What can cause lower back pain?
According to the National Institute of Neurological Disorders and Stroke, around 80% of adults will have lower back pain at some point during their lives.
The pain can appear suddenly or gradually and can range from a dull ache to intense, sharp pain. In some people, the pain may be chronic.
In this article, we look at some of the possible causes of lower back pain and their treatments. We also cover when to see a doctor.
Sprains and strains
Twisting awkwardly can cause lower back pain.
Sprains and strains are a common cause of lower back pain. A sprain occurs when a person overstretches or tears a ligament, while doing the same to a tendon or muscle causes a strain.
Back sprains and strains can result from overuse, sports injuries, twisting awkwardly, or lifting something too heavy or improperly.
The symptoms of back sprains or strains can include tenderness, swelling, and muscle spasms.
A person can often treat back sprains and strains at home with rest, ice packs, and over-the-counter (OTC) anti-inflammatory medications such as ibuprofen and naproxen.
Gently stretching and engaging in low-impact activities such as walking may help prevent the back muscles from becoming too tight.
Receiving a forceful impact to the back can cause spinal damage in the form of vertebral fractures and herniated or ruptured discs. Possible causes of this can include falls, motor vehicle accidents, and sports injuries.
Back pain usually occurs almost immediately after the injury. Other symptoms may include tingling and numbness that radiates down the legs.
The treatment options will depend on the type and severity of the injury. A person may be able to treat minor injuries at home with rest, ice, OTC pain relievers, and gentle stretching.
For people with more severe injuries, a doctor may recommend physical therapy, prescription medications, or surgery.
Cauda equina syndrome
Cauda equina syndrome is a rare condition that develops when something compresses or damages the cauda equina, which is a bundle of nerves in the lower part of the spinal cord.
This condition typically results from a herniated disc, but other causes include spinal stenosis and fractures, infections, and tumors that affect the spine. It can sometimes also occur as a complication of spinal surgery.
Symptoms of cauda equina syndrome can include:
- severe lower back pain
- bowel and bladder problems
- numbness, weakness, or loss of sensation in one or both legs
- difficulty walking
Cauda equina syndrome is a medical emergency that can lead to serious complications if a person does not receive immediate treatment.
Doctors will generally recommend surgery to relieve pressure on the nerves. This reduces a person's risk of developing permanent paralysis and incontinence.
A doctor may prescribe antibiotics or anti-fungal medication to treat an infection.
The spine and surrounding tissues can sometimes become infected with harmful bacteria, viruses, or fungi.
Spinal infections can occur when infections from other parts of the body travel to the spine. They can also develop following injuries or spinal surgery, or as a complication of conditions such as diabetes, cancer, and HIV.
Some examples of spinal infections include vertebral osteomyelitis, which is an infection of the spinal bones, and a spinal epidural abscess, which is an infection that develops in the protective membranes around the spinal cord.
Symptoms of a spinal infection can include:
- severe back pain
- swelling, flushing, and tenderness in the back
- muscle spasms
- loss of sensation in the legs
- fever and chills
Treatment depends on the cause but may include taking antibiotic or antifungal medications. For people with severe infections, a doctor may recommend surgery to relieve pressure on the spine and drain the infected area.
Degenerative disc disease
Degenerative disc disease occurs when the discs between the spinal vertebrae begin to wear down.
These discs act as protective cushions, so when they degenerate, the vertebrae may start rubbing against each other, which can cause back pain.
This pain may worsen with bending, twisting, and lifting but improve with walking or moving.
Treatment options for degenerative disc disease include:
- trying physical and occupational therapy
- maintaining a healthy weight
- taking OTC and prescription pain medications
If these treatments do not work, a doctor may recommend surgery.
Sciatica causes sharp back pain that radiates through the buttocks and down into the legs. It occurs when the sciatic nerve becomes compressed. Causes can include spinal stenosis and a herniated or ruptured disc.
Additional symptoms can include numbness or burning and tinging sensations that run down the leg. Symptoms may get worse when a person moves, sneezes, or coughs.
A person can often treat mild symptoms at home with rest, ice, and OTC pain relievers. For more severe symptoms, a doctor may recommend steroid injections or surgery.
Scoliosis is a sideways curvature of the spine that can cause uneven shoulders and hips. The condition tends to affect children ages 11–12, often just before they have a growth spurt. However, scoliosis can develop at any age.
Children with scoliosis are more likely to develop lower back pain as an adult.
Treatment depends on the extent of the curvature and the person's age. It might be beneficial for a child to wear a special back brace while they are still growing, as this may help prevent further curving of the spine.
In adults, treatment may involve pain medications and exercises to improve flexibility and posture.
A doctor may recommend surgery for children or adults with severe scoliosis. A common surgical approach to scoliosis is a spinal fusion, wherein a surgeon fuses two or more vertebrae together to straighten the spine.
Spinal stenosis is the narrowing of the spinal canal, which can place pressure on the spinal cord and nerve roots. This condition is most common in people over the age of 50 years.
Symptoms of spinal stenosis can include:
- lower back pain
- numbness or weakness in one or both legs
- difficulty walking
At-home treatments for spinal stenosis can include OTC pain relievers such as ibuprofen or naproxen and exercises to strengthen the back muscles and improve mobility.
For people with more severe symptoms, a doctor may recommend steroid injections, nerve blockers, or surgery.
Back pain is a common issue during pregnancy.
Lower back pain can sometimes also be a symptom of conditions that do not relate directly to the back.
Some other possible causes of lower back pain can include:
When to see a doctor
There is not always an obvious cause of lower back pain, and it often gets better on its own. Resting, trying hot or cold therapy, taking OTC pain relievers, and gently stretching may help speed up recovery.
However, a person should see a doctor for lower back pain that is severe, does not seem to be getting better, or occurs alongside other concerning symptoms, such as tingling or numbness down the legs.
People with lower back pain should seek immediate medical attention if they also have any of the following symptoms:
- difficulty walking or moving the legs
- loss of bowel or bladder function
- loss of sensation in the legs
- very severe pain
A doctor can help a person identify potential causes of lower back pain and recommend appropriate treatment.
Lower back pain is very common, and there is not always an obvious cause. However, lower back pain can sometimes be a symptom of an underlying condition, such as an injury, an infection, or spinal problems.
Exercising regularly, practicing good posture, and maintaining a healthy weight can help reduce the risk of lower back pain.
A person can often treat lower back pain at home by resting, trying hot or cold therapy, taking OTC pain relievers, and stretching gently.
However, a person should see their doctor for lower back pain that is severe, not getting better, or occurs at the same time as other concerning symptoms.
Seek immediate medical attention if the lower back pain is affecting coordination or bladder or bowel control.