What You Need To Know About Lower Back Pain

Approximately 60% to 80% of individuals will experience lower back pain at some point in their lives¹. For some, it can start as early as childhood.

The CDC cites a study in which lower back pain was the most commonly reported pain, with 25% of adults in the US experiencing it during the three months before the study².

Other sources show around 44% of American adults aged 45–64 reported lower back pain during three months in 2019. Even 28% of adults aged 18–29 experience lower back pain³.

Gender may also play a part in the prevalence of lower back pain, as women tend to experience more episodes of pain than men¹.

Symptoms vary from person to person. Health professionals often categorize the type of lower back pain based on how it starts and its location, nature, and symptoms. 

Different symptoms and locations

Depending on what's causing your low back pain, your symptoms may differ from those of other people. Common examples of symptoms include:

• Achy or dull pain localized around your lower back

• Muscle tightness and spasms in your pelvis, hips, and lower back

• Burning, stinging pain that radiates from your lower back to the back of your thighs, legs, and/or feet. Some people may also feel tingling or numbness. 

• Pain that worsens after standing or sitting for an extended time

• Pain that affects movement, such as walking, sitting to standing, or going up or down stairs

Different types of low back pain

Lower back pain is often categorized and treated based on medical imaging (e.g., x-ray, MRI), and according to what could be causing it, how long symptoms last, and if you have radicular symptoms (pain radiating from your back and hips into your legs).

Types of lower back pain include¹:

• Acute pain (lasts less than four weeks)

• Chronic pain (lasts more than 12 weeks)

• Subacute back pain (lasts four to 12 weeks)

• Radicular low back pain (resulting from nerve roots rubbing against each other that leads to pins-and-needles, lower extremity pain, and/or weakness)

Most people experiencing acute back pain don't seek medical care because the episodes tend to resolve on their own. For those who do require medical care, their pain usually improves within the first month of treatment.

How can you know if your symptoms are serious and require medical attention?

If your lower back pain doesn't start improving within a week or two, or if you develop concerning symptoms, you should seek medical care. The doctor will first determine the underlying cause of your pain and then come up with a strategy to manage it effectively.

Certain symptoms may be a medical emergency. Although these are rare conditions, you must seek medical attention immediately if any of the following accompanies your back pain:

• Unexplained fever

• Severe abdominal pain

• Bladder or bowel incontinence

• Altered or loss of sensation in the legs and/or groin

Could the symptoms of lower back pain be signs of a severe medical condition?

Certain severe but less common medical conditions may cause low back pain.

Spinal infection

Watch out for a coinciding fever and sudden onset of lower back pain, as this could be due to an infection of your spine.

Cauda equina syndrome

Your cauda equina is a group of nerves that leave your spine and travel down your legs, and they are responsible for the movement and feeling of these areas. With cauda equina syndrome, you may experience numbness and discomfort in your saddle region (near your genitalia, thighs, and buttocks). Other tell-tale signs are problems passing urine and with bowel motions. 

Spinal cancer

Growths and tumor(s) growing on your spine could be causing back pain or sciatica symptoms. 

Sleep disorders

People with sleep disorders such as insomnia have a higher risk of experiencing back pain².

Other infections

Kidney or bladder infections or pelvic inflammatory disease can cause back pain.

Shingles

A viral infection caused by the varicella-zoster virus (shingles) can lead to painful rashes on specific areas of the body. Other related symptoms include lower back pain and discomfort.

What are the complications of lower back pain?

Several complications can result from lower back pain, particularly when it is left untreated.

Neuropathy

Neuropathy results from pain caused by the compression or squashing of a nerve. For example, a herniated disk can press on a nearby nerve and cause pain. A 2014 study showed as many as 10% of people in the US experience some type of neuropathic pain³.

Neuropathic pain that originates from your spine or back may include:

• Gradually worsening discomfort after back surgery (failed back surgery syndrome)

• Pain that radiates down your leg (sciatica – lumbar radiculopathy)

• Pain that radiates down your arm (cervical radiculopathy)

Weight gain

When a person is in constant pain, it prevents them from engaging in physical activity. Chronic pain can keep you from exercising regularly, an essential part of a healthy lifestyle.

Having restricted movement because of back pain causes people to lose muscle mass and put on weight⁴. Being inactive can also lead to bad habits regarding posture.

Disability-related loss of work

Severe back pain is the leading reason people give for disability-related missed work. Around 83 million workdays are lost each year because of back pain⁵. Chronic back pain can make it hard to stand or sit for long periods, which can impact your ability to work.

Depression

Depression is another condition linked to chronic back pain⁶. Those living with chronic back pain are up to four times more likely to experience major depression in the general population.

