discs, and bones) and the nervous system (particularly the spinal cord and peripheral nervous system). Of these, the joints contribute the most because they direct how the other tissues move. 

Spinal Subluxation

A commonly overlooked back pain cause, a subluxation occurs when one or more of your vertebrae shift out of place. Physical trauma, chronic stress, and a prolonged poor diet can lead to this condition. Untreated, subluxations cause a domino effect on the body— back pain, bulging discs, herniated discs, and loss of mobility, just for starters. 

Bulging or Ruptured Disc

Your discs are gel-liquid-filled cushions found between the individual bones in your back. Their job is to prevent bone-on-bone contact and to avoid pinched or irritated spinal nerves/ This allows you to achieve a full range of motion without pain.

However, when a disc bulges, it can push against the nerve instead of protecting it, causing irritation. If that bulging goes untreated, the disc can burst, leaking that gel-like substance. We call this a ruptured or herniated disc. 

Your nerves do not like this gel. It’s very irritating.

Repetitive Stress

Poor posture, prolonged sitting, and unsafe lifting can weaken components and sections of your musculoskeletal system, causing uneven stress. In the end, you develop the dysfunction experienced as back pain.

Weight-Related Factors

We would do you a disservice if we ignored the fact that excess weight can cause back pain. Weight gain definitely plays a crucial role in back pain and how the back works in general. 

If you have more weight to lift, move, and carry, this can take a toll on the body in so many ways. That extra weight puts more stress on the structures of the spine such as the discs, the joints, and the nerves.

Inflammatory Diet

A study of over 3000 participants by the University of Pittsburgh found those eating inflammatory foods were 42% more likely to suffer from lower back pain.

Degenerative Disc Disease

Degenerative disc disease is a decaying spine. As the spine wastes away, it causes more pressure down on the discs, irritating the nerves. 

Arthritis or Osteoporosis

In the older community, degenerative conditions like these may cause back pain. The medical industry considers back pain an “age-related” wear-and-tear disease, and somewhat unavoidable. 

Even here, back pain treatments do exist. However, prevention and slowing the process are certainly better options, which we will discuss in depth.

To get to the root cause of pain and discomfort, schedule an initial consultation, including a comprehensive evaluation and first treatment.

Psychological Back Pain Causes

Poor stress response, depression, and anxiety can contribute to back pain and make it seem worse. Several studies have demonstrated that people with overwhelming mental stress conditions have more back pain and experience it more severely. In fact, mental stress at least plays a role in most low back pain cases.

This may be due to practical reasons. For example, feeling depressed may cause you to spend more time in bed, exercise less, or not eat a nutritious diet.

Any and all of these would lead to weakness and dysfunction in the musculoskeletal system over time. But researchers also believe people with certain mental health conditions feel pain more intensely, primarily because pain-relieving neurotransmitters like serotonin are less present.

Spinal Stenosis

A less common cause of back pain, spinal stenosis involves a narrowing of the spinal canal through which the spinal cord travels. If this condition is caused by dysfunction of large structures, such as muscles, tendons, and ligaments, a chiropractor can help.

Take our Pain Quiz to see whether chiropractic, acupuncture or both might help.


Humans are complex and all of our systems are connected.

For this reason, all—or several—of these back pain causes can be at play at the same time. Because of the interconnectedness of back pain causes, you need a holistic back pain treatment.

For back pain, exercises, nutrition, chiropractic, back pain stretches, and conventional medical care may be needed to address all the back pain causes and help you finally feel back pain relief.

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Back Pain Home Remedies

Back pain, especially very new back pain, can self-resolve with rest, stretching, and even some exercise. Yoga poses and back pain relief exercises specifically target soft tissues. They reduce inflammation, release tension, and help the body naturally re-align itself. As long as there is no traumatic injury, these are generally the first interventions people try. And they work!

But if your back pain lasts more than two weeks, we very highly recommended that you seek out professional care, especially if it’s interfering with your daily activities. It’s important to see your family doctor or chiropractor. 

Schedule an Initial Evaluation.

How to Prevent Back Pain from Coming Back

We’re of the mindset of “Prevention First”. If your back pain is currently occasional and generally mild, these preventive measures may stop it from progressing to a more severe condition.


A good exercise regimen prevents most back pain causes. But if you’ve already developed back pain, you need a personalized exercise regimen that specifically targets the tissues that experienced dysfunction, as well as, promotes whole body strength and function, since it’s all connected.

That may mean having your toolbox of exercises and stretches that you feel are having an impact, a positive impact on your back. 

Exercises may include a core strengthening regimen and stretch. These can tone, strengthen, and enhance function between musculoskeletal components. They can decompress the spine, allowing it to move more freely and naturally.

