Lower Back Pain

What is lower back pain?

Lower back pain affects the lumbar region of your spine or back. It can result from many different injuries and conditions. Most often, the cause is an injury to muscles or tendons in your back.

Nearly everyone experiences lower back pain at some point in their lives. The pain can range from mild to severe. For most, it’s temporary. But long-lasting (chronic) lower back pain is also common — up to 23% of adults worldwide have chronic lower back pain. In extreme cases, lower back pain can make it difficult or impossible to walk, sleep, work or do everyday activities.

Given how common it is, it may be hard to tell if you should be worried about your lower back pain. Trust your gut and reach out to a healthcare provider if something feels off — or if the pain keeps you from going about your usual activities.

What are the symptoms of lower back pain?

Lower back pain can involve a wide spectrum of symptoms. Lower back pain may:

• Come on suddenly or appear gradually.
• Happen after a specific event, like bending over to pick something up. You may hear a “pop” when it happens.
• Have an unknown trigger.
• Feel sharp or dull and achy.
• Come and go or be persistent.
• Radiate down to your buttock or down the back of your leg (sciatica).
• Feel worse in certain positions (like bending over or crouching down) and get better when lying down.

Other symptoms of lower back pain can include:

• Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice a decreased range of motion.
• Posture problems: Many people with back pain find it hard to stand up straight. You may stand “crooked” or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
• Muscle spasms: After a strain, muscles in your lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.

If you have severe pain and/or lower back pain that keeps you from doing daily activities, reach out to a healthcare provider.

What causes low back pain?

Many injuries and conditions can cause lower back pain. This kind of pain is so common because your lumbar (low back) vertebrae (bones) do a lot to support your body, including:

• Providing stability for the rest of your spine.
• Serving as a point of attachment for many muscles and ligaments that allow you to walk, run, sit, lift and move your body in all directions.
• Supporting most of your body’s weight.
• Functioning as the center of your body’s balance.

With all these important functions, any issue with the structures in your lower back can lead to pain. Specific causes of lower back pain include:

• Strains and sprains: Strains and sprains are the most common causes of back pain. You can injure muscles, tendons or ligaments by lifting something too heavy or not lifting safely. Some people strain their back by sneezing, coughing, twisting or bending over.
• Spinal fractures: The bones in your lumbar spine can break during an accident, like a car crash or a fall. Certain conditions (like osteoporosis) increase your risk of fractures. Spondylolysis is a specific type of stress fracture or crack in spinal bones. It’s common in young athletes.
• Disk problems: Spinal disks have the important job of providing a cushion between your vertebrae. Disks can bulge from their position in your spine and press on a nerve (pinched nerve). They can also tear (herniated disk). With age, disks can get flatter and offer less protection (degenerative disk disease).
• Structural issues: A condition called spinal stenosis happens when your spinal column is too narrow for your spinal cord. Something pinching your spinal cord (like vertebral bone spurs) can cause severe sciatic nerve pain and lower back pain. Lumbar scoliosis can also lead to pain, stiffness and difficulty moving. Another structural issue that can cause low back pain is spondylolisthesis. It happens when a vertebra slips out of place, resting on the bone below it.
• Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain. Ankylosing spondylitis, another type of arthritis, causes lower back pain, inflammation and stiffness in your spine.
• Disease: Spine tumors, infections and several types of cancer can cause back pain. Other conditions can cause back pain, too, like kidney stones and an abdominal aortic aneurysm. Chronic inflammatory conditions, like fibromyalgia, can also result in lower back pain.

Other temporary causes of low back pain

Other common temporary causes of lower back pain include:

• Menstrual cramps: Some menstruating people experience lower back pain or lower back cramps during their period.
• Pregnancy: Pregnancy can cause lower back pain, especially in the second and third trimesters. This is often due to hormonal changes, increasing weight from your uterus and fetus, and a changing center of gravity.
• Back labor: This is pain and discomfort in your lower back that happens during labor. It often occurs when the fetus is facing your belly instead of your back.

What are the risk factors for low back pain?

Some people are more likely to have lower back pain than others. Risk factors for lower back pain include:

• Age: People over 30 are more likely to experience back pain. Vertebral disks wear away with age. As the disks weaken and wear down, pain and stiffness can result.
• Weight: People who have a body mass index (BMI) greater than 25 (have overweight or obesity) are more likely to have back pain. Excess weight puts pressure on joints and disks. Increasing weight in pregnancy can also put pressure on your lower back.
• Poor core strength: Weakened abdominal muscles can’t properly support your spine, which can lead to back strains and sprains.
• Overall health: People who smoke, drink excess alcohol and/or get limited physical activity have a higher risk of back pain.
• Occupation and hobbies: Jobs and activities that require heavy lifting or frequent bending can increase your risk of a back injury. Lower back pain is also very common in athletes.
• Mental health conditions: Studies show there’s a connection between depression and back pain. But it’s difficult to tell for sure if depression can cause back pain.

