Lower Back Pain: What Causes Symptoms in Lumbar Spine
Medically reviewed by Amy Kwan, PT, DPT
Lower back pain can be a debilitating symptom, whether it is a new pain, is worsening, or is chronic. Back pain doesn't always have a serious cause and often improves on its own or with lifestyle changes. Other times, back pain is the body's way of telling you something isn't right and further treatment may be needed.
Lower back pain is pain in the lumbar spine, where the spine connects to your pelvis and bears the upper body's weight. It may present with radiating muscle aches or sharp, stabbing pains. These can extend to the hips, buttocks, or legs. You may also experience dull or achy pain or cramping of the lower back.
Lower back pain can be a symptom of many illnesses and conditions, often related to the back itself. Causes include:
Stress or injury in the back muscles
Disease or injury of the vertebrae (small bones of the lumbar spine)
Arthritis, including wear-and-tear arthritis (osteoarthritis) and inflammatory arthritis, such as rheumatoid arthritis
Infection of the bone or disk space, bloodstream, or other nearby body areas
Disease or injury of the spinal nerves
Spinal tumor or cancer
This article will cover causes of low back pain based on severity, chronic back pain, kidney-related back pain, diagnosis, and more.
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Causes of Mild to Moderate Lower Back Pain
The lumbar spine has five vertebrae that experience a lot of movement and stress, leading to the wear and tear of those tiny bones over time. Mild to moderate lower back pain has several possible causes. Some of these are more common than others. Some require medical attention, while others can be managed at home.
Such causes include:
Injuries: The affected area will become inflamed if you overstretch a back muscle or tear a ligament. You might experience tenderness, swelling, restricted movement, and spasms. Spasms occur because the muscles in the injured area become immobilized to protect the joints and ligaments from further injury.
Lifestyle: Back pain is more common in people with a primarily sedentary lifestyle (such as a desk job) or who are overweight. Jobs requiring a lot of heavy lifting or specific spine movements can affect your back health. Anxiety and depression also contribute to back stress. Smoking adds to your risk of developing back pain.
Arthritis: Different arthritis conditions, including osteoarthritis, can cause mild to moderate back pain. The lower back is a common site for arthritis. Symptoms of arthritis affecting the lumbar spine include pain, stiffness, swelling of the affected vertebrae, and a feeling of grinding within the spine with movement.
Bulging or herniated disks: A bulging disk results from an intervertebral disk losing fluid and drying out. The outer layer is intact but the weakened wall causes bulging. With a herniated disk, the outer layer of the disk tears and disk material leaks out, leading to pressure on nerve roots behind the disk space. Both bulging and herniated disks can cause severe lower back pain. Herniated disks also cause neurological symptoms like weakness, numbness, and changes to sensation in the lower back.
You're Not Alone
According to a 2022 Frontiers in Pain Research report, an estimated 80% of American adults have experienced lower back pain at some point in their lives.
Causes of Severe Lower Back Pain
Severe lower back pain has various causes. Some of these may require immediate medical attention.
Such causes include:
Sciatic nerve pain (sciatica): The sciatic nerve starts in the lower back and runs down the back of each leg. Pressure on the nerve root (often from a herniated disk) can lead to pain (sometimes severe) and other symptoms in the lower body. Symptoms include low back pain that radiates into one buttock and the back of the leg down to the foot, numbness in the buttock and leg, and ongoing leg weakness on the affected side of the body. Sciatica is not always a serious condition, but sometimes damage to this nerve can lead to disability.
Fractured vertebrae: Vertebrae fractures include compression fractures (where bone collapses and gets pushed together), burst fractures (where the bone comes apart and makes its way into nearby spinal tissues), and fracture-dislocations (where the bone breaks and ligaments tear, and the bones to slide away from each other).A vertebrae fracture can cause severe pain and limit movement.
