Lower Back Pain: A Comprehensive Overview

Suffering from lower back pain? It is a common issue that can affect anyone, even without prior injury or risk factors. While it may not be serious and may improve on its own, pain can signal underlying problems. Back pain is a leading cause of disability worldwide and a common reason for seeking medical help or missing work. Read this blog to discover more on lower back pain.
Understanding Lower Back Pain: An Overview
Lower back pain affects the lumbar spine, the area between the bottom of your ribs and the top of your legs. It is a common issue, with nearly everyone experiencing it at some point of their life. The pain can range from mild to severe and may occur from injuries to muscles, tendons, bones, or discs. Chronic lower back pain can severely impact daily activities, including walking, sleeping, and working.
Diagnosing the exact cause of back pain is challenging due to the complexity of spinal structures. If your pain interferes with your daily life, consult a healthcare provider promptly. Remember early attention can make a significant difference.
Types of Lower Back Pain
Lower back pain usually occurs as 3 different types, such as:
-
Acute low back pain
Acute pain arises suddenly, lasting days to weeks, as a normal response to injury or tissue damage. It gradually decreases as the body heals.
-
Sub-acute low back pain
Sub-acute low back pain lasts 6 weeks to 3 months and is often mechanical, like muscle strain or joint pain. A medical evaluation may be needed if the pain severely limits daily activities, sleep, or work.
-
Chronic low back pain
Chronic back pain persists for over 3 months, often severe and unresponsive to initial treatments. It requires a comprehensive medical evaluation to identify the underlying cause and guide effective management strategies.
You can again categorise lower back pain on the basis of:
-
Mechanical Pain
Mechanical pain, or axial pain, originates from muscles, ligaments, joints, or bones around the spine. It is usually localised to the lower back, buttocks, or upper legs and varies with motion or activity.
-
Radicular Pain
Radicular pain occurs when a spinal nerve root is compressed or inflamed. This sharp, electric, burning pain follows a nerve root pattern, radiating into the buttock or leg and may be accompanied by numbness or weakness. It typically affects only one side of the body.
Why is lower back pain so common?
Although your lower back has 5 vertebrae, fewer than your neck or mid-back, they handle significant stress. Connecting your spine to your pelvis, this region supports your upper body’s weight and enables movement. Its constant use makes it prone to wear, tear, and injuries.
Organs Responsible for Lower Back Pain
-
Kidneys
Kidney pain, often mistaken for back pain, can result from infections, kidney stones, or injury. It may feel dull and constant or sharp and discontinuous. Additional symptoms include nausea, vomiting, loss of appetite, changes in urination, muscle cramps, swelling in the hands, feet, or ankles, insomnia, and dry, itchy skin.
-
Colon
Faecal impaction occurs when dry stool becomes stuck in the colon or rectum, often in constipated individuals. This can lead to lower back pain, along with abdominal cramping, rectal bleeding, difficulty in passing stools, frequent urination, and loss of appetite.
-
Appendix
Located in the bottom right region of the abdomen, the tube like appendix is a small organ. Once it gets inflamed, leaky, or ruptures, you may experience sudden pain that starts in the lower right part of the abdomen and moves to the lower back.
-
Liver
Liver pain, often caused by liver disease, can radiate from the upper abdomen to the back. Symptoms include abdominal swelling, jaundice, leg and ankle swelling, fatigue, dark urine, and itchy skin. Liver disease leads to inflammation or damage, affecting liver function and causing these discomforting signs.
-
Gallbladder
Gallstones in the gallbladder can cause intense abdominal pain radiating to the lower back. Other symptoms include pain in the right shoulder or back, nausea, vomiting, fever, chills, abdominal bloating, indigestion, gas, and jaundice.
-
Pancreas
Pancreatic cancer can cause dull, intermittent back pain due to a tumour pressing on the spine. Symptoms vary but may include abdominal pain, loss of appetite, jaundice, dark urine, itchy skin, new or worsening diabetes, nausea, fatigue, and bloating.
-
Reproductive organs
Reproductive issues can lead to back pain as well. In women, conditions like endometriosis and fibroids can cause lower right back pain, along with irregular periods, painful intercourse, and frequent urination. In men, prostate problems may result in persistent pain in the lower back, hips, and pelvic or rectal areas.