Two good ones are the Cat-Cow and Child’s Pose yoga stretch. So those would be important stretches to possibly include in a back pain scenario. 

With that said, you want to build whole-body strength as well. So weight training is an important aspect of preventing back pain. Putting weights on yourself tells your body to turn on muscles, which could help to keep your core nice and strong. 

Using a more structured approach with a trainer can also be very beneficial to keeping your back nice and strong. And of course, maintaining a healthy diet and a healthy weight enhances exercise’s ability to prevent the recurrence of back pain. 


Like any health issue, what you eat matters. Your body needs proper nutrition to function at its best. For back pain treatment and prevention specifically, eat more anti-inflammatory food like vegetables, nuts, beans, and seeds. And eliminate inflammatory foods, most importantly sugar and processed foods. 

Other Preventive Lifestyle Changes

Additionally, consider some other lifestyle changes to prevent back pain:

  • Move more
  • Avoid prolonged sitting
  • Quit smoking
  • Set up a good sleep regimen
  • Commit to good sleep ergonomics
  • Work on your sitting posture, especially at your workstation
  • Alternate between standing and sitting 
  • Limit couch time

Replacement is always a better strategy than focusing on what you’re trying not to do. So, as an example, instead of saying, “don’t spend too much time on the couch”, replace it with more active hobbies. Even daily walks can help.

And we encourage you to Take our Pain Quiz.

All of the above are important, but by far, bad posture tops the list of back pain causes, so we’ll dig into this topic more deeply to really get at the core of back pain treatment and prevention.

Good Posture for Prevention and Relief

So, there are 3 scenarios where you can make the biggest difference with good posture. Stand, sit and sleep ergonomics are very important. 

One of the most important elements of good posture is your pelvic position. Always keep the pelvis neutral, especially when sitting. Making sure you’re ergonomically set up at the workstation, makes this easier.

If you find yourself resting on one hip or sitting awkwardly at the tip of your seat, ask why?

A neutral pelvis is one in which the base of the spine and pubic bone is on the same plane. At the same time, the left and right hips are in the same plane. In other words, your body isn’t twisted. You’re not under more pressure on one side or other, front or back. The pressure is applied neutrally. When in this position, the spine curves slightly.

Good Sleeping Posture

Sleep posture is critical because you spend a significant amount of time in one or a few positions. 

What are the best sleep positions for back pain?

  1. Back
  2. Side

In that order. The worst position is on your stomach, which puts stress on the spine.

But even if you are a back or side sleeper, there are some right and wrong ways of back/side sleeping that can cause or worsen back pain. And note, even if you were able to sleep in a certain position when you were younger, that doesn’t mean that position will work for you now.

Back Sleeping

If you’re a back sleeper, it’s important to have a pillow underneath your knees. This is to help keep the pelvis nice and level. A low pillow or no pillow under your head is best.

Side Sleeping

If you’re a side sleeper, then place a pillow between the knees while keeping the knees on one plane, which can also keep the pelvis level.

If you sleep on your side with one knee raised, you likely wake up with back pain because your pelvis is not neutral. The spine is twisted. But the simple act of putting a pillow under your knee can return your pelvis to neutral. 

Side Sleep Posture
Side Sleep Posture

Good Posture When Sitting

Similarly, back pain when sitting occurs when the pelvis is not neutral. Your desk setup should encourage a neutral pelvis and good posture as a whole.

And simple things like adjusting your monitor height to eye level can do this. Keep your keyboard and mouse pretty close to you. This will help you maintain your hip-torso angle above 90 degrees more naturally. 

You also want to choose a seat that’s going to be very ergonomic for your body type. Sometimes, you might have to experiment a little bit to find the right one. 

And it goes without saying, if you’re sitting for 8 hours a day, that will be way too long for most people. Build in breaks to get up and move more.

Good Standing Posture

Another thing that could be pretty important is standing posture. Keeping your legs evenly apart so that way we’re not standing on undistributed weight as well as taking breaks, that’s important. But you shouldn’t remain in one standing position for too long. Dynamic standing and moving around keeps your body from resting into a bad standing posture.

Dynamic Posture

Ideally, you shouldn’t stay in one rigid position for extended periods whether sitting or standing. Set up your workspace so that it encourages you to move around to reach things.

Sit-stand routines are great. But you don’t want to sit for 4 hours and then stand for 4 hours. Ideally, you’ll alternate every 1-2 hours. 

If you have to sit to work, make sure that you’re getting up every 45 minutes to an hour, moving around, walking, taking stretch breaks or water breaks and then coming back into sitting again. 

Lifting Posture

Avoid heavy lifting if possible. Team lift or use lifting support devices when you must lift something heavy. If you want to prevent back pain, set your ego aside and prioritize your health.

