Lower Back Pain

What is lower back pain?

Lower back pain often affects the lumbar area of the back or spine. This can occur due to various injuries or disorders, though it most commonly results from back muscle or tendon strains.

Almost everybody experiences lower back pain during their lifetime, and it can be either mild or severe. While most cases are temporary, chronic or long-term lower back pain affects up to 23% of adults worldwide. In severe cases, it can cause difficulties or make it impossible to work, sleep, walk, or perform daily activities.

Since it is so prevalent, knowing when to be concerned about lower back pain can be challenging. Always trust your instincts and consult a healthcare provider if your pain feels unusual or prevents you from carrying out your regular activities.

Symptoms

What are the common symptoms of lower back pain?

Lower back pain can be associated with a wide range of symptoms. It might:

• Appear suddenly or develop gradually.
• Occur following a particular event, such as bending to pick something up. When this happens, it may be accompanied by a 'pop' sound.
• Happen without a known cause or trigger.
• Come with sharp pain or feel dull and achy.
• Appear and disappear or remain constant.
• Radiate into the buttocks or down towards the leg (a condition called sciatica).
• Worsen in specific positions, such as bending or crouching, and improve when you lie down.

Additional lower back pain symptoms may include:

• Stiffness: Moving or straightening the back may become difficult. It may take some time to stand up from a sitting position, and you may feel the urge to stretch or walk in order to loosen up. A reduced range of motion might also be noticeable.
• Postural problems: Lower back pain can make it difficult for some people to stand upright. You might bend or stand 'crooked' with your torso misaligned with the spine. The lower back could also appear flat rather than curved.
• Muscle spasms: Following an injury or strain, the lower back muscles can contract or spasm uncontrollably. This may lead to intense pain, making it hard or impossible to stand, move, or walk.

If the lower back pain is severe and interferes with your day-to-day tasks, it's important to consult a doctor.

Causes

What causes lower back pain?

Lower back pain can result from a variety of injuries and conditions. This type of pain is highly common since the lumbar vertebrae (bones in the lower back) play a vital role in supporting the body by:

• Stabilising the rest of the spine.
• Functioning as attachment points for several muscles and ligaments that enable walking, running, sitting, lifting, and moving the body in every direction.
• Bearing much of the body's weight.
• Serving as the core of the body's balance.

Considering all these significant functions, any problem affecting the lower back structures can result in pain. Some of the specific causes of lower back pain include:

• Strains and sprains: The most common causes of low back pain are strains and sprains. When you lift something heavy or improperly, the muscles, ligaments, or tendons can be injured. For some people, coughing, sneezing, bending over, or twisting can also strain their backs.
• Spinal fractures: The bones located in the lumbar spine may sometimes break due to accidents such as falls or car crashes. Some medical conditions, such as osteoporosis, can also increase the chances of fractures. A specific kind of spinal bone crack or stress fracture is spondylolysis, which is particularly common among young athletes.
• Disc complications: Spinal discs cushion the vertebrae. Sometimes, they can bulge out of place in the spine, pressing against a nerve and causing a pinched nerve. Discs can also tear and result in a herniated disc or become flatter with age, providing less protection (degenerative disc disease).
• Structural problems: Spinal stenosis is a condition where the spinal column becomes too narrow for the spinal cord. A pinch on the spinal cord, such as from vertebral bone spurs, may result in intense pain in the sciatic nerve and lower back. Lumbar scoliosis can also cause stiffness, pain, and trouble moving. Spondylolisthesis is another structural problem that can lead to lower back pain. It occurs when the vertebra slides out of position and rests on the bone beneath it.
• Arthritis: The most common form of arthritis associated with low back pain is osteoarthritis. Ankylosing spondylitis is another form of arthritis that causes inflammation and pain in the lower back, as well as spinal stiffness.
• Diseases: Infections, spinal tumours, and certain forms of cancer can lead to back pain. Other health problems, such as abdominal aortic aneurysm and kidney stones, are associated with lower back pain. Additionally, chronic inflammatory diseases, including fibromyalgia, may cause back pain.

Additional temporary causes of lower back pain

Other common temporary factors that can contribute to low back pain include:

• Menstrual cramps: Some people experience low back cramping or pain during their menstrual period.
• Pregnancy: Sometimes, pregnancy can lead to low back pain, particularly during the second and third trimesters. This is usually due to hormonal changes, the shifting centre of gravity in the body, and increased weight due to the growing foetus and uterus.
• Back labour: Discomfort and pain in the lower back are common during labour. This usually happens when the baby faces the belly rather than the back.

Risk Factors

Some individuals have higher risks of experiencing lower back pain compared to others. Possible risk factors associated with low back pain include:

• Age: Individuals above the age of 30 are at a higher risk of back pain. The vertebral discs gradually wear down and weaken with age, resulting in discomfort and stiffness.
• Weight: A body mass index (BMI) over 25 (indicating overweight or obesity) increases the risk of low back pain. Excess weight strains the discs and joints. Pregnancy-related weight gain can also exert pressure on the lower back.
• Reduced core strength: Weak abdominal muscles don’t provide sufficient support to the spine, which can cause strains and sprains in the lower back.
• Overall well-being: Smoking, excessive alcohol consumption, and insufficient physical activity increase the risk of lower back pain.
• Occupation and hobbies: Certain jobs or leisure activities that involve heavy lifting or repeated bending are likely to cause back injuries. Athletes are also more susceptible to low back pain.
• Mental health disorders: Research shows a link between back pain and depression. However, it's difficult to determine whether depression directly contributes to back pain.

