Lower Back Pain: Causes, Symptoms, Treatment, and Prevention 

 Key takeaways:

• Lower back pain refers to pain in the area of the back below the rib cage and above the hips.
• Symptoms of lower back pain include stiffness, numbness, weakness, and tingling. 
• Poor posture, lack of exercise, sprains, and strains are common causes of lower back pain. But certain factors, like genetics, a sedentary lifestyle, and obesity, can also put individuals at high risk for lower back pain. 
• Physical exams and imaging tests are used to diagnose the cause of lower back pain. Blood and urine tests may also be done. 
• You can prevent lower back pain by regularly exercising, practicing good posture, and using ergonomic furniture. Medication, physiotherapy, corticosteroid injections, and surgery are available treatment options for people already experiencing it.

Lower back pain, or lumbar pain, is a common health problem. Age, obesity, genetics, and lifestyle habits such as smoking are some of the risk factors associated with it.

There are two types of lower back pain: acute and chronic. Acute (short-term) back pain typically lasts from a few days to a few weeks, while chronic (long-term) back pain can last months or even years.

 What is lower back pain?

Lower back pain is pain or discomfort experienced in the area of the back below the rib cage and above the hips. 

 What does it feel like?

The sensation varies from a dull ache to a sharp pain and everything in between, depending on the cause. For example, a fall is likely to cause sharp lower back pain.

 Common causes of lower back pain

Lower back pain can be caused by:

 1. Poor posture

Slouching and other improper sitting positions put a lot of stress on the muscles in your back and your spine. With time, the repetitive stress can result in back pain. 

 2. Lack of exercise

Little or no exercise can make your back muscles weak and rigid, which increases your susceptibility to back pain.

 3. Sprains and strains

Sprains and strains occur when muscles, tendons, or ligaments get stretched or torn due to overexertion.

Back pain due to strains and sprains is usually caused by strenuous physical activity or trying to lift something too heavy. 

 4. Fractures

Blunt trauma from an accident like a car crash or fall can cause the bones in your spine to break. The result is often sharp and severe back pain.

 5. Disk problems

Spinal disks are cushions found between each vertebra in the spinal column. They have a soft center known as the nucleus and a rubbery outer casing.

When the soft center of a disk bulges into the spinal canal through a tear in the rubbery exterior, it is known as a herniated disk. A herniated disk may cause back pain if it’s pressing on a nerve root in the spinal canal.

Age-related wear and tear is the most common cause of herniated disks.

 6. Sciatica

If a herniated disk or bone spur (bony growth that forms on the edge of a bone) in your spine presses on the sciatic nerve, it leads to a condition known as sciatica. Pain caused by sciatica may extend to the buttocks and legs because the sciatic nerve connects the spine and lower limbs.

 7. Arthritis

Arthritis is a disease that affects your joints, causing pain and inflammation. Osteoarthritis, also known as degenerative joint disease (DJD), is the most common type of arthritis and is usually responsible for spinal arthritis. 

In osteoarthritis, the protective cartilage that cushions the joints gradually wears away, and bones start to rub against each other. This friction can lead to the formation of bone spurs.

 Other health conditions that can cause lower back pain

Aside from the common causes already mentioned, a range of health conditions can cause lower back pain. They include: 

• Osteoporosis: A medical condition in which the bones become weak and break easily. 
• Scoliosis: Scoliosis is an abnormal sideways curve of the spine.
• Cancer: Spinal tumors can compress structures in the spinal canal, leading to back pain.
• Uterine fibroids: Growths that form in or on the wall of the uterus called fibroid can cause referred pain, which you perceive in your lower back.
• Kidney problems: These include kidney stones, kidney infections, and kidney cancer.

 Symptoms of lower back pain

Lower back pain can be accompanied by symptoms such as:

• Stiffness 
• Numbness 
• Weakness 
• Tingling 
• Muscle spasms (sudden, involuntary contractions) 
• Pain that spreads into the buttocks, leg, or hip 

When the spinal cord or a nerve root is affected by what is causing the pain, you may experience more severe symptoms like:

• Loss of sensation in the feet 
• Problems with muscle coordination 
• Loss of bowel or bladder control 
• Severe weakness in the legs that can make it hard to walk 
• Erection issues

 Who is at high risk for lower back pain?

Anyone can have back pain. However, certain factors can increase your risk of experiencing lower back pain. Some of the factors are:

• Fitness level: Individuals who engage in little to no physical activity are more likely to experience lower back pain.
• Age: Back pain is more common in people aged 45 and above.
• Excess weight: Being overweight puts extra stress on the back muscles and can cause lower back pain. 
• Smoking: Researchers have established an association between an increased risk of back pain and cigarette smoking. 
• Physiological factors: Anxiety, depression, and insomnia can contribute to and aggravate back pain.
• Genetics: You can inherit an increased risk of developing health conditions that cause lower back pain.
• Job-related stress: Jobs that require heavy lifting, pushing, pulling, and twisting can lead to back injuries. A desk job that involves sitting for many hours can also cause back pain.

 Diagnosis of lower back pain

To discover the cause of your lower back pain, your doctor may perform a lumbar spine examination. A lumbar spine examination tests your range of motion, reflexes, and response to certain maneuvers.