Severe trauma: You may experience severe back pain after a serious trauma, such as an automobile accident. You may experience a flexion-distraction injury if you plunge forward while wearing a seatbelt. This fracture causes excruciating pain because the vertebra is pulled apart. The fracture might also damage the spinal cord or nerves, leading to neurological symptoms, including bowel and bladder problems and weakness, numbness, and tingling of the limbs.
Spinal infections: A spinal infection can occur in the vertebral column, intervertebral disk space, spinal canal, and nearby soft tissues. A spinal infection of the lumbar vertebrae can occur after spine surgery or from spinal trauma. Symptoms associated with a spinal infection include severe back pain, fever and chills, muscle spasms, weakness and numbness of the arms and legs, and bowel or bladder incontinence.
Cancer: While rare, lower back pain is sometimes related to cancer. It can be one of the first signs of prostate cancer that has spread. Back pain might also occur with other cancer types, including spinal cancer. But, lower back pain in people with cancer usually occurs with other symptoms like weight loss and severe fatigue.
Related: What’s Causing My Back Pain?
When Does Lower Back Pain Become Chronic?
Lower back pain is either acute (short-term) or chronic. Acute lower back pain will last days to a few weeks and resolves on its own or with lifestyle changes. Chronic back pain will last more than three months and may worsen.
Conditions that can lead to chronic lower back pain include:
Osteoarthritis (OA): OA is a degenerative joint condition that worsens over time and can lead to chronic back pain.
Degenerative disk disease: This condition can cause chronic, severe pain that comes and goes. Degenerative disk disease can also cause hip and leg pain. Without treatment and lifestyle changes, it can progressively get worse.
Ankylosing spondylitis (AS): AS is an inflammatory arthritis that might lead to the fusing of the spine over time. Symptoms include pain, stiffness, and reduced mobility in the lower back and hips.
Facet joint syndrome: Each vertebra in the spine has two sets of facet joints. Facet joint syndrome is caused by natural wear and tear of the facets. While it can affect any pair of facet joints along the spine, it commonly affects the lumbar spine. Symptoms include back pain affecting one or both sides and pain that radiates into one or both sides of the buttocks, groin, and thighs. Pain may come and go and may become worse with spinal extension (bending back).
Spinal stenosis: Spinal stenosis is a narrowing of one or more of the spaces in the spine. It often affects the lower back but can also affect the neck. Symptoms include pain in the lower back, cramping of the legs, a heavy feeling in the legs, symptoms that worsen with activity, and relief from pain and stiffness when bending forward (i.e., similar to leaning on a grocery cart).
Spondylolisthesis: With spondylolisthesis, one vertebra slips forward, coming out of place. This can affect any vertebra of the spine, but it often affects the lower back. It can be asymptomatic (no symptoms) or cause back and leg pain ranging from mild to severe.
Many of these more serious conditions might also cause nerve compression that leads to more neurological symptoms, i.e., weakness, numbness, and tingling in the back and legs, and bowel or bladder dysfunction. Symptoms might worsen over time and require surgery to relieve pressure off the spine or spinal nerves.
Lower Back Pain: Males vs. Females
Back pain can affect anyone regardless of age or sex. However, people assigned female at birth experience back pain more frequently. Researchers suggest this may be related to hormones and body structure.
Lower back pain causes common in people assigned female at birth include:
Pregnancy
Sciatica
Herniated disks
Disk degeneration
Muscle strains
Overlap Between Lower Back Pain and Kidneys
Lower back pain is sometimes related to kidney problems. Kidney problems that might lead to lower back pain include:
Kidney stones: Kidney stones are hard mineral deposits that form in the kidneys and can block urine flow in the kidney or ureters (the tubes leading to the bladder).
Urinary tract infection: A bacterial infection of the urinary tract can affect the bladder, ureters, and kidneys. A kidney infection can occur when bacteria from the bladder travel to the kidneys, causing inflammation and pain that spreads to the back.