If you must, it’s important to know what proper lift posture is. Everyone says, “lift with your knees”. But they rarely explain what this means. 

  1. Make sure you’re centered with the heavy object in front of you. Keep the heavy items close to your body to keep them close to the center of gravity. Never try to lift from the side.
  2. Bend your knees. Simultaneously, allow the hips to go back and the chest to come forward. 
  3. Test the object weight. If it’s extra heavy but doable, spread your legs slightly and to either side. This can reduce strain. 
  4. Grasp the object firmly. Unbend your legs, using them to lift the weight off the ground. As you do your torso will naturally move back and your hips forward until your back is in a vertical position and legs straight. 

But you’re using your back, aren’t you? Well, yes. The difference is that when lifting with your back you use your back as a lever. When you lift with your legs, your back still comes up, but it is supported by your much stronger leg muscles.

Prepare for Heavy Lifting

If you know that you’re going to have a day of heavy lifting, say to move to a new apartment, it’s important to have a good routine or a toolbox of stretches and exercises that you can do before and after that difficult task to reduce the risk of injury. Joints, muscles, everything works best when you warm it up first. The after exercises can cool inflammation and allow the back to recover.

Ergonomic Products to Prevent Back Pain

This is definitely important, especially because we are in San Francisco Silicon Valley. Most of us are sitting in front of our computers for long hours on end. It’s important to set yourself up so that way we’re not adding to the damage. 

A few products that are just essential:

  • Lumbar Support – Something behind your lower back to help keep that nice lumbar curve 
  • Seating Cushion – It can reduce pressure points so you’re less likely to move into a poor posture to compensate for pressure-sore points on the body.
  • Seating Disc – You can get them on Amazon. It almost looks like a half-a-ball you can sit on top of. It encourages you to engage your core more often. It’s like you’re sitting on one of those nice big fitness balls without it being too distracting for you or your co-workers.
  • Ergonomic keyboard and mouse – Properly positioning these can reduce strain on the upper back and wrists.
  • Foam roller – I have a nice 36-inch foam roller at home and at the workplace. When you take breaks you can use it on the floor or wall.

How to Diagnose Back Pain

Of course, the first part of diagnosis involves listening to what your problems are and testing how well you can perform daily tasks.  But sometimes imaging is called for. This can identify issues that are hard to spot and confirm our original diagnosis through objective means.

X-ray is going to be looking at the bone structure to look at the alignment and disc spacing. An MRI will look more at the soft tissue and the liquid. So that will be like the discs and the nerves. Each has its place in showing us what we’re looking for.

We’ll get an X-ray if we’re suspecting a bone or joint issue, an alignment issue. An MRI might be taken more if we’re maybe assuming there might be a disc or a nerve irritation going on. 

If your back pain is paired with nerve pain, then a nerve conduction velocity test or an NCV test might be done by your primary care doctor as well. Other things could be a CT scan and blood work if there are other suspecting causes for your back pain.

Best Treatments for Back Pain

Now, I always get the question of what are the best treatments for back pain and there are many different types of treatments out there. But there are some clear winners. 

Of course, we encourage you to Take our Back Pain Quiz to see which might be best for you.

Chiropractic Care 

Chiropractic Care seems to be at the very top of that. Most types of back pain respond well to chiropractic care over a long time window. Most back pain is due to misalignment of the bones and other connected structures—something chiropractic care can fix over a series of sessions.


Acupuncture helps by addressing muscles and nerves. In combination with chiropractic care, they address the whole musculoskeletal system.

Dry Needling

Dry needling is similar to acupuncture but works differently by targeting trigger points that work as reset buttons for your body.

Complementary Back Pain Treatment

It’s important to note that neither chiropractic nor acupuncture is a quick fix. They take longer than your traditional or conventional forms of care but offer a more long-term solution because you’re treating the cause.

For this reason, if back pain is severe and causing significant disability, some people choose to receive back pain injections or oral medication while working on the root cause. 

Combining holistic treatment with conventional back pain treatment can be very effective. This is called Complementary Medicine or Complementary Treatment.  If this is the route you want to go, you’d need to also talk to your primary care doctor.  


A (Transcutaneous Electrical Nerve Stimulation) or TENS unit is one holistic method that can provide some more immediate relief. Although IT IS temporary, so it’s important to also work on correcting what’s behind your back pain symptoms. 

Massage Therapy

Massage therapy is also very complementary to both Chiropractic and Acupuncture Care. It can loosen up physical tension and reduce the impact of psychological stress so that your body is in a better state to heal. 

Over-the-Counter Medicine

If you choose not to request pain injections or prescription medications from your primary care physician, you still have some options for instant relief. Temporarily, you can take OTC pain medications when you need them. 

