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How Do I Know if My Back Pain Is Spinal or Muscular?

A patient experiencing lower back pain.
A photo of Dr Colum Nolan, Senior Consultant Neurosurgeon of Oxford Spine & Neurosurgery Centre

Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Back pain can easily disrupt your routine, affecting every part of your day from work to sleep. For many people, it is difficult to narrow down the cause. Muscular injuries and spinal conditions often feel similar in the early stages, and the differences are not always obvious.

To aid you in taking practical steps to protect your back and reduce discomfort, it is important to understand the difference between spinal back pain and muscular back pain. A specialist assessment can provide a clear diagnosis that supports your recovery and empowers you to move forward with confidence.

What Does Each Type of Back Pain Feel Like?

Back pain varies in intensity, duration and underlying causes. It may come on suddenly after strain or develop gradually over time, manifesting as either acute or chronic pain.
Although muscular and spinal pain can overlap in the early stages, they often present distinct patterns that are recognisable over time. Paying attention to how the pain feels, when it occurs and aggravating factors can provide helpful clues to its origin. 

Muscular Pain

Muscular back pain often feels like a dull ache or tightness in a specific area of the back. It may worsen with movement, heavy lifting or prolonged sitting. The discomfort is usually localised and can feel tender to the touch. Muscle spasms or stiffness are common, especially after sudden strain or overuse. In many cases, the pain improves with rest, gentle stretching and simple pain relief measures. Massaging the area may also aid in reducing tightness and easing symptoms.

Spinal Pain

Spinal pain is more likely to feel deep, sharp or persistent. It may radiate into the buttocks or legs if nerves are involved. Some patients describe tingling, numbness or weakness alongside the pain. Unlike muscular strain, spinal pain does not always improve with rest and may worsen with specific movements such as bending forward or standing for extended periods. Attempting to massage the area may not provide any relief, as the pain is often structural and deep within a section of bone or cartilage.

What Causes Muscular Back Pain?

Muscular back pain is usually related to strain, overuse or minor soft tissue injury. It commonly affects the muscles and ligaments that support the spine. Potential causes include:

  • Having a poor sitting posture for prolonged periods
  • Heavy lifting or improper lifting technique
  • Making a sudden twisting movement
  • Exerting force during sports
  • Prolonged sitting without lumbar (lower back) support
  • Muscle imbalance or weak core muscles

What Causes Spinal Back Pain?

Spinal back pain is often linked to a degeneration of the spine. It may arise from structural issues within the vertebrae, discs, joints or nerves. These conditions may involve degeneration, compression or inflammation affecting the spine itself.
Potential causes include: Apart from these common conditions, it is possible for spinal pain to be caused by a fracture, infection or tumour.

How Does a Spine Specialist Diagnose Your Type of Back Pain?

In order to determine the type of back pain you are experiencing, a spine specialist will typically carry out a structured examination. They will usually begin this test with a detailed assessment of your medical history. You may be asked when the pain started, what activities worsen or relieve it, whether it radiates to other areas and if there are associated symptoms such as numbness or weakness.
They may then conduct a physical examination that involves:
  • Assessing your posture and spinal alignment
  • Checking your range of motion
  • Testing your muscle strength and reflexes
  • Evaluating areas where you experience tenderness
  • Performing specific nerve tension tests
If your specialist suspects that your pain is being caused by a spinal issue, they may recommend further imaging studies. These can include:
  • X-rays to assess bone alignment and degeneration
  • MRI scans to evaluate discs, nerves and soft tissues
  • CT scans
  • Nerve conduction studies
By combining clinical findings with imaging results, a spine specialist may be able to distinguish between muscular strain and possible spinal degeneration. This helps them create a treatment plan that is targeted, appropriate and aligned with the underlying cause of your pain.

How is Spinal and Back Pain typically treated?

When pain originates from the spine itself, treatment is tailored to the specific condition.

Conservative Management

When back pain is not severe enough to warrant surgical treatment, a specialist may recommend conservative management, such as lowering your levels of physical activity or giving your back the opportunity to relax. 
This approach focuses on reducing inflammation, relieving nerve irritation and improving spinal support while allowing the body to recover naturally. Potential treatments include:
  • Physiotherapy focused on spinal stability 
  • Modifying your activity
  • Prescription medication for nerve-related pain
  • Epidural steroid injections to combat inflammation
  • Nerve blocks in selected cases

Surgical Treatment for Spinal Conditions

Surgery is typically recommended when there is significant nerve compression, progressive neurological symptoms or structural instability that cannot be effectively managed with non-surgical measures. The type of surgery depends on the underlying condition, severity of symptoms and overall spinal alignment.

Minimally Invasive Surgery & Motion Preservation

For selected patients, minimally invasive techniques may be used to reduce tissue disruption, shorten recovery time and preserve spinal movement where possible. Procedures may include:

Conventional Surgery

In more complex or advanced cases, conventional open surgery may be required to stabilise or decompress the spine adequately. Procedures may include:
A doctor examining a patient’s back to diagnose spinal or muscular pain.

Getting an Accurate Diagnosis from a Spine Doctor

Distinguishing between muscular and spinal back pain is not always easy, especially when symptoms overlap in the early stages. In order to put the clues together and receive an accurate diagnosis, it can be helpful to seek out a clinical evaluation by a spine specialist. Understanding the true cause of your recurring pain can allow you to take the appropriate steps to recovery.

At Oxford Spine & Neurosurgery Centre, patients receive a thorough assessment that uses evidence-based recommendations to address their unique conditions. Dr Colum Nolan, our senior consultant spine and neurosurgeon, focuses on identifying the root cause of back pain before recommending treatment. This aims to ensure that care is aligned with both the severity of the condition and the long-term health of your spine.

If you are experiencing persistent back pain, radiating symptoms or discomfort that is affecting your quality of life, book an appointment with our team today to receive a comprehensive evaluation and a personalised plan for recovery.

Our Spine Specialist in Singapore

Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Dr Colum Nolan is a senior consultant spine and neurosurgeon, as well as the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.

Dr Colum held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.

With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.

Read More About Dr Colum
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