Backache is among the top five reasons for doctor's visits, along with colds, flu, hypertension, infections and regular checkups, said Dr. Michael Cannon, associate professor of family practice at St. Louis University Medical School.

For chiropractors, it's the No. 1 reason, said Dr. Ralph Barrale, dean of postgraduate studies at Logan College of Chiropractic.

Both say back pain is often taken lightly because it seems so common. But it's important to know the source of the pain, they say, because it can run from sore muscles to organ failure.

"There are so many reasons why people come in, there's no typical back-pain patient," Cannon said. "It can be frustrating for the patient. We don't have active treatments for the patients that can provide significant relief and cure immediately." Physicians see backache as any discomfort in the back, says Cannon, who practices in Des Peres, a suburb of St. Louis. Anyone can develop it and nearly everyone does in some form.

Most cases are caused by tender muscles, which can result from repetitive work, bad posture while sitting or standing, bad form while lifting and twisting, playing sports without warming up or playing harder than your physical condition can tolerate.

The next most common group of back ailments includes malformed discs and arthritis. As the body ages, discs — the shock absorbers between the vertebrae — wear out. The discs flatten, expand, rupture and slide out of place. When that happens, they can put pressure on the nerves in the spinal column. The resulting pain can range from a nuisance to disabling.

The vertebrae age, too. Sometimes that includes bone deposits that narrow the spinal column, causing pain that can lead to incapacitation.

Less frequently, the problem is not actually in the back. The cause may lie in something connected to the back, such as the hips and ribs, or it can be the failure or infection of organs just behind the lower back.

Know what to do

Cannon suggests giving the pain a few days to go away, then seeing a family physician if it hasn't gotten better in a week. The doctor will determine whether the problem is mechanical, meaning that the pain is somewhere in the parts that make up the back: the muscles, the spine or body parts attached to them. If so, the next option can be painkillers, physical therapy, a chiropractor or patience.

Most back pain will go away, even though it often returns. "The only remedy that's been shown to work best is time," said Cannon. "Most of the time, when people have a back problem, if it's related to muscles or joints or bones, it'll be worse to move the back. If someone has other problems, the back movement won't cause the same sort of pain."

Another ailment, such as infection or organ failure, will hurt whether you're moving or not. In that case, see a specialist.

"Essentially, serious conditions can mimic mechanical problems," said Barrale of Logan College. "If we think the pain is not mechanical in nature, we'd refer that patient to the appropriate doctor, a family practitioner or a specialist."

Doctors also can check for indications of pinched or squeezed nerves. Sometimes the doctor will order tests, including X-rays or an MRI, to get a look inside and determine the best treatment.

Surgery tends to be a last resort and is warranted when the pain is incapacitating, Cannon said.

The chiropractor

Barrale said a chiropractor can help when the problems are from body mechanics — spinal problems resulting from the stresses of daily living, posture problems, occupational problems or injuries from stressing a body part.

Chiropractors manipulate the spine and might administer acupuncture and massage, Barrale said. "We look at shortening of the muscles, overuse of the muscles, poor posture, repetitive activities," he said. "For example, a house painter who does the same activity with a brush all day using one side of the body, but not the other side, or problems from weekend sports, where you play without warming up or the sport requires a lot of twisting.

"Most often, back pain generally is the result of poor posture and poor body mechanics. ... Patients I've had tend to do a repetitive action 750 times a night with one arm, and they slowly stress the mechanics of the lower-back joint."

Barrale agreed with Cannon that backache can be relieved but never really cured: "If you do certain exercises, you have less chance of serious injury, but I don't think you ever really prevent it."

Fast facts on healthy backs

Q. Who gets back pain?

A. More than 80 percent of people report back pain; physicians and chiropractors believe many who don't report pain just live with it.

Q. What's the cause?

A. Back pain can come from your occupation, your weight, your hobby, your family tree or any combination of these factors:

• Work that requires lifting and twisting.
• Work that requires sitting for long periods without stretching.
• Inactivity and obesity, which often go hand in hand. Even athletic people can be inactive at work, sitting hours at a time in terrible positions. Couple that with obesity and the back is in trouble.

Q. Why the back?

Ann Hayes, associate professor of physical therapy with St. Louis University, said that over the years, the discs get old and harden, then break, rupture, expand and put pressure on nerves in the spinal column.

The pain also can stem from cracked vertebrae and other degenerative problems that could come from lack of calcium or years of misuse. In addition, muscles can get injured or overstressed.

Chiropractor Ralph Barrale said the knot in a muscle, or a muscle spasm, is the body's way of locking a muscle in place so it and the joint can't be used while the system heals.

Sometimes the pain comes from more serious causes: infections of organs, organ failure or cancer near or in the back. That's why physicians want a diagnosis.

Q. What's the treatment?

A. Treatment ranges from advice on exercise and lifestyle to ice and heat, spinal manipulation by a chiropractor, exercises by a physical therapist, over-the-counter painkillers, prescription painkillers and shots. The extreme remedy, surgery, is for incapacitating pain. Backache clinics often have success with patients because the clinics deal with backaches exclusively.

Q. What can you do to prevent back pain?

A. Back pain can be delayed, but people who pay the most attention to their posture, exercise and weight still can have recurring back pain.