Common Causes of Lower Back Pain
-
Arthritis of the Spine
Arthritis or degeneration of spinal joints is a leading cause of lower back pain. As we age, wear and tear naturally occurs, leading to the breakdown of cartilage between spinal joints. This thinning cartilage increases joint friction and inflammation, often resulting in discomfort and pain in the lower back.
-
Back Injuries
Lower back injuries can result from sudden events, like a fall or car accident, or everyday activities, such as carrying laundry or bending over. While athletes may seem more prone to injuries, daily tasks can also lead to back strain.
-
Herniated Discs
A herniated disc occurs when the disc’s contents spill out, usually in the lower back. While the disc itself may not be painful, it can press on nearby nerves, causing pain in the lower back and other areas.
-
Facet joint pain
Facet joints in the spine control its motion, allowing extension within a limited range. When osteoarthritis affects these joints, it can cause lower back pain and tenderness, leading to discomfort and restricted movement in the affected area.
-
Ligament or Muscle Strain
Repeated heavy lifting or sudden awkward movements can strain back muscles and ligaments. For those in poor physical condition, continuous strain may lead to painful muscle spasms, causing discomfort and limiting movement.
-
Spinal Fractures
Lumbar spine fractures can occur from accidents, such as car crashes or falls. Conditions like osteoporosis increase risks of fracture. Spondylolysis, a stress fracture in spinal bones, is common among young athletes.
-
Spinal Stenosis
Spinal stenosis occurs when spinal spaces narrow, compressing the spinal cord and nerves. It often results from disc degeneration, causing pressure from bony spurs or soft tissues. Symptoms include numbness, weakness, and cramping, worsening with standing or walking.
-
Unusual spine curvatures
Conditions like scoliosis, lordosis, and kyphosis cause abnormal spinal curvatures, often diagnosed in childhood or adolescence. These conditions can lead to pain and poor posture by putting pressure on muscles, tendons, ligaments, and vertebrae.
-
Fibromyalgia
Fibromyalgia is a chronic condition causing widespread pain, stiffness, and fatigue, often affecting the back and legs. Symptoms may include increased sensitivity, headaches, memory problems, depression, numbness, sleep issues, and digestive problems, with pain worsening over time.
-
Osteoporosis
Brittle, porous vertebrae in the spine can also lead to painful fractures.
-
Ankylosing spondylitis or spondyloarthritis
This inflammatory disease can cause spinal bones to fuse, reducing flexibility and limiting movement in the spine.
-
Spondylosis
Spondylosis, a form of arthritis, is a degenerative disorder that affects spinal structure and function. While aging is the main cause, degeneration varies in location between individuals.
-
Cauda equina syndrome
Cauda equina syndrome occurs when the nerves at the lower spine are compressed, often by a herniated disc or other spinal conditions. Symptoms include severe back pain, leg numbness, and bladder issues.
-
Menstrual cramps
Some people experience lower back pain or cramps during their menstrual period.
-
Pregnancy
Pregnancy can lead to lower back pain, especially in the second and third trimesters, due to hormonal changes, added weight from the uterus and foetus.
-
Endometriosis
Endometriosis, a cause of lower back pain in females, can lead to ovarian cysts. If a cyst ruptures, it can result in sudden, intense back pain.
-
Spinal Infections
Spinal infections can cause back pain, tingling, fever, and swelling. They may result from infections spreading to the spine or complications from surgery, injuries, or conditions like diabetes.
-
Degenerative disc disease
Degenerative disc disease occurs when spinal discs wear down, causing vertebrae to rub together. This leads to back pain, often worsening with bending or lifting but improving with walking or movement.
Lifestyle Factors Causing Lower Back Pain
Three major lifestyle factors can increase the risk of lower back pain:
- Smoking: Smoking raises inflammation and impairs the body’s healing process, contributing to back pain.
- Obesity: Excess weight adds stress to the spine, leading to wear and tear, increasing the risk of chronic pain.
- Physical Activity: Both a sedentary lifestyle and excessive physical activity can contribute to back pain. It is important to perform a balanced level of activity to avoid back pain.
Other contributing factors include lifting heavy objects, long durations of standing, stress from work, depression, or overexertion during exercise.
