Lower back pain is a widespread issue, and while sometimes the cause is obvious – like lifting a heavy object incorrectly – often the reason behind your discomfort can feel like a puzzle.
“Your lumbar spine, situated in your lower back, is vital for supporting your upper body weight. It’s also crucial for everyday actions such as bending, twisting, and coordinating muscles in your hips, pelvis, legs, and feet,” explains Dr. Kenneth Palmer, an orthopedic surgeon specializing in spine surgery at Houston Methodist. “This frequent use makes the bones, muscles, ligaments, disks, and nerves in your lumbar spine prone to injuries and wear and tear over time, 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 in the lower back area
- Sharp, shooting pain that begins in the lower back and radiates down one leg (sciatica)
- Pain that intensifies when sitting but eases quickly with walking
- Pain that is noticeably worse in the mornings
Dr. Palmer notes, “Individuals typically experience a combination of these symptoms, which can appear suddenly or gradually. For some, lower back pain may seem to come and go, flaring up occasionally but generally worsening over time.”
It’s also important to recognize that lower back pain symptoms can differ from person to person, depending on the underlying cause. Let’s delve into those causes.
Common Culprits: Strains and Sprains
Throughout your day, your lumbar spine is constantly engaged, whether you realize it or not.
Amidst this constant activity, a lower back sprain or strain can occur due to a sudden injury, such as a fall, lifting something too heavy, or during sports. These can also develop over time due to repeated motions or poor posture.
“Muscle strains and ligament sprains are the most frequent reasons for lower back pain,” says Dr. Palmer. “While they can be quite painful, these common causes are usually not long-lasting, typically resolving within a few days to a few months at most.”
Your doctor can guide you on the best self-care practices to aid in healing your lower back pain.
“Treatment for a pulled back muscle or strained ligament is generally straightforward and may include pain relievers, anti-inflammatory medications, muscle relaxants, applying ice to reduce inflammation, using heat to encourage healing, and avoiding strenuous activities until the pain subsides,” Dr. Palmer explains. “The optimal treatment plan 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 necessary to consider other potential causes.
Chronic Lower Back Pain: When It Lasts
“Chronic lower back pain is less likely to stem from muscle or ligament injuries and more likely to originate from problems with the lumbar disks, nerves, joints, or vertebrae,” Dr. Palmer clarifies. “Several conditions can lead to chronic pain in the lower back.”
Osteoarthritis, the most common form of arthritis, and degenerative disk disease, the natural wear and tear of spinal disks, are often the root causes of chronic lower back pain. However, trauma from accidents and acute stress can also contribute.
Herniated Disk
“The adult thoracic and lumbar spine comprises about 17 vertebrae stacked upon each other. Between each vertebra is a cushioning disk that helps absorb pressure on these bones,” Dr. Palmer explains.
Each disk consists of a tough outer layer and a gel-like inner core.
A lumbar herniated disk occurs when the inner gel of one of the five disks in your lower back protrudes or squeezes out beyond the outer layer, pressing on nearby nerves and causing pain. This can result from injury or gradual, age-related degeneration.
Facet Joint Damage
The facet joints, connecting the vertebrae in your lower back, endure significant compressive forces and stress. Over time, the cartilage in these joints can deteriorate, leading to lower back pain.
“Facet joint damage, often due to osteoarthritis, can result from poor posture or repetitive overuse, causing inflammation, stiffness, muscle spasms, and pain,” Dr. Palmer says. “Furthermore, if a damaged facet joint impinges on a nearby nerve, it can lead to sciatica.”
Compression Fracture
“A spinal compression fracture happens when a vertebra in your lumbar spine essentially collapses. This is frequently due to osteoporosis but can also be caused by trauma,” Dr. Palmer explains.
This collapse can cause intense pain, and individuals with a lumbar compression fracture often experience sudden pain and restricted spinal movement.
Spinal Stenosis
Lumbar spinal stenosis occurs when the spinal canal in your lower back narrows, putting pressure on nerve roots. It can be triggered by bone spur formation, thickening of a nearby ligament, or degeneration of a lumbar disk or joint.
“Compressed nerve roots can be extremely painful,” Dr. Palmer states. “Spinal stenosis not only causes lower back pain but can also lead to sciatica, pain radiating down the legs.”
Spondylolisthesis
If a lumbar vertebra slips forward over the vertebra below, it places significant compressive force on the disk separating them. As this disk deteriorates, it can cause lower back pain. Additionally, flattening of the disk from this force can lead to nerve compression and sciatica.
“One common type, isthmic spondylolisthesis, is caused by a fracture in a small bone piece called the pars interarticularis, located near the facet joint. This fracture often occurs in youth, though pain may not appear until later in life,” Dr. Palmer mentions. “Spondylolisthesis can also arise from degenerative or congenital factors.”
Scoliosis
Your spine naturally curves in an ‘S’ shape when viewed from the side, with the upper back curving backward and the lower back forward. Scoliosis, a sideways spinal curvature seen from behind, is a spinal deformity that can cause back pain.
“An improper spinal curvature increases the likelihood of lumbar joint and disk degeneration,” Dr. Palmer warns. “Most scoliosis cases don’t need treatment, but severe curvature can significantly stress the lower back and cause pain.”
When Should You See a Specialist for Lower Back Pain?
If your lower back pain doesn’t improve with rest and self-care, it’s advisable to consult a spine specialist.
“A spine specialist will likely conduct a physical examination and may order imaging scans to pinpoint the cause of your lower back pain. Based on the diagnosis, they will create a treatment plan to alleviate your pain and help you return to your daily activities,” concludes Dr. Palmer.