Insomnia

People who are struggling with severe pain often have disrupted sleep patterns, which can lead to insomnia⁷. Sleep pattern disruptions can include:

• Waking up throughout the night more often and for longer periods 

• Taking longer to fall asleep

• Shorter total sleep time

• Poorer sleep quality

There are several causes of low back pain, including:

1. Strains

Excess activity can cause the muscles in your back to stretch, tighten, or tear. Symptoms will often present as stiffness or muscle spasms around the lower back region.

2. Sciatica

This occurs when the disk nerve has been compressed by herniated disks or nearby muscles. The sciatic nerve starts from the spine and attaches to the hips, hamstring, and calves. As a result, sciatica can lead to numbness, tingling, pain, and even burning in these areas.

3. Disk injury

The disks in your back are susceptible to injury. As you age, this risk increases but decreases in the elderly, particularly over 80 years old¹¹. Examples of disk injuries include degenerative changes, herniations, and bulges.

One of the most common disk injuries is a herniated disk (ruptured or slipped disk). It occurs when the inner contents of the disk exit the cartilage and can start pushing against the nerve roots or spinal cord.

This can lead to compression of the nerve roots as it exits through your vertebral bones from your spinal cord. These types of disk issues are common in lifting and bending injuries.

4. Spinal stenosis

This condition occurs when the space narrows between the spinal cord and/or exiting nerves from the spinal column. This can create extra compression on your nerves, leading to symptoms down your legs. Examples of these include:

• Tingling

• Pain

• Cramping

• Numbness

• Weakness

 Activities that may aggravate symptoms include standing and/or walking.

5. Abnormal spine curvatures

Abnormal spine curvatures are caused by conditions known as kyphosis, scoliosis, and lordosis. These are congenital conditions that are typically diagnosed during adolescence and childhood. The abnormal curvature leads to pain due to poor spinal alignment and overall imbalances.

6. Osteoarthritis

Osteoarthritis affects millions of people all over the world. It is a type of arthritis that occurs when the protective cartilage on the ends of your bones wears down over time.

The condition can cause joint damage, often in the joints in your hips, knees, hands, and spine. It also causes lower back pain.

Risk factors for developing lower back pain

Anyone can experience lower back pain. However, certain factors can increase your risk, including:

Age

Low back pain often occurs first in individuals between the ages of 30 and 50

Genetics

Certain back-pain causes, such as ankylosing spondylitis (an inflammatory condition that can cause fusion of the vertebral joints), have a genetic mechanism

Weight gain

Being obese or overweight or gaining weight rapidly can place stress on your back, leading to lower back pain

Workplace-related factors

If you work in a job that requires pushing, pulling, or heavy lifting, it increases the likelihood of injuring your back. Even stationary tasks, such as sitting at a desk all day, can lead to back pain, particularly if your posture is poor or your work environment isn’t ergonomic.

How is lower back pain diagnosed?

Your doctor will ask you about your symptoms and perform a physical examination. They may also order imaging tests to confirm or exclude a diagnosis. These tests help your doctor see clear images of your disks, vertebrae, muscles, tendons, and ligaments. Examples include:

• X-ray of your spine: Recreates an image of your spine and bones using radiation

• CT scan: Uses a computer and x-rays to create 3D images of your soft tissues and bones

• MRI: Uses radio waves and a magnet to create images of muscles, tendons, bones, and other soft tissues

• Electromyography (EMG): This is used on your muscles and nerves to check for nerve damage (neuropathy)

The doctor may also order urine tests or blood tests, depending on the cause of your pain. Urine tests help the doctor check for kidney stones that cause flank pain (pain in the sides of your lower back). The blood tests can help them look for genetic markers for certain conditions that lead to back pain (e.g., ankylosing spondylitis).

The goal of low back pain treatment is to reduce pain. However, these treatments might not alter the underlying cause of the pain. Physicians will usually recommend the following treatments in combination with physical therapy.

What are early treatments for lower back pain?

Early treatments may include:

Self-care

Some self-care measures you can try are:

• Avoid prolonged bed rest and gradually resume normal activities. Your doctor or physical therapist may recommend some restrictions temporarily to help with recovery.

• Cold and/or hot packs

• Corrective or strengthening exercises to help relieve pain

You must always check with your doctor or physical therapist before beginning any exercise program.

OTC medications

Taking over-the-counter pain relievers, such as acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin IB, Advil), may help temporarily relieve the pain.

Physical therapy

There are specific programs designed to help relieve and prevent lower back pain. Depending on your condition, these exercises may help strengthen your core, improve posture, increase trunk flexibility, and stretch out tight muscles.

