All Back Pain Is Not Created the Same: Causes of Back Pain by Age

Back pain is a common affliction — about 80% of the U.S. population will experience it at some point in their life. That said, all back pain is not the same. When treating back pain, it is important to recognize that there are many different causes, and certain types of back pain tend to occur within certain age groups. Understanding which causes are most likely at a given age helps guide the right evaluation and treatment.

Under age 10

Back pain is very rare in patients younger than 10 years of age. When it does occur in this age group, it is usually caused by an infection, trauma, or some form of skeletal deformity such as scoliosis. Because back pain is uncommon at this age, it should always be taken seriously and evaluated.

Ages 10–20

Back pain in this age group is often due to physical activities such as sports. Patients in this age group are frequently playing baseball, football, gymnastics, and similar sports that place stress on the spine. Because the body is still developing, these patients are prone to:

• Stress fractures in the spine
• Muscle overuse
• Spinal deformity such as scoliosis

Tumors are a rare cause of back pain in this group.

Ages 20–40

Overuse is the main cause of back pain in this group. This is often the result of an occupation involving heavy work, such as heavy construction or manual labor. Tumors and deformity are less common causes of back pain at this age. Rare causes include:

• Spine infection that has spread from another part of the body
• Abdominal disorders such as kidney stones or other gastrointestinal conditions
• Pelvic disorders such as an ovarian cyst

Ages 40–60 and older

As we age, the incidence of back pain increases, and there are multiple possible causes in this age group — including overuse, degenerative changes, infection, GI disorders, pelvic pathology, vessel aneurysm, and tumors.

Degenerative conditions are by far the most common cause of back pain in this age group. Degenerative changes are caused by a combination of age and physical activity. As we age, the discs in the spine become stiffer and smaller (this is the reason we lose height as we age). As a result, arthritis develops and causes back pain. This type of pain is typically worse with activity and often worse in the morning when first getting out of bed.

These same age-related changes can also lead to compression on the spinal nerves, causing neurogenic, or nerve-related, back pain. This type of pain is different from arthritis pain: it tends to be worse with standing or walking but improves with sitting.

Other causes of back pain in this age group include:

• Tumors. A rare cause. Most originate elsewhere in the body — commonly the breast, prostate, lungs, and kidneys. Tumors that start in the spine itself are a less common cause.
• Compression fractures. A result of age-related bone weakening called osteoporosis.
• Intra-abdominal or intra-pelvic conditions. These are usually investigated when imaging studies of the spine fail to explain the patient’s back pain.

The takeaway

Because the causes of back pain vary so much by age, an accurate diagnosis is the first and most important step toward relief. A careful history, physical examination, and the right imaging study can identify whether back pain is coming from the discs, the joints, the nerves, or a source outside the spine altogether — and that determines the most effective treatment.