If you’re living with persistent back pain, you might assume that something is wrong with your spine. But according to Jason Smith, MD, a physiatrist at Atlantic Health, the spine isn’t always to blame. He breaks down some common causes of back pain that really stem from health issues that refer—or radiate—pain to the back.
“Back pain is complex. It’s important to understand that there’s always the possibility of referred or radiating pain,” says Dr. Smith. “When we find the real source of back pain, we open the door to a better diagnosis, more effective treatments, and faster recovery.”
What is referred pain?
Referred or radiating pain occurs when the brain misinterprets where pain signals are coming from. It’s the reason people feel left arm pain during a heart attack or jaw pain with certain dental problems. In the case of back pain, discomfort can stem from joints, soft tissue, or internal organs—but feel like it’s coming from the spine.
Sources of back pain that aren’t due to the spine
- Musculoskeletal and joint issues
Knees, hips, and the SI (sacroiliac) joint, which connects the spine to the pelvis, can all place extra stress on the lower back and shift your gait and posture. This can lead to muscle imbalances—even small ones—that quietly build over time and lead to chronic tightness and discomfort in your back. - Neurologic and muscular conditions
Inflammation around nerves and improper walking patterns can cause pain that radiates along the sciatic nerve, which runs from the lower back through the legs. Back pain is associated with neurological conditions such as stroke, Parkinson’s disease, or multiple sclerosis, which all throw off gait and body alignment. - Abdominal, pelvic, and organ-related problems
Men and women with pelvic floor conditions, gastrointestinal issues, or bladder dysfunction can all experience referred back pain. “Cancer can even present as back pain,” says Dr. Smith. “Ovarian cysts, uterine fibroids, pelvic floor dysfunction, or an enlarged bladder can trigger back discomfort that has nothing to do with your spine.”
Why an accurate diagnosis matters
According to Dr. Smith, people can sometimes misidentify where their back pain is coming from, and that’s why physical exams are so critical. Think of it this way: treating spinal pain when the spine isn’t the problem is like fixing the roof when the leak is coming from a broken pipe.
“Misdiagnosis can lead to ineffective or unnecessary treatments,” says Dr. Smith. “That’s why a hands-on evaluation is so important. Watching a patient walk, examining their posture, and feeling for specific pain triggers help us tease out the problem within a few minutes.”
Don't suffer in silence
If you're dealing with chronic back pain, talk with a doctor who can evaluate your whole body—and not just your spine.
“A physical exam can save months—even years—of misdiagnoses, unnecessary imaging, or ineffective treatments,” says Dr. Smith. “If your back hurts, schedule a visit. 15 minutes may provide you years’ worth of answers and relief."
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