Sometimes, the reason for your lower back pain is obvious. You might have strained it lifting something heavy, or perhaps years of poor posture have finally caught up. But often, the cause of lower back pain can feel like a puzzle.
“Your lower back, or lumbar spine, is essential for supporting your upper body weight and enabling everyday movements like bending, twisting, and coordinating your hips, pelvis, legs, and feet,” explains Dr. Kenneth Palmer, an orthopedic surgeon specializing in spine surgery at Houston Methodist. “This constant use makes the bones, muscles, ligaments, discs, and nerves in your lumbar spine vulnerable to injuries and wear and tear, leading to lower back pain.”
Lower back pain can manifest in various ways, including:
- A persistent dull ache in the hips and/or pelvis
- Muscle spasms or tightness
- Sharp, shooting pain that begins in the lower back and radiates down one leg (sciatica)
- Pain that worsens when sitting but eases quickly with walking
- Increased pain in the morning
Dr. Palmer notes, “People usually experience a combination of these symptoms, which can appear suddenly or gradually. Lower back pain can also be intermittent, flaring up occasionally but generally worsening over time.” He also emphasizes that symptoms can vary depending on the individual and the underlying cause of the pain.
Let’s delve into the common reasons behind lower back pain.
Common Culprits: Strains and Sprains
Your lumbar spine is constantly working, whether you realize it or not. This continuous activity makes it susceptible to sprains and strains, which are among the most frequent causes of lower back pain.
These injuries can stem from sudden events like falls, improper heavy lifting, or sports-related incidents. They can also develop gradually due to repetitive motions or poor posture.
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“Muscle strains and ligament sprains are the most common reasons for lower back pain,” Dr. Palmer states. “While they can be quite painful, these common causes are usually not long-lasting, typically resolving within a few days to a few months.”
Your doctor can guide you on the best self-care strategies to help your lower back heal.
“Treatment for a pulled back muscle or strained ligament is generally straightforward and may involve pain relievers, anti-inflammatory medications, muscle relaxants, ice to reduce inflammation, heat to promote healing, and avoiding strenuous activities until the pain subsides,” Dr. Palmer advises. “The specific approach will depend on the severity of your injury and your overall core and lower body strength.”
If your lower back pain persists despite these treatments, it might be time to explore other potential causes.
Chronic Lower Back Pain: Uncovering the Deeper Issues
“Chronic lower back pain is less likely to originate from muscle and ligament injuries and more often points to problems with the lumbar discs, nerves, joints, or vertebrae,” Dr. Palmer clarifies. “Several conditions can lead to chronic lower back pain.”
Osteoarthritis, the most prevalent type of arthritis, and degenerative disc disease, the natural wear and tear of spinal discs, are often at the root of chronic lower back pain. However, trauma from accidents and acute stress can also contribute.
Herniated Disc
“The adult thoracic and lumbar spine comprises about 17 vertebrae stacked upon each other. Between each vertebra is a cushiony disc that absorbs pressure on these bones,” Dr. Palmer explains.
Each disc consists of a tough outer layer and a gel-like inner core.
A lumbar herniated disc occurs when the inner gel of one of the five discs in your lower back protrudes through the outer layer, pressing on nearby nerves and causing pain. This can be triggered by trauma or gradual, age-related degeneration. The pressure on the nerve is what leads to the sharp, often radiating pain associated with a herniated disc.
Facet Joint Damage
The facet joints, connecting the vertebrae in your lower back, bear significant compressive force and stress. Over time, the cartilage in these joints can deteriorate, leading to lower back pain.
“Facet joint damage, often resulting from osteoarthritis, can be caused by poor posture or repetitive overuse and can lead to inflammation, stiffness, muscle spasms, and pain,” Dr. Palmer elaborates. “Furthermore, if a damaged facet joint impinges on a nearby nerve, it can trigger sciatica.” The pain from facet joint issues can range from a dull ache to sharp, localized pain, and may worsen with certain movements.
Compression Fracture
“A spinal compression fracture happens when a vertebra in your lower back essentially collapses,” says Dr. Palmer. “This is frequently due to osteoporosis, but can also result from trauma.”
This collapse can cause intense pain, and individuals with a lumbar compression fracture often experience sudden, severe pain and restricted spinal mobility. The pain is usually immediate and can be debilitating, requiring medical intervention to manage pain and stabilize the spine.
Spinal Stenosis
Lumbar spinal stenosis occurs when the spinal canal in your lower back narrows, putting pressure on the nerve roots. This narrowing can be caused by bone spurs, thickening of ligaments, or degeneration of a lumbar disc or joint.
“Compressed nerve roots can be incredibly painful,” Dr. Palmer points out. “Spinal stenosis not only causes lower back pain but can also lead to sciatica, pain that extends down the legs.” The pain associated with spinal stenosis is often described as cramping or burning and may worsen with prolonged standing or walking, often relieved by sitting or bending forward.
Spondylolisthesis
If a lumbar vertebra slips forward over the vertebra below, it places significant compressive force on the disc between them. As this disc deteriorates, it can cause lower back pain. Additionally, disc flattening from this force can compress nerves and lead to sciatica.
“One common type, isthmic spondylolisthesis, is caused by a fracture in the pars interarticularis, a small bone adjacent to the facet joint. This fracture often occurs in youth, though pain may not manifest until later in life,” explains Dr. Palmer. “Spondylolisthesis can also arise from degenerative or congenital factors.” The pain from spondylolisthesis can be felt in the lower back and buttocks, and may radiate down the legs, often aggravated by activity and relieved by rest.
Scoliosis
Your spine naturally curves in an ‘S’ shape when viewed from the side. However, scoliosis is a sideways curvature of the spine when viewed from behind, a spinal deformity that can cause back pain.
“When the spine has an improper curvature, it increases the likelihood of degeneration in the lumbar joints and discs,” Dr. Palmer cautions. “Most scoliosis cases don’t require treatment, but severe curvature can place considerable stress on the lower back and cause pain.” Scoliosis-related back pain can be chronic and may worsen with age, and in severe cases, it can affect posture and breathing.
When to Seek Expert Help for Lower Back Pain
If your lower back pain doesn’t improve with rest and self-care, it’s time to consider consulting a spine specialist.
“A spine specialist will likely conduct a physical examination and may order imaging scans to pinpoint the root cause of your lower back pain. Based on the diagnosis, they will develop a treatment plan to alleviate your pain and prevent it from interfering with your daily life,” concludes Dr. Palmer. Seeking timely professional help can lead to accurate diagnosis and effective management of your lower back pain, helping you regain comfort and mobility.
