Lower back pain, also called lumbago, is not a disorder. It’s a symptom of several different types of medical problems. It usually results from a problem with one or more parts of the lower back, such as:
- the bony structures that make up the spine, called vertebral bodies or vertebrae
It can also be due to a problem with nearby organs, such as the kidneys.
According to the American Association of Neurological Surgeons, 75 to 85 percent of Americans will experience back pain in their lifetime. Of those, 50 percent will have more than one episode within a year. In 90 percent of all cases, the pain gets better without surgery. Talk to your doctor if you’re experiencing back pain.
Understanding the back
To understand the causes of lower back pain it helps to understand the back. Your back comprises many parts, including:
- vertebrae (spine bones)
- blood vessels
The lower spine is one of the keys to low back pain. It’s made up of:
- the bones of the lower spine, including the lumbar and sacral vertebrae
- disks of cushioning tissue between the vertebrae
- nerves and your spinal cord
- muscles and ligaments
What causes back pain?
The most common causes of lower back pain are strain and problems with back structures.
Strained muscles and ligaments often cause back pain. Strain commonly occurs with incorrect lifting of heavy objects and sudden awkward movements. Strain can also result from over-activity. An example is the sore feeling and stiffness that occurs after a few hours of yard work or playing a sport.
Vertebrae are the interlocking bones stacked on top of one another that make up the spine. Disks are areas of tissue that cushion the space between each vertebra. Disk injuries are a fairly common cause of back pain.
Sometimes these disks can bulge, herniate, or rupture. Nerves can get compressed when this happens. Herniated disks can be very painful. A bulging disk pressing on the nerve that travels from your back down your leg can cause sciatica or irritation of the sciatic nerve. Sciatica can be experienced in your leg as:
Abnormalities of the skeleton can also cause back pain. This includes scoliosis or narrowing of the spinal canal due to arthritis.
Loss of bone density and thinning of the bone, called osteoporosis, can lead to fractures in your vertebrae. These fractures can cause serious pain and are referred to as compression fractures.
Other causes of back pain
There are many other potential causes of back pain, but most of these are rare. Be sure to see your doctor if you experience regular back pain that does not go away. After ruling out the more common causes of back pain, your doctor will perform tests to determine if you have a more rare cause. These can include:
- narrowing of the spinal canal, or spinal stenosis
- displacement of one vertebral body onto another, called degenerative spondylolisthesis
- loss of nerve function at the lower spinal cord, called cauda equina syndrome (a medical emergency)
- fungal or bacterial infection of the spine, such as Staphylococcus, E. coli, or tuberculosis
- cancer or nonmalignant tumor in the spine
What are the characteristics of back pain?
Back pain can have many symptoms, including:
- a dull aching sensation in the lower back
- a stabbing or shooting pain that can radiate down the leg to the foot
- an inability to stand up straight without pain
- a decreased range of motion and diminished ability to flex the back
The symptoms of back pain, if due to strain or misuse, are usually short-lived but can last for days or weeks. Back pain is chronic when symptoms have been present for longer than three months.
Back pain symptoms that may indicate a serious problem
The Mayo Clinic recommends you see your doctor if back pain does not improve within two weeks of developing. There are times when back pain can be a symptom of a serious medical problem. Symptoms that can indicate a more serious medical problem are:
- loss of bowel or bladder control
- numbness, tingling, or weakness in one or both legs
- onset following trauma, such as a fall or a blow to the back
- intense, constant pain that gets worse at night
- presence of unexplained weight loss
- pain associated with a throbbing sensation in the abdomen
- presence of fever
Let your doctor know if you have any of these symptoms.
Risk factors for back pain
According to the Mayo Clinic, you’re at an increased risk for back pain if you:
- work in a sedentary environment
- engage in high-impact activity without stretching or warming up first
- are of older age
- are obese
- are a smoker
Studies show that your emotional health also has an effect on your risk for back pain. You may be at a higher risk for back pain if you have a stressful job or suffer from depression and anxiety.
How is back pain diagnosed?
A physical exam is typically all that’s needed to diagnose back pain. During the physical exam, your doctor may test your:
- ability to stand and walk
- spine’s range of motion
- leg strength
- ability to detect sensations in your legs
If a serious condition is suspected, your doctor might order other tests, including:
- blood and urine tests to check for underlying conditions
- X-rays of the spine to show alignment of your bones and check for breaks
- computed tomography (CT) scan or magnetic resonance imaging (MRI) to assess your disks, muscles, ligaments, nerves, and blood vessels
- bone scan to look for abnormalities in the bone tissue
- electromyography (EMG) to test nerve conduction
Treatment for back pain
The majority of back pain episodes are relieved by treatment with nonsteroidal anti-inflammatory medications, such as:
Pain relievers, or analgesics, such as acetaminophen (Tylenol), are also an option, though they don’t have as much anti-inflammation properties. Except for acetaminophen, these medications should be taken with food because they can irritate the stomach lining. Be careful with medications like ibuprofen if you have kidney problems or stomach ulcers. Never take more than the recommended dose of over-the-counter medicine without talking to a doctor, as even these medications may have severe side effects if taken incorrectly.
If back pain is severe, your doctor may try other medications that focus on different parts of the pain response, such as gabapentin or amitriptyline, a tricyclic antidepressant. The latter may work better for nerve-related pain.
Your doctor might recommend cortisone steroid injections for severe back pain. Pain relief from steroid injections usually wears off by around three months.
Ice packs may relieve discomfort and help lessen inflammation in acute phases of back pain. Warm compresses may relieve pain when inflammation has subsided.
Exercises to improve posture and strengthen the muscles of the back and abdominal muscles, called the core muscles, are a treatment option that should be strongly considered. This treatment often involves:
- improving posture
- using proper lifting techniques
- strengthening core muscles
A physical therapist can teach you how to perform these types of exercises at home.
Surgery is a treatment of last resort and is rarely needed for back pain. It’s usually reserved for structural abnormalities that have not responded to:
- conservative treatment with medicines and therapy
- severe, unremitting pain
- nerve compression that cause muscles to become weak
Spinal fusion is a surgery in which painful vertebrae are fused into a single, more solid bone. It helps eliminate painful motion of the spine.
Surgery to partially remove and replace disks and vertebrae may be done to relieve pain caused by degenerative bone diseases.
Alternative therapies that may help relieve back pain include:
- chiropractic adjustments
- cognitive behavioral therapy
- relaxation techniques
Be sure to talk to your doctor before undergoing any alternative or complementary treatment.