Symptoms
Back pain can vary from a dull ache to sharp, shooting, or burning sensations, often radiating down the leg. It may result from twisting, bending, standing, walking, or lifting. Symptoms can appear suddenly or gradually, sometimes following a specific event like lifting something heavy. Pain may worsen in certain positions and improve when lying down. Other signs include stiffness, difficulty moving, poor posture, or muscle spasms. Pain may be acute or chronic. If severe or persistent, consult a healthcare provider.
Risk Factors
-
Age
Back pain often begins around age 30 or 40 and becomes more common with ageing.
-
Lack of exercise
Weak, unused muscles in the back and abdomen may lead to lower back pain.
-
Excess weight
Extra body weight places additional stress on the back.
-
Poor core strength
Weak abdominal muscles cannot adequately support the spine, increasing the risk of back strains and sprains.
-
Diseases
Certain conditions, such as arthritis and cancer, can contribute to back pain.
-
Improper lifting
Using the back instead of the legs while lifting can cause back pain.
-
Psychological conditions
Depression, anxiety, and stress can lead to muscle tension, heightening the risk of back pain.
-
Smoking
Smoking may cause herniated disks through coughing, reduce blood flow to the spine, and increase risks of osteoporosis.
-
Overall health
Smoking, excessive alcohol consumption and inactivity elevate the risk of back pain.
-
Occupation and hobbies
Jobs or activities involving heavy lifting or frequent bending, as well as sports, commonly cause lower back pain.
Diagnosis
- Spine X-ray: Uses radiation to produce images of bones.
- MRI: Utilises a magnet and radio waves to create detailed pictures of bones, muscles, tendons, and soft tissues.
- CT Scan: Combines X-rays and a computer to generate 3D images of bones and soft tissues.
- Electromyography (EMG): Evaluates nerve and muscle function, detecting nerve damage causing pain, tingling, or numbness.
- Blood or urine tests: Blood tests identify genetic markers for conditions like ankylosing spondylitis, while urine tests check for kidney stones causing flank pain.
Treatment
Mild to moderate lower back pain improves with getting rest, applying ice, and taking pain relievers. However, treatment varies according to the cause of the pain.
-
Medications
Your healthcare provider may recommend non-steroidal anti-inflammatory drugs (NSAIDs), prescription medications, or muscle relaxers to relieve pain and back spasms.
-
Physical Therapy
Physical therapy strengthens muscles, improves flexibility, and enhances posture, alignment, and body mechanics to reduce back pain and prevent injury.
-
Hands-on Manipulation
Hands-on treatments like osteopathic manipulation, chiropractic adjustments, and massage therapy can relax muscles, reduce pain, and improve posture.
-
Injections
Your provider may suggest lumbar epidural steroid injections to help manage chronic lower back pain effectively.
-
Surgery
Some severe lower back injuries need surgery, including different minimally invasive techniques for treatment. Surgeries may vary from discectomy, foraminotomy, intradiscal electrothermal therapy (IDET), and nucleoplasty to radiofrequency lesioning, spinal fusion, or spinal laminectomy.
Prevention
Improving physical fitness and practicing proper body mechanics can strengthen the back and help prevent pain or injuries.
-
Regular exercise
Low-impact aerobics like walking, swimming, and cycling improve back strength and endurance without strain.
-
Build muscle strength and flexibility
Core exercises strengthen abdominal and back muscles, improving coordination and support for the back through better muscle conditioning.
-
Healthy body weight
As overweight strains back muscles, a balanced and healthy body weight is essential.
-
Warming up before sports and physical activity
Before exercising, perform some gentle stretches to warm your body up.
-
Quit smoking
Smoking raises the risk of low back pain, which increases with cigarette use. Quitting smoking can significantly lower this risk.
Prevention also includes avoiding those movements which strain or twist your back muscles.
-
Stand smart
Stand upright with a neutral pelvis. Use a footstool to relieve lower back strain, alternating feet. Maintain good posture.
-
Sit smart
Select a supportive seat with armrests and swivel. Use a pillow for back support. Keep hips, knees level, and shift positions often.
-
Lift smart
Refrain from lifting heavy objects. Use your legs, not your back. Bend your knees, keep the load close, and get help if needed.
Home Remedies to Manage Lower Back Pain
If lower back pain starts, note your symptoms, times, dates, and triggers. Share this with your doctor if it persists. Avoid movements that worsen pain, ice the area, and use pain relievers for fast relief from symptoms.
