Lower Back Pain: Causes, Diagnoses, and Effective Treatments

Lower back pain is one of the most common reasons people seek medical care. It often stems from issues with the musculoskeletal system, particularly the spine, including the vertebrae, discs, muscles, and ligaments. In some cases, lower back pain may arise from conditions unrelated to the spine.

As people age, lower back pain becomes more prevalent, affecting over half of adults aged 65 and older. It also carries significant economic costs due to medical expenses, disability claims, and lost productivity at work.

Anatomy of the Spine

The spinal column consists of stacked bones called vertebrae, cushioned by shock-absorbing discs. These discs have a tough outer layer and a soft, gel-like center. Behind each disc are facet joints, which connect the vertebrae and allow movement. Ligaments and muscles stabilize the spine, including:

• The iliopsoas muscles along the spine’s sides
• The erector spinae muscles running behind the spine
• Small paraspinal muscles between the vertebrae

The abdominal and gluteal muscles also support the spine, collectively forming the core muscles. The spinal cord runs through the spine, with nerve roots branching out between vertebrae. If these nerves become compressed, often due to injury, it can lead to pain.

The lumbar spine (lower back) connects to the upper spine and pelvis, providing flexibility for bending, twisting, and lifting while supporting posture and movement. Because of its role in daily activities, lower back pain can significantly impact quality of life.

Types of Lower Back Pain

Lower back pain can manifest in different ways, including:

Localized Pain

This is the most common type, felt in a specific area of the lower back. Causes include muscle strains, disc injuries, or arthritis. The pain may be constant or intermittent, sharp or dull, and worsen with certain movements. Muscle spasms and tenderness when touched are also common.

Radiating Pain (Sciatica)

This pain travels from the lower back down the leg, often due to nerve compression from conditions like a herniated disc or spinal stenosis. It may feel like a sharp, shooting pain or a dull ache, sometimes reaching the foot. Activities like coughing, sneezing, or bending can trigger it. Severe cases may cause muscle weakness, numbness, or even loss of bladder/bowel control.

Referred Pain

This type of pain originates elsewhere (e.g., organs) but is felt in the lower back. Unlike musculoskeletal pain, it doesn’t worsen with movement and is often harder to pinpoint.

Causes of Lower Back Pain

Lower back pain can stem from various causes, including issues with the spine, muscles, ligaments, joints, and even nerve roots surrounding the spine. In many cases, the exact cause of lower back pain cannot be pinpointed, but it is often linked to certain risk factors and conditions that affect the musculoskeletal system. Understanding these causes can help you seek the appropriate treatment and relief for this condition.

Common Causes of Lower Back Pain

Lower back pain can result from several factors. The following are some of the most common causes:

• Muscle and Ligament Injuries: Sudden movements, improper lifting techniques, or accidents such as a fall or car crash can cause muscle strains or ligament sprains in the lower back. These injuries often occur during everyday activities or physical exertion and may lead to muscle spasms.
• Osteoarthritis: Also known as degenerative arthritis, osteoarthritis affects the cartilage between the facet joints. Over time, the cartilage wears down, and bone spurs form, narrowing the space between the vertebrae. This degeneration can cause inflammation, stiffness, and pain in the lower back.
• Vertebral Compression Fractures: Osteoporosis, which weakens bones, can make the vertebrae susceptible to fractures. While most fractures caused by osteoporosis occur in the upper and middle back, they can also lead to severe lower back pain if the fracture affects the lower vertebrae.
• Herniated Disc: Discs in the spine act as cushions between the vertebrae. A herniated or ruptured disc occurs when the outer layer of the disc tears, causing the inner jelly-like substance to protrude. This bulging material can press against nearby nerves, leading to pain, numbness, or tingling in the lower back or legs (often referred to as sciatica).
• Lumbar Spinal Stenosis: This condition involves the narrowing of the spinal canal, which puts pressure on the spinal cord and nerves. It is common in older adults and may be caused by arthritis or other degenerative conditions. Symptoms include lower back pain and leg weakness, especially when walking or standing.
• Spondylolisthesis: This occurs when one vertebra slips forward over the one below it, often due to a fracture or degeneration of the spine. It can cause lower back pain, particularly in athletes or older adults.
• Fibromyalgia: Fibromyalgia is a chronic condition that causes widespread pain, including in the lower back. It is often accompanied by fatigue, sleep disturbances, and muscle stiffness.

