Back Pain

At Nexus Pain Management we are experts in diagnosing and treating all facets of pain from the top of your head to the tips of your toes. We offer treatment solutions for any cause of pain from mechanical issues (such as joint, tendon, ligament damage, hypermobility), neuropathic pains (pain resulting from nerve damage or over-activation), pre- and post-surgical pain, acute to chronic pains and anything in between.

Back pain is a common issue affecting millions worldwide, and its causes can vary depending on the affected region of the spine. Whether it originates in the lumbar spine (lower back), sacroiliac joint (pelvis), or thoracic spine (mid-back), identifying the root cause is essential for effective treatment.

1. Lumbar Spine (Lower Back) Pain

The lumbar spine is a frequent source of back pain due to its role in supporting body weight and facilitating movement. Common causes include:

Structural Causes

• Herniated Disc – A bulging or ruptured disc pressing on nerves, causing pain, tingling, or weakness.

• Degenerative Disc Disease – Wear and tear of spinal discs leading to pain and stiffness.

• Facet Joint disease e.g. arthritis – Joint disease affecting the joints in the lower back, leading to stiffness and discomfort.

• Spinal canal Stenosis – Narrowing of the spinal canal that puts pressure on nerves.

• Spondylolisthesis – A vertebra slipping forward over another, leading to instability and nerve compression.

Muscular & Soft Tissue Causes

• Muscle Spasm and Strains – Overuse or sudden movement causing muscle tears and spasms.

• Ligament damage – Overstretched or torn ligaments due to sudden movements or improper lifting. Leads to chronic instability and pain in the spinal unit.

• Myofascial Pain Syndrome – Trigger points in the lower back muscles causing chronic pain.

Nerve-Related Causes

• Sciatica – Compression of the sciatic nerve leading to radiating pain down the leg.

• Piriformis Syndrome – Irritation of the sciatic nerve due to muscle tightness or spasm.

Other Conditions

• Ankylosing Spondylitis – Inflammatory arthritis causing stiffness and fusion of the spine.

• Osteoporosis-Related Fractures – Weak bones leading to compression fractures.

Superior cluneal nerve irritation/entrapment- An extremely common cause and consequence of lower back pain. The superior cluneal nerves supply the upper 2/3 of the buttock region and pass through the lower back (erector spinae) muscles. These commonly become irritated with back muscle spasm. However, their irritation and pain causes more muscle spasm, which irritates the nerves further, and the cycle continues.

Sacroiliac Joint (SIJ) Pain

The sacroiliac joint (and its associated ligamentous structures) is a hugely unappreciated cause of lower back pain.

The sacroiliac joint is the intersection point between everything above the waist pushing down through the spine with gravity, and everything below the waist being pushed up from the ground. It also interconnects the spine to the hips and pelvis and can be a source of significant pain when dysfunctional. Understanding the interconnections of these areas is crucial to properly understanding and treating lower back and SIJ pain.

SIJ pain can also very commonly refer down into the legs mimicking (and often incorrectly labelled as) lumbar spine radicular pains.

Causes include:

Mechanical & Structural Causes

• Sacroiliac Joint Dysfunction – Abnormal movement and instability in the SI joint causing localized pain.

• Pelvic Imbalance – Misalignment or leg-length discrepancies placing stress on the joint.

• Pelvic floor dysfunction – The SIJ can both cause pelvic floor dysfunction as the pelvic floor muscles try to compensate for SIJ instability. Or chronic pelvic floor dysfunction eventually places excessive stress on the SIJ causing instability and pain.

• Pregnancy & Hormonal Changes – Ligament relaxation leads to increased joint mobility and pain. SIJ pain is more common in (but not exclusive to) women that have had pregnancies

Inflammatory & Degenerative Causes

• Sacroiliitis – Inflammation of the SI joint due to arthritis, infection, or trauma.

• Ankylosing Spondylitis – A progressive inflammatory condition affecting the SI joint and spine.

Trauma & Overuse Causes

• Falls or Direct Impact – Trauma to the pelvis causing SI joint irritation. Commonly even big falls onto the buttocks even as a child can set up a chronic instability that may only present itself years later.

• Repetitive Stress – Overuse from sports, prolonged sitting, or improper movement patterns.

Thoracic Spine (Mid-Back) Pain

Although less common than lumbar pain, thoracic spine pain is still very common. It can be caused by:

Musculoskeletal Causes

• Poor Posture – Slouching, prolonged sitting, or excessive screen time leading to strain.

• Muscle Imbalances – Weak core or back muscles leading to improper spinal support.

• Rib Dysfunction – Misalignment or irritation of ribs attaching to the thoracic spine as well as associated diaphragmatic dysfunction.

Spinal & Disc-Related Causes

• Thoracic Herniated Disc – Less common but can cause nerve compression and pain.

• Kyphosis (Hunchback Deformity) – Excessive curvature leading to discomfort and stiffness.

• Thoracic Spondylosis – Degenerative changes causing stiffness and localized pain.

• Facet joint degeneration/irritation

Neuropathic causes

• Thoracic radiculopathy - Thoracic nerve roots can commonly be compressed or irritated commonly causing pains that refer around to the side or front of the chest

Inflammatory & Systemic Causes

• Osteoporosis & Compression Fractures – Weakened bones increasing fracture risk.

• Scheuermann’s Disease – A developmental disorder causing excessive spinal curvature.

• Referred Pain from Internal Organs – Conditions like heart disease or digestive issues mimicking thoracic spine pain.