Diagnosis and Tests

How do doctors diagnose lower back pain?

During diagnosis, your doctor will ask about the symptoms you are experiencing, review your medical history, and conduct a physical examination. They may also recommend various tests to check for spinal injuries and evaluate your overall health. Some of the tests they may order include:

• Spine X-ray: Uses radiation energy to provide clear pictures of the bones.
• MRI: Utilises magnetic and radio waves to produce detailed images of muscles, bones, tendons, and soft tissues.
• CT scan: Uses X-rays along with computer technology to produce 3D pictures of the bones and other soft tissues.
• Electromyography (EMG): Evaluates nerve and muscle function by checking for any nerve damage (neuropathy) that may cause discomfort, numbness, or tingling.
• Blood or urine tests: Doctors may order blood tests to identify genetic markers for medical conditions that may lead to back pain, such as ankylosing spondylitis. Urine tests, on the other hand, detect kidney stones, a possible cause of pain in the sides or flanks of the lower back.

Since there are numerous potential causes of lower back pain, it may take some time for doctors to make an accurate diagnosis.

Management and Treatment

What are the treatments for lower back pain?

Most mild and moderate back pain cases often improve with rest, applying ice, and taking over-the-counter painkillers. You should be able to resume your usual routine after resting for a few days. Generally, being active promotes blood flow to the region and aids in recovery.

For severe back pain or pain that results from a traumatic accident such as a fall, it’s advisable to seek immediate medical attention.

Additional low back pain treatments are based on the pain's root cause, severity, and duration. The available options include:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription drugs may be recommended for pain relief. In some cases, the doctor may also recommend muscle relaxers to help ease back spasms.
• Physical therapy (PT): This helps strengthen muscles to provide more support to the spine. Physical therapy also promotes flexibility and reduces the risk of future injuries. Additionally, PT assists with posture, spinal alignment, and body mechanics to relieve back pain.
• Hands-on manipulation: Many hands-on techniques can help reduce pain, ease tight muscles, and improve alignment and posture. Depending on the underlying causes, you may require chiropractic adjustments or osteopathic manipulation. Moreover, massage therapy helps relieve pain and restore functionality.
• Injections: Lumbar epidural steroid injections may be recommended to address long-term low back pain.
• Surgery: Certain cases of low back injuries and disorders require surgical correction. There are many types of low back pain surgeries, including several minimally invasive procedures.

Finding the right course of treatment, particularly for chronic low back pain, can take time. Your healthcare provider will work with you through the process to determine the best approach.

Prevention

How can I effectively prevent low back pain?

While not every cause of low back pain can be prevented, there are measures you can take to avoid injuries that cause discomfort. These include:

• Maintaining a healthy weight: Excess weight puts more pressure on the discs and vertebrae.
• Strengthening the back, abdominal, and hip muscles: Pilates or other workout programmes help build and strengthen the hip, back, and core muscles that support the spine.
• Safe lifting: It’s advisable to lift using the legs rather than the back to prevent injuries. You should also hold heavy items close to the body and avoid twisting your torso when lifting.
• Warming up before engaging in sports or physical activity: You can warm up the body by doing gentle stretches before exercising or playing sports.

Outlook / Prognosis

What is the outlook for low back pain?

The outlook for an individual with lower back pain depends on factors such as:

• The cause of the back pain
• The severity
• Duration of the pain
• The body’s response to treatment
• Age and general health.

Depending on your specific condition, your doctor will give you an insight into what you can expect. Most individuals with back sprains or strains recover without long-term medical problems. However, some may experience a recurrence within a year.

Chronic lower back pain can sometimes persist and fail to improve after weeks. Individuals with degenerative disorders like osteoporosis and arthritis may experience symptoms that worsen over time. Surgical repairs and other treatment options are usually effective and help relieve pain in those with different conditions and injuries.

Living With

When should I be concerned about low back pain?

Some symptoms occurring alongside back pain could be warning signs that something is wrong. Therefore, it’s important to consult a doctor as soon as possible if you experience lower back pain accompanied by any of the following symptoms:

• Numbness
• Fever
• Weakness in one or both legs
• Trouble urinating or defecating
• Fainting or light-headedness
• Intense abdominal pain.

Even if it doesn’t seem urgent, it’s advisable to talk to a doctor sooner if you experience lower back pain along with the following:

• A history of cancer
• Unexplained weight loss
• Severe discomfort at night
• You are 55 years old or above with no clear cause for the back pain
• You have a high risk of getting an infection because you are immunocompromised.

A Note from MD.co.uk

Lower back pain affects millions of individuals worldwide. Pain, stiffness, and reduced mobility can significantly impact one's overall quality of life. However, you don’t have to endure such pain. Consult your doctor if the low back pain fails to improve or prevents you from doing your favourite activities. There are many treatments available that can alleviate pain, improve your movement, and enable you to live a full life.