Low Back Pain

Low Back Pain:

Everything you need to know

Low and lower back pain can vary from a dull ache that develops gradually to sudden, sharp, or persistent pain felt below the waist. Here’s what we know about causes, diagnosis, treatment, and more.

If you’ve ever had low back pain stop you from doing what you want, you’re not alone. It’s a leading reason why people visit a doctor, affecting more than 80% of adults at some point in their lives. According to the Global Burden of Disease—a significant study published in the Lancet medical journal—lower back pain is also a leading cause of disability.

You may not be able to prevent lower back pain, especially as you age and your back loses some strength and resilience. Fortunately, there are many ways you can get relief, no matter the cause of your back pain.

Causes

Low Back Pain Causes

The most common causes of low back pain include:

Spasms, sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. They’re often related to overuse.

Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear (see below).
Herniated disc. The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves.
Sciatica. Pain that results from a pinched or irritated sciatic nerve. This nerve runs down your lower back through your hips and buttocks and down each leg. Sciatica is how laypeople refer to pain that travels down the leg from the lower back, although your doctor may use the term lumbar radiculopathy.
Spondylolisthesis. A vertebra slides forward out of position, disrupting your spine’s alignment and sometimes compressing nerve roots. It is most common in the lumbar region, but can happen anywhere along the spine. This slippage is often caused by either disc degeneration or a fractured vertebra (pars fracture or spondylolysis).
Spinal stenosis. A narrowing of the inside spaces of your spine, most often from a herniated disc but sometimes from bone spurs caused by spinal osteoarthritis (aka spondylosis). This can result in painful pressure on your spinal nerves. Spinal stenosis can occur in anywhere in the spine, but lumbar spinal stenosis is the most common.

Scoliosis and other spinal deformities. Scoliosis, the most common spinal deformity, is one or more a side-to-side curves to the left or right. Other abnormal curves include:

Lordosis, in which the spine curves too far inward at the lower back
Kyphosis, in which the spine is abnormally rounded in the upper back

Arthritis. There are more than 100 types of arthritis, many of which can cause lower back pain. The most common types include spondylosis (the most common by far), rheumatoid arthritis, and ankylosing spondylitis.

Less common causes can include:

Cauda equina syndrome. Compression of the bundle of nerves that forms below the spinal cord in the lumbar spine. Cauda equina syndrome is an emergency. The condition got its name from the fact that the fanned-out bundle of nerves resembles the base of a horse’s tail.
Discitis or osteomyelitis. Both infections of discs (discitis) and vertebral bone (osteomyelitis) can cause severe pain and require prompt medical attention.
Osteoporosis. Your bones lose mass faster than it can be replaced, making them brittle. They can even fracture with little or no warning. These fractures are especially common in the spine, where they’re called vertebral compression fractures. Both men and women lose bone mass as they age, but postmenopausal women lose it much faster and so are more at risk for osteoporosis.
Spinal tumors. When cells divide and multiply unchecked, the result is a tumor. Both benign and malignant tumors can cause lower back pain. They can either originate in the spine or metastasize there, meaning they’ve spread from somewhere else in the body.

Symptoms

Low Back Pain Symptoms

Low back pain symptoms—and treatment—can vary based on the underlying cause.

Symptoms occurring with low back pain can include:

Numbness
Tingling
Weakness
Tenderness
Limited range of motion
Pain radiating down one or both legs (radiculopathy)

Low back pain can be categorized as acute, subacute or chronic. Acute episodes of lower back pain usually last from a few days to four weeks, and subacute lower back pain lasts between four and 12 weeks.

According to the National Institutes of Health, about 20% of people with acute back pain go on to develop chronic back pain—defined as pain that lasts 12 weeks or longer. Most cases of back pain go away on their own within two weeks.

When to Seek Medical Attention for Back Pain

Most episodes of lower back pain eventually resolve on their own, but there are times when you should seek urgent medical attention. Some of these situations include:

Patient is a child
Accident, injury, other trauma
Fever or nausea
Weakness, numbness and/or tingling sensations develop in the legs and/or feet
Loss of bladder or bowel control
Pain is severe, constant, suddenly or progressively worsens, and/or doesn’t go away
Pain interrupts sleep

While some situations may warrant immediate intervention, most cases are not urgent and can be scheduled at a time convenient for the patient.