What are non-surgical treatment options?

Other non-surgical treatment methods may include:

Medication

Your doctor may prescribe short-term medication therapy for your lower back pain. Examples of medication that they may prescribe are:

• Muscle relaxants: Relieves muscle spasms and tightness

• Anti-inflammatories: Reduces inflammation

• Opioids: Powerful drugs which help to relieve pain

Epidural steroid injections

A steroid is injected around the spine. The doctor uses fluoroscopy (a live x-ray) to guide the needle to the proper location. The injection should relieve your pain temporarily by decreasing inflammation around the affected area.

Spinal mobilization and spinal manipulation

Spinal mobilizations and manipulations are commonly performed by healthcare practitioners, such as physical therapists and chiropractors.

During manipulation, rapid movement helps relieve pressure through the spine, which is heard in the form of a crack or pop. Slower adjustment movements are used during mobilization, which can gently ease stiffness in the spine.

The methods may offer short-term, mild-to-moderate relief in individuals with lower back pain, but neither approach can sustain long-term relief in chronic conditions (such as arthritis and spondylitis).

Transcutaneous electrical nerve stimulation (TENS)

This approach involves attaching electrodes to your back that are connected to a portable battery-power device. It generates electrical impulses that help modify or block pain signals to and from the brain.

Other treatment options

• Cognitive therapy: This involves coping methods and relaxation techniques to alleviate back pain

• Electrical biofeedback: Electrodes are attached to your skin, and an electromyography device allows you to become aware of and control your heart rate, breathing, skin temperature, and muscle tension. It helps you regulate your response to pain through relaxation techniques.

• Acupuncture: Acupuncture is anecdotally effective for those with chronic lower back pain. A specialist inserts thin needles into acupressure points throughout the body.

What are surgical treatment options?

Your doctor may recommend surgery when other therapies aren't effective at relieving pain. Some conditions that may need surgery are serious musculoskeletal injuries or severe nerve compression.

Some common surgeries include:

Spinal decompression or spinal laminectomy

A part of the spine is removed to decrease the narrowing and compression on the nerve(s). 

Spinal fusion

This surgery is performed to prevent excessive spinal movement in individuals with certain conditions, such as spondylolisthesis. Parts of the spine are fused to avoid further movement.

Kyphoplasty and vertebroplasty

Used for a fractured vertebra. These are minimally invasive procedures to help repair breaks in the spinal bones.

Can lower back pain be reversed or cured?

Most lower back pain can improve within a month of home remedies or with the assistance of healthcare professionals. However, low back pain can be a complex condition that varies from person to person, and many people experience persistent pain for several months or more.

Preventing lower back pain is possible, and prevention is better than cure. Practicing prevention approaches may be particularly beneficial if you regularly experience lower back discomfort.

Examples of prevention strategies include:

• Losing weight if you're obese or overweight

• Exercising your back and abdominal muscles

• Maintaining a proper posture

• Developing correct lifting and carrying techniques

Other less proven strategies include:

• Sitting on supportive chairs at the proper height

• Sleeping on a medium-firm mattress 

• Quitting smoking

• Avoiding high-heeled shoes

Different types of doctors and specialists diagnose and treat lower back pain. They often have varied interests and training.

The first step is usually when you make an appointment with a primary health care provider (e.g., doctor, physical therapist, doctor of osteopathic medicine, or chiropractor). If your pain persists after initial treatment, you may require a spine specialist's services.

Three broad groups of doctors and specialists treat lower back pain:

1. Primary care doctors

Primary care doctors are typically the first type of healthcare specialist you'll call when you start experiencing back pain. They include:

• Medical doctors (e.g., family physicians, sports doctors)

• Doctors of osteopathic medicine

• Chiropractors

2. Spinal specialists

These doctors have more specific expertise in specific spinal conditions. Examples of common specialists who treat spinal conditions include:

• Neurosurgeons

• Neurologists

• Rheumatologists

• Orthopedic specialists

3. Therapists

Therapists are experts in physical health and movement. They use strategies such as manual therapy, physical rehabilitation, and psychological support to help treat lower back pain.

Therapists you can help seek support from include:

• Occupational therapists

• Physical therapists

• Clinical psychologists

Your outlook for recovery will depend on what's causing your pain. Most individuals with back sprains and strains tend to recover without experiencing long-term health problems. However, other people may require support from some or all healthcare professionals above.

Seek support early to prevent your lower back pain from becoming chronic. Older individuals with degenerative disorders such as osteoporosis and arthritis may experience ongoing symptoms. However, various treatments are available for these problems, including self-care strategies, physical therapy, medication, and specialist interventions.