Lower back pain can be debilitating, and is a common reason for many doctor’s visits. Examples of lower back pain include radiating pain in the back, lower back pain that radiates to the front, a sharp stabbing pain in the lower left side of the back, or even pain in the back ribs. The discomfort can range from an occasional dull ache to sharp, unrelenting pain. The pain can also vary from side to side. You might feel lower left back pain or lower right back pain. However, treatments and ways of alleviating the pain are available.
Basics of the Back
First, it can be helpful to know a little about the structure of your lower back. Also known as the lumbar spine, it is comprised of five vertebrae (L1-L5) that support much of your upper body weight. There are intervertebral disks between each vertebrae, which are rubbery pads that act as shock absorbers for the spine. These vertebrae, in addition to a complex system of ligaments, tendons, muscles, joints, and nerves, are what comprise your lumbar spine.
Causes of Lower Back Pain
There are two types of lower back pain: mechanical pain and radicular pain.
Causes of mechanical pain
Lower back pain is typically caused by mechanical injuries, such as muscle strains or sprains, in the low back area. Strains or sprains can happen overtime, for example from bad posture, or from sudden movements that put stress on the body, like a sports injury or picking up a heavy box. Both muscles and ligaments can be at the source of mechanical pain.
- Muscle strain: A muscle strain occurs when a muscle tears from being stretched too far.
- Ligament sprain: A ligament sprain occurs when tearing and over-stretching happens to the ligaments, which connect bone to bone.
Acute pain caused by lower back strains or sprains can often be remedied with home treatment.
The treatment of strains and sprains is the same. The mainstay of treatment is non-steroidal anti-inflammatory medications (NSAIDs).
Causes of radicular pain
Radicular pain happens when the spinal nerve roots become compressed or inflamed. It can feel like a sharp, burning pain, and in many instances is only present on one side of the body. Radicular pain is most often found with chronic back pain, which I will discuss shortly.
Chronic lower back pain can be defined as pain and discomfort in the lower back area that lasts for at least three months. About 20% of people with chronic lower back pain still have persistent symptoms after one year. Chronic back pain typically involves dysfunction with the joints, vertebral discs, or nerves.
Did you know?
Lower back pain is extremely common.
- 80% of adults will experience back pain at some point in their lives.
- It is the most common cause of job-related disability.
Different Types of Lower Back Pain
Some common causes of lower back pain include:
- Degenerative disc disease: This occurs when the intervertebral discs start wearing down due to aging and lose their ability to act as cushions between the vertebrae.
- Osteoarthritis: Osteoarthritis is caused by wear of the discs and the facet joints, which connect the bones of your spine.
- Herniated or ruptured lumbar disc: A herniated lumbar disc is when a piece of the intervertebral disc’s center gets pushed into the spinal canal through a tear in the disc’s exterior.
- Spondylolisthesis: Spondylolisthesis is the slipping of vertebrae, which most often occurs in the lower back.
- Sciatica: Sciatica is defined as lower radiating back pain along the path of the sciatic nerve, which connects from your lower back and down each leg. It can start as back pain that radiates to the front or back of your thigh, leg, or feet.
- Sacroiliac joint dysfunction: Sacroiliac joint dysfunction refers to pain in the sacroiliac joint. It occurs when the joint is overactive or underactive.
- Spinal stenosis: Spinal stenosis happens when the spinal canal, which houses the spinal cord and nerve roots, narrows and compresses the spinal cord and nerves.
- Traumatic Injury: A traumatic injury can cause injury to the muscles, ligaments, or tendons in your back. It can also cause compression in the spine and pain in the nerve roots.
Lower Back Pain Symptoms
There are many types of back pain and everyone can experience it differently. Common symptoms of lower back pain include:
- Dull pain confined to the lower back
- Stinging or burning lower back pain that starts radiating to the upper back or lower body
- Back pain that happens bilaterally, or pain that only happens on one side of the body, such as lower left back pain
- Pain that gets worse with standing, bending, walking, etc.
- Pain that is alleviated by reclining
- Muscle spasms in the pelvis or lower back
- Lower back pain on the right side
- Lower back pain on the left side
Diagnosing Lower Back Pain
There are numerous ways to diagnose lower back pain. A thorough history is taken including factors that make the pain better (like pain medication) or worse, and the patient is examined to locate the areas of pain. If further evaluation is needed, the following techniques might be used:
- X-ray: An X-ray can detect broken bones or signs of arthritis.
- CT or MRI: CT and MRI scans will be used to look at issues that can’t be viewed with an X-ray, such as disc ruptures, or problems with the bones, muscles, nerves, etc.
- Electromyography: Electromyography (EMG) analyzes the electrical activity in your muscles with thin needles that are inserted directly into the muscles. It can see if muscle weakness or pain is the result of a nerve issue.