Diagnosis

Low Back Pain Diagnosis

Getting diagnosed with a specific cause of low back pain is the first step to getting treatment. If you land in your doctor’s office hoping for back pain relief, they’ll use a variety of diagnostic tools and methods, such as:

A thorough medical history including any recent injuries, other diagnoses, family history of disease, and your job, activities and other lifestyle considerations
Physical exams, which may include manipulating the painful area or reflex or other neurological tests
Electromyography, which measures muscle and nerve function
Imaging—X-rays can show bone spurs and damage to bone, while CT scans and MRIs can depict damage to soft tissue like discs or ligaments

Treatment

Low Back Pain Treatment

Home Remedies

Unless you’ve had a major injury, such as a fall or car accident, you probably don’t need to rush to the doctor for back pain. You may want to try these simple self-care strategies first.

Avoid bed rest. When lower back pain strikes, people often think complete rest will relieve back pain. However, a 2010 review of many clinical studies found that patients who retreated to bed actually experienced more pain – and recovered more slowly – than patients who stayed fairly active.
Use ice and/or heat. Many people find that using ice or cold packs for periods of up to 20 minutes at a time helps reduce pain and swelling. Always wrap ice or a cold pack in a thin towel before putting it on your body so you don’t injure your skin. You may also find that heat, such as a heating pad or warm bath, eases pain. Ice is recommended in the first 48 hours after injury; then you can try a combo of ice and heat.
Try over-the-counter (OTC) remedies. Short-term use of OTC pain relievers, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen, may ease your lower back pain. Also consider OTC creams, gels, patches, or sprays applied to the skin. They stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain.

Nonsurgical Treatments

Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.

Medications. When over-the-counter pills and topicals don’t do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:

Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
Muscle relaxants, such as baclofen or carisoprodol
Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
Opioids such as oxycodone or hydrocodone, on a short-term basis. (For a variety of reasons, opioids aren’t good long-term options for many patients.)

Physical therapy (PT). PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:

Exercise
Ice/heat
Massage
Transcutaneous electrical nerve stimulation (TENS)
Ultrasound

Injections. An epidural steroid injection or a selective nerve block may provide short-term pain relief when lower back pain causes sciatica symptoms, such as leg pain.

Low Back Pain Surgery

Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:

Spinal Fusion. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spine’s stability in severe cases of spinal osteoarthritis or herniated discs.
Laminectomy and laminotomy. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.
Discectomy and microdiscectomy. When a herniated disc in the lower back is causing severe symptoms like pain or loss of sensation, your surgeon might operate to remove a portion of the damaged disc. When the surgeon operates through standard incisions in your back, the surgery is known as a discectomy. When the surgeon uses a minimally invasive technique and small incisions, the surgery is called a microdiscectomy. Discectomies are rarely performed anymore due to the safety, effectiveness, ease and low rate of complications that microdiscectomy brings to the table.

Complementary, Alternative, Emerging Treatments

In some cases, doctors suggest therapies that are not considered current “standard of care.” They probably won’t be covered by insurance, but they may be worth considering. Examples include:

Platelet-rich plasma (PRP). PRP treatments use a small sample of your own blood that has concentrated amounts of blood building blocks known as platelets. Your doctor then injects the PRP directly into a damaged disc. The theory is that PRP injections use your own healing system to accelerate improvement of injured tendons, ligaments, muscles, and joints. PRP treatment has a longer track record in knee osteoarthritis, but a 2018 review in the Journal of Spine Surgery suggests it may have a useful role for back pain, too. PRP needs a lot more research before it can be considered a proven technique.
Stem cells. In this emerging treatment, your doctor injects stem cells harvested from your hip into the intervertebral disc or discs causing your pain. Doing so may lessen pain and the degenerative effects of aging, though, like PRP, more research is needed before stem cells for lower back pain could eventually become the standard of care.
Acupuncture. Your doctor probably doesn’t perform acupuncture (some do), but may support you trying it as a complementary therapy. Acupuncture involves careful insertion of fine, sterile needles into specific points on your body. This may stimulate the release of your natural pain-killing chemicals.