Lower Back Pain
Are you looking for low back pain relief? You're not alone.
Your lower back is one of the most critical areas of your body for movement. And it's also one of the trickiest to diagnose and fix.
Pain in the low back region is a widespread problem affecting up to 80% of people in their lifetime. And many people deal with it chronically, meaning they're in pain for over three months.
Whether your pain is new or you’ve been dealing with it for a while, you’re ready for some relief, so let’s dive in to understand it and figure out what can be done to relieve your pain.
In this article, we'll start by looking at the parts of your lower back to establish where pain might come from so we can effectively treat it. We'll discuss common causes of a bad lower back. Finally, we'll cover some of the treatments for low back pain and what you may want to consider doing to repair it and help avoid it happening again.
By the end of this post, you should have the knowledge needed to understand the pain that you’re feeling, work through some self-guided assessment and treatment, and accurately discuss what you’re feeling with healthcare professionals.
Let's start by better understanding what we mean by the low back and what causes pain in the first place.
What do we mean by the lower back?
Your lower back is the rear, midsection of your body, or your core, extending from and including your hips up to your ribcage. The low back is a beautiful structure of bones, muscles, tendons, ligaments, and nerves that are critical to the normal movement of your body.
The significant parts of your lower back include:
Your lumbar spine
Lower back muscles
Ligaments and tendons
Your Lumbar Spine
The lumbar spine is a series of five interlocking bones stacked on each other, called vertebrae. These bones serve a critical job in protecting your spinal column, and they bear most of your upper body's weight and allow you to flex and twist.
Spinal discs (Intervertebral discs) are the shock absorbers that separate the five vertebrae, and ligaments tie the lumbar spinal structure together.
Your Lower Back Muscles
Your lower back muscles are robust straps that run through your lower back to connect your upper and lower body.
To many people's surprise, your lower back muscles often run far beyond your lumbar spinal region. Some start at your inner thigh, while others run up to your neck and even include your buttocks!
The muscles of your lower back include:
The erector spinae muscles run along your spine.
The multifidus muscles are deep in your back.
The quadratus lumborum muscles.
The powerful gluteus muscles.
The psoas, which attaches to the front of the vertebra.
The transverse abdominal muscle and the internal and external obliques.
Nerves of your lower back
Nerves are the delivery network to control movement and for pain and pleasure. And your lower back contains some of the largest nerves in your body.
Compression or damage to any of your nerves can cause pain, weakness or numbness in your lower back, legs and feet.
The more significant nerves in your lower back are:
The Sciatic nerve, the largest nerve in your body, is primarily responsible for sensation and movement in your legs and feet.
The femoral nerve provides sensation to your thighs and inner leg.
The obturator nerve provides sensation to your inner thigh.
And the ilioinguinal and genitofemoral nerves provide sensation to the groin and genitals.
Ligaments and tendons
Ligaments and tendons bind bone-to-bone in joints and muscle-to-bone to create and control movement. They are the unsung heroes of our body's incredible structure. However, they can also be the primary cause of back pain.
Why lower back pain occurs
Low back pain occurs because it’s a critical intersection of your body’s movement, control, and unity.
To establish an idea of its importance, think of a tow ball and trailer plug; all trailer control and movement hinges around this area, paired with a plug for electrics. Our upper body is the vehicle, our legs are the trailer, and our nerves are the electrics.
Your lower back supports and controls forces applied on it from above while managing movement and sensation in your legs.
If a structural abnormality or trauma disrupts any part of the harmonious balance of the working parts, we experience pain.
Degenerative conditions, spinal disorders, and disease also cause lower back pain. These conditions disrupt normal movement, cause inflammation, or directly impose upon the nerves localised in the area.
Now, let's consider how the medical industry regards the different back pain types and what causes them.
How back pain is categorised
The duration, severity, and location of pain categorise low back pain. Understanding the terms can help you with your self-education and support conversations with your healthcare professionals to describe what you're feeling.
Lower back pain ranges from mild to severe and from acute to chronic. Its location can also determine whether the pain is mechanical or radicular. Let's investigate further:
Acute vs. chronic pain
Acute lower back pain is the sudden onset lasting a few days to a few weeks, whereas chronic pain is consistent suffering lasting longer than three months.
Acute injuries are usually the most severe in intensity, as we're more likely to see a healthcare professional to help with our recovery. Chronic injuries are less severe but impact our daily lives enough to affect our lifestyles, sleep, and ability to move normally.
Mechanical vs. radicular pain
Mechanical pain often results from a physical condition, whereas radicular pain radiates down the legs and is associated with nerve impingement or injury.
Mechanical pain is caused by the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. It is localised pain in your lower back, buttocks, and sometimes in your upper legs.
Radicular pain can occur if a spinal nerve becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome (area of skin supplied by the nerve) down into the buttock and leg. It is a specific sensation that is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica), typically felt on one side of the body.
What lower back pain feels like
Lower back pain can present itself with different sensations and feelings depending on the cause. The pain can be localised to the lower back or may radiate down the legs, depending on the underlying cause.
Symptoms can include:
Sharp, dull, or achy pain in the lower back.