But even OTC medications shouldn’t be taken long-term. That’s because they can cause hearing and liver damage among other concerns, so it’s important to keep your chiropractic appointments. That way, you’ll not need those medications long.

OTC back pain medications include Advil, Tylenol, Aleve, etc. These are also anti-inflammatory, which can support the healing process. You may choose to pair them with a prescription muscle relaxer. 

Steroid Injection

If your back pain is very severe, your doctor may even suggest getting a back pain injection, such as a steroid injection (corticosteroid injection). Back pain medication can be very effective at taking care of the immediate problem, so you can work on fixing it long-term. 

Injections can be very beneficial. In fact, they really give you pinpoint relief in the area where you’re feeling the most amount of pain.  However, again, long-term use can cause known medical side effects.

Other Back Pain Treatment Options

Sometimes it’s necessary to get surgery. 

We want to do everything possible to avoid that. And that’s why I do what we do as a holistic health clinic. I don’t want you to feel like you have to take your last resort and have surgery. Often back surgeries work by limiting how your back can move, which can cause a lot of discomforts, disability, and the need for lifelong pain medication, so this is not something you don’t want if you don’t have to. 

I work with patients who are trying to avoid surgery. Together, in most cases, we can keep you from getting to that point. 

Schedule an Initial Evaluation.

What to Expect at a Back Pain Appointment

Preparing for a back pain appointment

To prepare for a low back pain consultation at our clinic follow this back pain appointment checklist:

  • List out any medications you’re taking, including over-the-counter and herbal or homeopathic remedies.
  • Write down any solutions you’ve tried and how they worked. How often were you doing these things and for how long did you try this?  Did you experience some relief, temporary or partially? 
  • Do you have an idea what caused your back pain? Did it start suddenly or has this been gradual? 
  • How does it affect your daily life? Are you struggling at work or sleeping? Maybe you can’t pick your child or grandchild up anymore? Or you had to give up a hobby you love. If you’ve lost something due to back pain, one of my goals is to help you get back what you’ve lost.
  • Wear loose-fitting clothes. So avoid jeans or a thick sweater, because we want to make sure that we have access to different parts of your body, especially if it’s your back. We want to make sure we have access to your back. But, also, we want to make sure that you’re comfortable as we’re having you move around during your session. 

We’ll ask for some information ahead of time so the visit goes smoothly. Your appointment may last 30 minutes to an hour, depending on the severity of your back pain.

Possible Imaging

We may want to take imaging. So, we will refer you for maybe either an X-ray or an MRI, as discussed earlier, depending on what we may think your back pain is due to or what your cause might be. 

Now, if imaging is necessary, that doesn’t mean that we cannot start treatment right away. It just really is on a case-by-case basis. 

Consultation and Orthopedic Exam

So, at your appointment, we’ll do the consultation and an orthopedic examination. So, muscle testing. This involves pushing in the areas that you feel are painful, so we can get a better idea of the severity of your pain and where it is precisely.

Range of Motion and Ability

We’re going to have you moving around to test your range of motion. Can you bend forward? Can you extend backward? Are you able to pick an item off the ground? Are you able to get on our chiropractic table easily? 

Treatment Plan & Possible First Treatment

If we do feel like you’re a good candidate for our therapy, we’ll discuss a personalized treatment plan.

At our clinic, we have several tools and techniques that work well for different types of back pain. 

  • Chiropractic adjustments
  • Dry needling to soften up muscles and soft tissues
  • Acupuncture to reduce soft tissue dysfunction and restore balance in the musculoskeletal system
  • Nutritional intervention
  • Home exercise
  • Shockwave Therapy, to reduce inflammation
  • Laser Therapy, to reduce inflammation or quickly alleviate more severe pain
  • Massage therapy

If more cutting-edge technologies like laser and shockwave therapies are warranted for your back pain, we will definitely let you know on your first visit.

In most cases, we’ll be able to begin your first chiropractic treatment during your initial appointment. 

And by the end of your visit, you’ll have a pretty good idea of what it’s going to take to get your type of back pain better and what that looks like in terms of a care plan.

Getting Back Pain Relief

We look forward to seeing you at our San Francisco clinic soon. Look out for Truspine. Schedule your first consultation including your first treatment.


Top 5 Back Exercises

Home » back pain symptoms

According to the American Chiropractic Association, up to 80% of the population will experience low back pain at least once in their lifetimes. Therefore, finding specialized back exercises can diminish the suffered symptomatology. The following exercises are most recommended for people with debilitating back pain. However, for people with moderate or severe back pain, we recommend a San Francisco Chiropractor‘s assessment first.

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