For an accurate evaluation of nerve function, an electromyography (EMG) test can be used to check for nerve damage due to spinal compression.

If your healthcare provider suspects a problem with the bones or structures in your back,  they may order imaging tests like an X-ray, a computerized tomography (CT) scan, or a magnetic resonance imaging (MRI) scan.

You may also have to undergo blood and urine tests if you have symptoms that suggest the presence of an infection or a health condition like kidney stones.

 Treatment for lower back pain

Treatment for lower back pain depends on the severity and cause of the pain. Medication, physiotherapy, lumbar epidural injections, and surgery are available options.

 Medication

Most people use over-the-counter (OTC) pain relievers to deal with lower back pain. However, if your back pain doesn’t respond positively to OTC drugs, your doctor may prescribe a stronger medication.

Some prescription pain medications contain narcotics, also known as opioids, and can lead to addiction with long-term use. Such drugs are only used under the close supervision of a medical professional.

 Physiotherapy

A physiotherapist can help manage lower back pain by prescribing a customized exercise plan to help strengthen the muscles supporting the spine and improve their flexibility.

They can also use techniques such as spinal manipulation, remedial massage (a type of massage used to treat damaged, knotted, tense, or immobile muscles), and transcutaneous electrical nerve stimulation (TENS) to alleviate your pain.

 Lumbar epidural injections

Injections for back pain usually contain a corticosteroid to fight inflammation and reduce pain and a numbing agent that provides immediate pain relief during the procedure.

The corticosteroid is injected into the epidural space of the lumbar (lower back) spine. The epidural space is the space between the protective covering of the spinal cord (dura mater) and the vertebral column. 

This procedure is routinely performed with fluoroscopic (real-time X-ray) guidance to ensure the medication is delivered correctly and safely. Ultrasound can be used as an alternative when fluoroscopy is unavailable or if there’s a contraindication. 

 Surgery

Surgery is only used to treat severe lower back pain that doesn’t improve with other types of treatment. Surgery may be recommended to treat a herniated disk, especially if it is pressing on a nerve and causing serious pain.

Types of surgeries for low back pain include:

• Diskectomy: This surgery involves the removal of a portion of a herniated disk to relieve pressure on nearby nerve roots.
• Disk nucleoplasty: It is a minimally invasive procedure that uses radiofrequency energy to shrink a portion of a herniated disk.
• Laminectomy: A surgeon removes a part of the vertebra known as the lamina to decompress the spinal canal.
• Spinal fusion: In spinal fusion, two or more vertebrae are joined together. The fusion helps to stabilize the spine and reduce pain.
• Artificial disk replacement: Degenerated intervertebral disks are replaced with artificial disk implants. 
• Foraminotomy: A foraminotomy enlarges the opening through which nerve roots exit the spinal canal. It is used to treat nerve compression. 

 Tips for preventing lower back pain

Keeping your lower back pain-free may require lifestyle tweaks and a change of habits. Here are some expert tips that can help.

 Exercise

Regular exercise can increase the strength and stability of the muscles that support your spine. This reduces the risk of back pain and may alleviate existing pain. In addition to exercise, try to maintain a healthy weight. 

 Maintain proper posture

Maintaining proper sitting and standing posture is important if you want to avoid back pain. Sit with your back straight, shoulders relaxed, and feet flat on the floor. Your knees should be at the same level as your hips, or slightly lower.

When standing, keep your head upright and in line with the rest of your body. Keep your feet shoulder-width apart and allow your arms to hang naturally by your sides. Also, ensure that you put most of your weight on the balls of your feet.

 Lift properly

Always pay attention to your form when lifting heavy objects. Do not bend your back while standing. Squat down instead and keep your back straight, then lift the object with your leg muscles. Keep the load close to your body, and avoid twisting your torso. 

 Avoid prolonged sitting

Prolonged sitting can cause muscle fatigue, as well as stiffness and discomfort due to reduced blood flow. It can also increase your tendency to slouch. 

Take regular breaks to stretch your muscles while working at a desk. Do not sit for more than an hour at a time. You can set timers to remind yourself to get up and move.

 Use ergonomic furniture

Ergonomic chairs promote good posture and provide support for the spine. Most ergonomic chairs have adjustable height, lumbar support, and armrests. Some have adjustable headrests. 

Like the chair, an ergonomic table also has an adjustable height, which allows you to work while sitting or standing. This is a very useful feature because available research suggests that using standing desks can improve lower back pain.

Other interesting features of ergonomic desks include an adjustable keyboard tray and monitor mounts to keep screens at eye level. 

 Quit smoking

Smoking decreases blood supply to the lower back, and this can contribute to spinal disk generation. Smoking equally increases your risk of osteoporosis and slows down healing. 

The good news is that the effects of smoking are reversible. Once you stop smoking, your risk for osteoporosis and lower back pain significantly drops. 

 When to see a doctor

Lower back pain can be treated at home by taking OTC non-steroidal anti-inflammatory pain relievers like ibuprofen and applying a heating pad or ice pack to the painful area.

See a doctor immediately if you’re experiencing severe back pain after a fall or injury or if your back pain is accompanied by severe symptoms such as loss of bladder control.

You should also book an appointment with your healthcare provider if you have chronic back pain that doesn’t improve with home remedies and suitable lifestyle changes.