Stiffness or limited range of motion.
Muscle spasms or cramping.
Pain that radiates down into the buttocks, legs, or feet.
Numbness, tingling, or weakness in the legs or feet.
Difficulty standing up straight or walking normally.
Pain increases with movement or activity.
Pain that improves with rest or changes in position
Loss of bowel or bladder control.
What are the most common causes of lower back pain?
There are several common causes of lower back pain, the most common being an injury, a muscular strain, and overuse or incorrect loading due to poor posture. Other less common causes are the result of spinal health due to degeneration, disease, and even stress can lead to pain.
The leading causes of a bad lower back are mechanical, which means that the pain results from something physical. Other less common causes can be the result of wear and tear (age) as well as specific diseases.
Common causes of low back pain are:
Osteoarthritis of the spine.
Degenerative disc disease.
Sacroiliac joint dysfunction.
Autoimmune inflammatory conditions - eg. rheumatoid arthritis and ankylosing spondylitis.
One of the most common causes of low back pain is the result of a muscular strain or tear. Strains occur when stretching a muscle too far, causing it to tear and are most often the result of overuse or sudden and forceful movement with an improper technique, such as lifting something heavy.
When muscular strains cause back pain, it presents as an acute injury that's sharp and will cause stiffness and, often, muscular spasms.
Posture is the alignment of your body when sitting or standing. And when this alignment goes offline, additional pressure is placed on other parts of your body to try to keep a balance.
Sitting or standing for an extended period can lead to postural corrections, placing additional strain on the lower back.
For example, sitting causes your hip flexor muscles to shorten and your buttocks (glutes) to weaken. The resulting anterior pelvic tilt postural imbalance is a leading cause of a bad back.
And many people's current lifestyle and working conditions are leading to long periods of sitting, resulting in a growing number of low back injuries.
Osteoarthritis of the spine is a degenerative condition that commonly affects the lower back and develops through wear and tear.
This degenerative condition worsens over time and sometimes occurs in conjunction with degenerative joint disease.
Osteoarthritis results in the cartilage of the joints breaking down over time, resulting in a buildup of inflammation within the joints and associated back pain.
This type of lower back pain is mechanical and is often more noticeable when bending or twisting your spine.
Degenerative disc disease
Over time, our bodies break down due to motion, stress, and loading. And the discs between our spinal vertebrae are prone to deterioration.
The intervertebral discs in our back are 80% water that tends to dry out as we age, reducing their height and affecting their ability to absorb shocks and load.
While its title suggests it's a disease, it's more a natural condition resulting from ageing.
Activities of daily living or sports can also cause damage to the disc, which can make it more susceptible to injury and degeneration.
A disc bulge happens when a disc's spongy centre presses through a degenerated fibrous exterior of the spinal disc, causing a bulge to form. This bulge can impose upon the nerves around the disc or nerve root as it exits the spine, which results in pain.
This condition is usually related to age or wear and tear. Usually, it results in a progressive, gradual onset of pain.
A herniated disc is similar to a disc bulge, but rather than the gradual onset of pain, a herniated disc happens quite suddenly. The disc's spongy centre forces its way through the fibrous exterior due to injury, sudden impact, or prior damage.
This condition is often associated with an acute injury and usually affects an individual nerve root.
Spinal stenosis is a condition where the spaces in the spine narrow, putting pressure on the nerves and causing pain in the neck and lower back.
The most common causes of spinal stenosis are degenerative and due to osteoarthritis. Radicular pain can be experienced through this condition if the nerve root becomes irritated, where the pain radiates from your lower back to your legs.
Sacroiliac joint dysfunction
The sacroiliac (SI) joints are the connecting tissue between your hips and spine. Their primary job is to absorb shock sent through the upper and lower body. It is, therefore, critical to your body's movement and supporting huge loads.
It can become painful if the joint has too little or too much range of motion.
Congenital deformities are abnormal physical or mechanical traits present at or before birth that can cause pain over time. Examples that result in back pain involve the curvature of the spine, such as scoliosis (S-curved spine) or kyphosis and lordosis (minimal/excess lumbar curve).
The deformity may be associated with lower back pain if it leads to the breakdown of the discs, facet joints, sacroiliac joints or stenosis. Chronic tension in muscles compensating for the curvatures may also produce pain.
Autoimmune inflammatory conditions
There are a number of autoimmune inflammatory conditions that can also cause back pain. The most common are rheumatoid arthritis and ankylosing spondylitis.
Autoimmune conditions wrongly attack the body's immune system and can cause inflammation of the facet joints in the spine. The result is chronic pain and stiffness, especially in the morning or after periods of inactivity.
Lower back pain caused somewhere else in the body.
Low back pain can originate in another part of the body. A "viscerosomatic" reflex is a mechanism where the body responds to organ impairment with musculoskeletal symptoms due to the shared nerve root.
When an organ is inflamed, irritated, or malfunctioning, the associated spinal segment may become hypersensitive and trigger pain in the corresponding back region. For example, kidney irritation, as seen with infections or stones, can cause pain in the lower back on the side of the affected kidney.