- Bone scans: Bone scans can detect disorders within the bone. They aren’t commonly used, and are most often utilized to search for bone tumors.
Lower Back Pain Treatment
Most low back pain is acute, and is resolved within 4-12 weeks with self-care. If self-care does not resolve the pain, other non-surgical methods could help. There is a wide variety of non-surgical treatments to improve low back pain, which focus on reducing inflammation in the back or calming irritation in the nerve roots. These include:
At home self-care
- Exercises and stretches: Exercises and stretches can be very effective for helping lower back pain. Check out this guide for exercises and stretches that can help alleviate your discomfort, all of which can be done at home.
- Weight reduction: Weight loss and increased movement can be beneficial for reducing lower back pain in overweight individuals. One study at Stanford University found that overweight people who increased the amount of time they spent moving by 20 minutes per day were able to reduce their risk of back pain by 32%.
If chronic lower back pain is present for three or more months, you may require professional treatment such as physical therapy, alternative medicine, injections, medication, or even surgery. Make sure to consult with your doctor if your back pain persists for several months.
- Physical therapy: Physical therapy helps relieve pain symptoms and strengthens the lower back musculature to regain motion and core control. For example, if you’re experiencing right side back pain, your therapist will be able to identify the cause of the pain and pinpoint which muscles or ligaments need to be stretched or strengthened.
- Acupuncture: Acupuncture uses tiny needles that are inserted at various pressure points throughout the body. They target energy or “qi” points and have been shown to be very effective for pain relief.
- Steroid injections: Steroid injections (epidural steroids) can calm inflamed tissues and joints. They do not speed up the healing process.
- Nonsteroidal anti-inflammatory medications (NSAIDs): NSAIDs can provide short-term relief. They can be used for acute or chronic pain. NSAIDs are not safe if you have kidney disease or a history of stomach bleeding.
All of these treatment options are aimed at relieving inflammation in the back and irritation of nerve roots. I usually recommend four to six weeks of conservative therapy before considering surgery. Your doctor can help guide you on which of the above treatments might be best for you.
If conservative treatments aren’t working, surgical treatments may be considered. Surgical options can include the following:
- Spinal fusion: A spinal fusion is one of the most common options for back pain surgery. A surgeon will join vertebrae together to inhibit movement between the bones of the spine.
- Disc replacement: A disc replacement removes a damaged spinal disc and inserts an artificial disc in its place.
- Laminectomy: A laminectomy removes a portion of the vertebral bone, to make the size of the spinal canal larger.
- Foraminotomy: A foraminotomy cuts bone from the sides of the vertebrae to create space for the nerve roots.
- Discectomy: A discectomy involves the removal of all or part of a herniated lumbar disc that is pressing on the spinal cord or nerve root.
Back Pain Prevention
Back pain can be preventable. Let’s go over a few techniques that can help you prevent back pain from happening:
- Good posture: Make sure to stand and sit at work with good posture. Good biomechanics can help you move pain-free.
- Core exercises: Exercises for lower back pain that strengthen the core, like Pilates, can strengthen the back, abdominals, and hips, giving you a stronger center.
- Proper mechanics: Try to avoid lifting heavy objects, but if you need to, be sure to lift with bent knees so your legs do the work, not your back.
- Quit smoking: Nicotine reduces blood flow to the lower spine and causes degeneration of the spinal discs.
Risk Factors and Related Conditions
Risk factors for lower back pain are:
- Age: Some degeneration of the spine may occur with age, increasing the likelihood of developing pain and/or injury.
- Excessive weight: There is a correlation to being overweight or obese with lower back pain. If you’re trying to lose some weight, check out our guide on staying physically active.
- Sedentary lifestyle: A sedentary lifestyle increases the odds of developing back pain. Get tips for eating healthy.
- Pregnancy: Pregnancy can put strain on the lower back muscles.
- Occupational hazards: Jobs that include tasks such as heavy lifting are more likely to put extra stress on the body.
Related conditions of lower back pain include:
- Spondylitis: Spondylitis is inflammation of the vertebrae. When it involves more than one vertebral joint it is called spondyloarthritis.
- Arthritis: Arthritis is an inflammation of the joints. The most common form is osteoarthritis.
- Fibromyalgia: Fibromyalgia is long-term pain in the muscles, tendons, and joints. Symptoms can include problems with sleep, memory, and fatigue.
When to See a Doctor
You should contact a medical professional if home-treatments are ineffective, typically within a few weeks. In rare cases, the pain can indicate a serious issue. You should get immediate medical attention if:
- Your pain follows an acute injury to the spine, such as a fall
- It is accompanied by a fever
- There is loss of normal bladder/bowel control
You should also contact your doctor if you have:
- Difficulty walking or standing
- Leg numbness or weakness
- Pain that is severely limiting activities of daily living