Renal cancer (kidney cancer): This type of malignant tumor starts in the kidney cells. Advanced cases can sometimes cause severe back pain due to growths near the spine. Only a small percentage of people with back pain have kidney cancer. Advanced kidney cancer will present with additional symptoms like weight loss, night sweats, fever, fatigue, and blood in the urine. Contact your primary healthcare provider if you are concerned about back pain presenting with these additional symptoms.
Related: Understanding Kidney Pain vs. Back Pain
Associated Symptoms
You may experience pain in one part of the lower back, or pain may spread throughout the back. Lower back pain can lead to pain in other areas, including the hips, buttocks, and legs.
Back pain might cause additional symptoms, including:
A dull, achy feeling in the lower back
Stabbing or shooting pain that radiates into one or both legs and down to the foot
An inability to stand or walk without pain
Decreased range of motion that affects the ability to move the back
Pain with lifting and bending
Pain and stiffness after sitting or lying down for extended periods
Pain and stiffness that improve with activity
You should contact a healthcare provider if your lower back pain does not improve within a few weeks.
Contact a healthcare provider right away or head to your local emergency room for the following lower back symptoms:
Ongoing numbness and tingling that travels into the legs
Back pain with persistent weakness or heaviness in the thighs and buttocks
Severe back pain that does not improve with over-the-counter (OTC) pain relievers
Back pain after an injury
Back pain that presents with problems urinating, fever, or weight loss
Loss of bladder or bowel control
Back pain associated with abdominal pain
An inability to walk or stand
How to Find Out What's Causing Your Lower Back Pain
Lower back pain is a common occurrence that often resolves without needing to be under medical care. Seeing a healthcare provider for persistent or worsening back pain and back pain that presents with neurological symptoms is a good idea.
Determining the cause of back pain typically starts with the healthcare provider asking about your medical history and symptoms. They will also examine your back and ability to sit, stand, walk, and move your legs. You will be asked about your pain level on a scale of zero to 10 and how pain and other symptoms affect your ability to perform daily activities.
The physical exam and symptom history might be enough for the healthcare provider to determine what is causing your lower back pain. But if you have additional symptoms or if the pain is severe and affecting your ability to perform daily activities, more testing will be requested to rule out or confirm more severe back pain causes.
Additional testing might include:
Blood work to rule out or confirm inflammatory disorders like AS that lead to spinal inflammation
Imaging, such as X-rays, to look for arthritis and broken bones, and magnetic resonance imaging (MRI) or computed tomography (CT) scans for detailed images of the spinal cord, disks, muscles, and nerves
An electromyography nerve study to look for nerve compression (herniated disks) or narrowing of the spinal canal (spinal stenosis)
Once a diagnosis is made, a treatment plan can start. A treatment plan for low back pain might include:
OTC pain relievers
Prescription medicines, as needed
Exercise and physical therapy
Lifestyle changes, such as losing weight and quitting smoking
Surgery (as a last resort)
You might also consider alternative therapies, such as chiropractic care, acupuncture, and massage, to ease back pain. Before trying any alternative therapy, you will want to let your healthcare provider know so they can advise you on the benefits and risks of the therapy.
Related: 10 Things to Stop Doing If You Have Low Back Pain
Summary
Most adults have lower back pain at some point in their lives. Back pain typically isn't serious and often improves on its own. Other times, it may be a sign of a more concerning condition.
Common causes of lower back pain include injuries to the back muscles or vertebrae, osteoarthritis, inflammatory arthritis, infections of bones and disk areas, diseases or injury of the spinal nerves, kidney stones, or a urinary tract infection. A spinal tumor or cancer is a much rarer cause. People assigned female at birth experience back pain at higher rates than those assigned male at birth.
You should reach out to your healthcare provider for low back pain that is persistent or getting worse. Most of the time, lower back pain can be treated at home with OTC pain relievers and lifestyle changes. However, some people may need prescription therapies and physical therapy. Surgery is rarely needed to treat back pain.
Read the original article on Verywell Health.
