Understanding Causes of Lower Back Pain

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Lower Back PainPain in the lower back, sometimes called lumbago, is something that every person goes through at least once. This is because the lumbar region is home to a collection of joints, muscles, nerves, and spinal discs, bears most of the body’s weight and is responsible for much of your flexibility. Consequently, this combination also makes the area highly susceptible to injury from wear-and-tear, strain, and so on. Additionally, “lower back pain” is sometimes used to refer to the pelvic area or flank, areas which open up extra potential culprits. As with most symptoms, the best way to begin treatment for lower back pain is to find out what the underlying cause is. The task is best left to your doctor, but here are some common causes and potential signs that you should watch for in order to better inform the diagnosis.

What Causes Lower Back Pain?

Slipped Disc
The bones of the spine (vertebrae) are connected by what are known as “intervertebral discs.” These discs are best envisioned as a “puck” of cartilage and fiber tissue with a jelly-like core. Their purpose is to act as shock absorbers and generally aid in movement. Certain circumstances, such as a combination of twisting and directional movement (like lifting something heavy and twisting the waist), can place more pressure on the disc than it can handle. This causes the jelly-like interior of the disc to get squeezed out and put pressure on the spinal cord, resulting in nerve compression and pain.

Sciatica
Sciatica is a condition that arises when something begins to compress the sciatic nerve, located in the lower back. A slipped disc (see above) is the most common cause, but others can include degeneration, bony overgrowths, spinal infections, or tumors. Symptoms of sciatica typically present as a sudden lower back pain that radiates into the buttocks, back of the thigh, and into the legs. The pain can be sharp and/or accompanied by pins and needles or general numbness. Sitting, coughing, sneezing, or bending can trigger pain or make existing pains worse, while lying down on one side can help offer relief. Muscle spasms in the affected area are not uncommon, either.

Spondylolysis
This is a type of stress fracture that is most often seen in younger athletes that engage in sports that require bending backwards and rotating the spine (a throwing or serving motion). Due to the way the spine bends, the fracture will usually be on the opposite side of the triggering activity. If you are a right-handed thrower, the fracture is likely to be on your left side. Symptoms include one-sided lower back pain that can be made worse by bending backwards, sudden spikes of pain from specific bending activities, tight hamstring muscles, tenderness over the fracture, and an exaggerated inward curve to the spine.

Muscle Injury
The same forces that can cause a slipped disc (twisting, lifting heavy objects, sudden movement, etc.) can cause the muscles and tendons of the lumbar region to tear from stretching beyond their normal range. The result is usually pain, especially if you try to use the muscle, stiffness, bruising, and inflammation around the injured site. The exact nature of the pain varies from injury to injury. Some people may find their pain to be uncomfortable while others can have pain so severe as to wholly restrict activities or motion.

Kidney Stones
A kidney stone is a mass of (usually) calcium that can form in the kidneys. Small kidney stones can appear and be passed without symptoms. Problems arise when larger stones start to move and begin to irritate the passageway or become lodged. The most infamous result of this is “renal colic,” a type of one-sided back or abdominal pain that is routinely described as one of the most painful sensations possible. Other symptoms can include pain radiating to the groin (in men), blood in the urine, vomiting/nausea, discolored or foul-smelling urine, chills/fever, feeling a frequent need to urinate, and only expelling a small amount when you pee.

Spinal Infection
Infections of the spine are rare, but they do happen and usually appear in the lumbar area since that region has such a good blood supply. It is also possible for pelvic, urinary, soft-tissue infections, or pneumonia to spread to the spine if left untreated. Spinal infections can be subtle at first, and it is not unknown for them to persist for weeks or months before being recognized for what they are. Symptoms will usually begin with tenderness in the lower back that worsens with movement but cannot be relieved by traditional means. As the infection progresses, fevers, chills, and unexplained weight loss can arise as well.

Treatments for Lower Back Pain

Treating lower back pain depends on the cause. Most musculoskeletal injuries like sciatica or muscle strain are usually treated with the RICE protocol (rest, ice, compression, elevation) and/or with heat therapy. Muscle relaxants and anti-inflammatories may be prescribed as well, along with painkillers if symptoms become too much. In some advanced cases like a slipped disc, surgical repair may be required if initial treatments fail. Some level of physical therapy is often called for as well.

Kidney stone treatment depends on severity. Drinking extra water and taking diuretics to promote urination is common, along with lithotripsy (using sound waves to break up stones). Surgery may be required if noninvasive methods fail. Painkillers may also be prescribed.

Spinal infections are treated using antivirals or antibacterial drugs depending on the culprit. Hospitalization may be required since getting the drugs to the necessary area can require an IV. Otherwise, rest is the main treatment along with potential bracing to help improve spinal stability during the healing process. If nerve compression arises, then surgery may be needed.

When to See Your Doctor

Since lower back pain is a common experience, it is easy to try and “sleep it off”. However, there are certain circumstances in which your pain should be brought to your doctor’s attention. Even if the cause is not life threatening, the presence of any of the following symptoms may suggest a need for medical intervention:

  • Tapping the spine or muscle is painful
  • Fever or chills
  • Unexplained weight loss
  • Malaise (general “unwell” feeling)
  • Difficulty urinating
  • Incontinence
  • Numbness around the groin and/or buttocks
  • Muscle weakness
  • Pain has persisted for over six weeks
  • Pain is intense enough to interfere with daily activities
  • Pain appears to be worsening
  • Any blunt-force injury within two weeks of the pain starting

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Michael J. Watson

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