Less Common Causes of Lower Back Pain

In some cases, lower back pain may be due to conditions that affect other organs or systems in the body. Some less common causes include:

• Spinal Infections: Infections such as osteomyelitis or discitis can cause inflammation and pain in the spine, often leading to severe lower back pain.
• Spinal Tumors: Though rare, tumors in the spine can cause lower back pain by pressing against the spinal cord or nerves. These tumors may be benign or malignant and require immediate medical attention.
• Abdominal Aortic Aneurysm: A bulge in the abdominal aorta, known as an aneurysm, can cause pain that radiates to the lower back. This is a serious condition that requires prompt medical intervention.
• Kidney Disorders: Conditions like kidney stones, kidney infections, and other urinary tract disorders can sometimes cause pain in the lower back. In such cases, the pain may be accompanied by other symptoms such as fever or difficulty urinating.
• Pelvic Disorders: Issues such as ectopic pregnancy, pelvic inflammatory disease, or ovarian cancer can sometimes cause lower back pain as well as other pelvic symptoms.
• Shingles: A reactivation of the chickenpox virus, shingles can cause a painful rash on the skin and sharp pain in the lower back before the rash appears.
• Inflammatory Arthritis: Conditions like ankylosing spondylitis and other types of inflammatory arthritis can cause chronic lower back pain, especially in younger individuals.
• Digestive Disorders: Problems like diverticulitis or other digestive tract conditions can also lead to lower back pain, often accompanied by abdominal pain or bloating.

How Lower Back Pain Can Be Affected by Other Conditions

Sometimes, lower back pain is linked to conditions in other areas of the body. These include:

• Lower Back Pain and Abdominal Pain: Conditions like gas pain in the lower back or issues with the digestive system can cause pain that feels like it is originating from the lower back but may actually be related to stomach or intestinal problems.
• Lower Back Pain During Pregnancy: Hormonal changes and weight gain during pregnancy can put additional stress on the spine, leading to lower back pain, especially during the second and third trimesters.
• Lower Back Pain and Testicle Pain: In some cases, problems with the lower back, such as a herniated disc, can lead to referred pain that is felt in the testicles.
• Lower Back Pain When Bending Over: Pain while bending over is a common symptom of conditions like a herniated disc, muscle strain, or lumbar spinal stenosis.
• Lower Back Pain When Walking or Standing: Conditions like lumbar stenosis or spondylolisthesis may cause pain that worsens when walking or standing for extended periods of time.
• Lower Back Pain After Coughing: This type of pain can be linked to conditions like herniated discs or muscle strain, which may worsen with sudden pressure from coughing.

Diagnosing Lower Back Pain

When evaluating lower back pain, doctors first aim to rule out serious conditions. Since multiple factors often contribute to discomfort, pinpointing a single cause isn’t always possible. Many cases are diagnosed as general musculoskeletal strain with attention to severity and potential complications.

Serious Conditions Requiring Immediate Attention

Certain symptoms accompanying lower back pain may indicate serious underlying issues. Seek emergency care if you experience:

• Neurological symptoms: Numbness, leg weakness, or loss of bladder/bowel control (signs of nerve compression)
• Systemic symptoms: Fever, unexplained weight loss, or severe nighttime pain
• Abdominal concerns: Pulsing abdominal mass, severe stomach pain, or bloody stools
• Urinary issues: Blood in urine, inability to urinate, or intense flank pain radiating to groin
• Cancer risk factors: History of cancer or immunosuppression

For persistent lower back pain lasting over 6 weeks without these warning signs, schedule a non-urgent doctor’s visit.

Preventing Lower Back Pain

Proactive measures can significantly reduce your risk of developing chronic lower back pain. These evidence-based approaches focus on strengthening, posture, and daily habits.

Exercise: Your First Line of Defense

Regular physical activity is the most effective prevention method. A balanced routine should include:

Aerobic Activities

• Walking (30 minutes daily improves circulation to spinal structures)
• Swimming (reduces impact stress while building endurance)

Targeted Core Strengthening

• Pelvic tilts (stabilizes lumbar spine)
• Modified abdominal curls (builds support without straining)

Gentle Stretching

• Knee-to-chest stretch (relieves pressure on lumbar discs)
• Cat-Cow stretches (improves spinal mobility)

Important: Stop any exercise that increases lower back pain. Consult your doctor before starting new routines, especially if you have existing back issues.

Posture Optimization

Proper alignment reduces spinal stress during daily activities:

Sitting Posture

• Keep feet flat with knees slightly higher than hips
• Use lumbar support (a small pillow works well)
• Avoid crossing legs to maintain pelvic alignment

Standing Posture

• Distribute weight evenly on both feet
• Engage core muscles gently when standing for long periods
• Consider using a footrest to alternate weight distribution

Safe Lifting Techniques

Prevent acute injuries with proper mechanics:

1. Stand close to the object with feet shoulder-width apart
2. Bend at hips and knees (not waist)
3. Keep the load close to your body as you lift
4. Avoid twisting – pivot with your feet instead
5. For heavy items, ask for assistance or use equipment

Lifestyle Factors

• Weight management: Excess weight strains lumbar structures
• Bone health: Calcium/vitamin D and weight-bearing exercise prevent osteoporosis
• Activity breaks: Change positions every 30 minutes when sitting/standing

Implementing these strategies can help maintain a healthy back and prevent many cases of lower back pain before they start.

Treatments for Lower Back Pain

When lower back pain strikes, the right treatment approach depends on whether a specific cause is identified. While infections or systemic conditions require targeted therapies, most musculoskeletal cases benefit from general pain management strategies. Here’s what works for lower back pain relief.