How is lower back pain diagnosed?

Your healthcare provider will ask about your symptoms and medical history and do a physical exam. Your provider may recommend a variety of tests to check your spine for injuries and assess your health in other ways. Tests may include:

• Spine X-ray: This test uses radiation to produce images of your bones.
• MRI: This test uses a magnet and radio waves to create pictures of your bones, muscles, tendons and other soft tissues.
• CT scan: This test uses X-rays and a computer to create 3D images of your bones and soft tissues.
• Electromyography (EMG): This test assesses the function of your nerves and muscles. It checks for neuropathy (nerve damage), which can cause pain, tingling and numbness.
• Blood tests or urine tests: Blood tests can detect genetic markers for some conditions that cause back pain (like ankylosing spondylitis). Urine tests check for kidney stones, which cause pain in your flank (the sides of your lower back).

Because there are so many possible causes of low back pain, it may take time to find the correct diagnosis.

What are the treatments for lower back pain?

Many cases of mild to moderate lower back pain get better with rest, ice and over-the-counter (OTC) pain relievers. After a few days of rest, you should be able to get back to your normal activities. Staying active increases blood flow to the area and helps you heal.

If your back pain is severe and/or happens after a traumatic accident, like a fall, you should seek medical treatment as soon as possible.

Other treatments for lower back pain depend on the underlying cause, severity and how long you’ve had pain. They may include:

• Medications: Your healthcare provider may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription medications to relieve pain. They may also prescribe muscle relaxers in certain situations to relieve back spasms.
• Physical therapy (PT): PT can strengthen your muscles so they can better support your spine. PT also improves flexibility and helps you avoid another injury. PT can also help with posture, alignment and body mechanics to reduce back pain.
• Hands-on manipulation: Several “hands-on” treatments can relax tight muscles, reduce pain and improve posture and alignment. Depending on the cause of the pain, you may need osteopathic manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief and restore function.
• Injections: Your provider may recommend lumbar epidural steroid injections to help manage chronic lower back pain.
• Surgery: Some lower back injuries and conditions require surgical repair. There are several types of surgery for low back pain, including many minimally invasive techniques.

It may take time to find the best treatment for you, especially if you have chronic lower back pain. Your provider will be by your side throughout the process.

How can I prevent lower back pain?

Not all causes of lower back pain are preventable. But you can take some steps to avoid injuries that cause lower back pain, including:

• Maintaining a weight that’s healthy for you: Excess weight puts pressure on your vertebrae and disks.
• Strengthening your abdominal, hip and back muscles: Pilates and other exercise programs strengthen core, hip and back muscles that support your spine.
• Lifting safely: To avoid injuries, lift with your legs, not your back. Hold heavy items close to your body. Try not to twist your torso while you’re lifting.
• Warming up before physical activity or sports: Do gentle stretches to warm up your body properly before exercise.

What is the prognosis for someone with lower back pain?

The prognosis (outlook) for someone with lower back pain depends on several factors, including:

• The underlying cause.
• The severity of the pain.
• How long the pain lasts.
• How your body responds to treatment.
• Your age and overall health.

Your healthcare provider will be able to give you a better idea of what to expect based on your unique situation. Most people with back strains and sprains recover and don’t have long-term health issues. But many people will have another episode within a year.

Some people have chronic back pain that doesn’t get better after several weeks. People with degenerative conditions such as arthritis and osteoporosis may have symptoms that get worse over time. Surgery and other treatments are often effective at helping people with a range of injuries and conditions live with less pain.

When should I worry about lower back pain?

Certain symptoms that happen alongside lower back pain can be warning signs of something more serious. You should see a healthcare provider right away if you have lower back pain and any of these symptoms:

• Numbness.
• Weakness in one or both legs.
• Problems peeing or pooping.
• Fever.
• Light-headedness or fainting.
• Severe abdominal pain.

While not as urgent, it’s a good idea to see a provider soon if you have lower back pain and any of these:

• History of cancer.
• Unexplained weight loss.
• Severe pain at night.
• You’re 55 or older and there’s no obvious reason for the back pain.
• You’re at increased risk of infection due to being immunocompromised.