-
Bed Rest
If you have back pain from muscle strain, doctors recommend resuming normal activities quickly. Prolonged bed rest can worsen pain and reduce flexibility.
-
Yoga
If back pain persists for 3 months, yoga may help. About 12 weeks of yoga sessions reduced pain, with lasting benefits.
-
Massage Therapy
Massage can help relieve chronic low back pain, especially when combined with exercise and stretching, improving movement and reducing both short-term and long-term pain.
-
Acupuncture
Acupuncture’s effectiveness for back pain is mixed. While short-term sufferers do not find any difference between real and sham acupuncture, chronic pain patients experienced improvement with treatments.
-
Switch shoes
Wearing properly fitted shoes can relieve lower back pain.
-
Changing workstation designs
A proper workstation can reduce back pain. Keep your screen at eye level, chair at the right height, and use legs, not back, for lifting. Ask for help with heavy objects.
-
Get adequate sleep
Poor sleep quality over time can increase chronic back pain risk. Adults need more than 7 hours of sleep. Using pillows for support and consulting a healthcare professional can help.
-
Make dietary changes
People with chronic spinal pain should eat less whole grains, dairy products, and fruit. Added sugars may increase the risk of pain. Anti-inflammatory foods, such as whole grains, fruits, vegetables, fibre, yogurt, turmeric, ginger, green tea, and black pepper, can help reduce pain. Foods that worsen inflammation include refined flours, sugars, trans fats, red meat, and certain vegetables.
-
Manage stress with meditation
Moderate to high stress may contribute to lower back pain. To reduce stress and relieve pain, try:
-
- Mindfulness Meditation: Helps older adults manage pain by increasing body awareness.
- Deep Breathing: Breathing exercises can alleviate lower back pain.
- Progressive Muscle Relaxation: Tensing and relaxing muscle groups may help reduce pain.
- Guided Imagery: Focuses on mental images to promote relaxation and decrease stress.
Here are some other tips for home care:
- heat therapy
- cold therapy
- The RICE protocol - take rest, apply ice, compress, and elevate the lower back
- getting a warm bath - this can relax your stiff and knotted back muscles
Many mobile apps offer relaxation and meditation guidance for pain relief.
Severe Lower Back Pain: What to do?
If you experience severe pain in lower back, consult a doctor immediately. If the cause has not been identified, discuss diagnostic tests. After diagnosis, your doctor will recommend treatment options. Seek immediate medical attention if your lower back pain is accompanied by loss of bowel or bladder control, or worsening neurological symptoms. These could indicate a serious condition requiring emergency surgery. Prompt action is crucial for proper care and recovery.
Who is the right doctor to see my lower back pain?
Your primary healthcare physician is your first point of contact for lower back pain, as they understand your medical history the best. If they cannot diagnose or treat the issue, they may refer you to a specialist, such as a rehabilitation physician (physiatrist). These experts take a comprehensive approach to diagnosing and treating various conditions with lower back pain as a symptom. Depending on the diagnosis, you may be referred to a physical therapist, chiropractor, or another practitioner. No need to panic as surgery is a rare option for most cases of lower back pain, with non-invasive treatments usually being effective.
When to see a doctor?
In many cases, lower back pain resolves on its own. However, if it persists, consider seeking professional help from a private GP London under the following conditions if the pain: worsens over time, radiates down your legs, is accompanied by numbness or weakness, or interferes with your daily activities. Consulting a specialist can provide tailored advice and treatment options to address your specific needs.
- Lasts more than 4 weeks.
- Worsens over time.
- Accompanied by symptoms like fever, significant weight loss or gain, weakness in limbs, or bladder issues.
- Radiates down the legs, especially below the knee.
- Causes numbness in the legs.
- Causes new bowel or bladder problems.
- Follows an injury or fall.
Summary
Lower back pain is a widespread issue with diverse causes, ranging from muscle strains to serious conditions. While most of the cases resolve with rest and home care, persistent pain requires medical attention. Early diagnosis and appropriate treatment are crucial for effective pain management and preventing long-term complications. By understanding risk factors, incorporating preventive measures like regular exercise and maintaining a healthy weight, and seeking professional guidance when needed, individuals can significantly reduce the impact of lower back pain on their daily lives.