First-Line Treatment Approaches

Activity Modification

• Avoid heavy lifting and bending during acute pain phases
• Continue light activity – bed rest beyond 1-2 days worsens stiffness
• Skip unproven methods like spinal corsets or traction

Medication Options

For mild to moderate pain:

• Acetaminophen (first choice for non-inflammatory pain)
• NSAIDs like ibuprofen (when inflammation is suspected)

For severe cases (short-term only):

• Opioids under strict medical supervision
• Muscle relaxants (limited to 72 hours for visible spasms)

Non-Medication Therapies

Heat and Cold Therapy

• First 48 hours: Ice packs (20 minutes on/off) reduce inflammation
• After 48 hours: Heating pads promote blood flow (use cautiously to avoid burns)

Movement and Exercise

Once acute pain subsides:

• Begin lower back pain stretches gradually
• Start physical therapy exercises for lower back pain
• Focus on core strengthening to prevent recurrence

Complementary Approaches

• Massage for temporary relief
• Chiropractic adjustment (avoid with herniated discs or arthritis)
• Acupuncture (evidence is mixed but low-risk)

Sleep Positions for Lower Back Pain

The best sleep position for lower back pain depends on your natural posture:

Back Sleepers

• Place pillow under knees to reduce spinal pressure

Side Sleepers

• Use pillow between knees to align hips
• Keep head pillow at neutral height

Stomach Sleepers

• Only continue if pain-free in this position
• Consider placing thin pillow under hips

A medium-firm mattress typically provides optimal support for lower back pain when standing up the next morning.

Recovery Timeline

• Most acute cases improve within 2 weeks
• 80-90% resolve fully by 6 weeks
• Chronic cases may require ongoing core strengthening

Managing Chronic Lower Back Pain

When lower back pain persists beyond three months, it’s considered chronic and often requires a multifaceted approach. Unlike acute pain, chronic cases demand strategies that address both physical symptoms and long-term functionality.

Lifestyle Modifications for Lasting Relief

1. Targeted Exercise Programs

• Low-impact aerobic activities: Swimming or water therapy reduces joint stress while improving circulation
• Core stabilization routines: Focus on deep abdominal and back muscles to support the spine
• Gradual progression: Start with lower back pain exercises for just 10-15 minutes daily

2. Weight Management

Every extra pound increases load on lumbar discs by four times. Combined diet and exercise plans show best results for:

• Reducing mechanical stress on the spine
• Decreasing inflammatory markers
• Improving mobility

Medical Interventions for Persistent Pain

Epidural Steroid Injections

• Combines corticosteroids with local anesthetic
• Most effective for sciatica from herniated discs
• Provides 4-6 weeks of relief – ideal window to start physical therapy
• Limited to 3-4 injections annually due to side effect risks

Surgical Options

Discectomy for Herniated Discs

Recommended when:

• Severe radiating lower back hip pain persists after 6+ weeks
• Neurological deficits appear (leg weakness, loss of bowel/bladder control)

Procedure removes only the protruding disc portion, preserving spinal mobility.

Laminectomy for Spinal Stenosis

• Removes part of vertebrae to relieve nerve compression
• 70% success rate for pain reduction
• 3-4 month recovery period

Spinal Fusion

Used for:

• Severe spondylolisthesis
• Post-laminectomy instability
• Certain fracture cases

Trade-off: Reduced flexibility may transfer stress to adjacent vertebrae.

Treating Vertebral Compression Fractures

Non-Surgical Approaches

• Bracing for 8-12 weeks
• Calcitonin nasal spray for pain control
• Osteoporosis medications to prevent future fractures

Surgical Options

• Vertebroplasty: Bone cement injection
• Kyphoplasty: Balloon-assisted cement placement

Creating Your Chronic Pain Management Plan

Effective long-term strategies often combine:

1. Physical therapy tailored to your specific condition
2. Pain management that minimizes medication dependence
3. Lifestyle adjustments to reduce flare-ups
4. Psychological support for pain coping skills

Remember: Chronic lower back pain relief is typically a journey rather than a single solution. Working with a pain management specialist can help create the right combination of therapies for your unique situation.

Final Thoughts

Lower back pain doesn’t have to control your life. While acute episodes often resolve with time and proper care, chronic discomfort requires a proactive approach combining movement, mindfulness and professional guidance. Remember that most cases improve with conservative treatment – surgery is rarely needed. By staying active, maintaining healthy habits, and listening to your body’s signals, you can both recover from current pain and reduce future flare-ups. If symptoms persist or worsen despite self-care, don’t hesitate to consult a healthcare provider. Your back carries you through life – with the right knowledge and care, you can return the favor.

Author

Dr. Adeela Mohyuddin

Consultant Radiologist, MCPS, FRCR, MMED

Dr. Adeela Mohyuddin is a highly skilled radiologist with extensive expertise in breast and musculoskeletal radiology. She is adept in advanced imaging techniques, including MRI, CT scans, breast imaging, X-rays, fluoroscopy, and ultrasounds. A Fellow of the Royal College of Radiologists (UK), she currently serves in the UK's National Health Service (NHS), providing exceptional diagnostic services.