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Lower Back Pain – Causes, Symptoms and Treatment

Lower back pain is one of the most common health complaints worldwide. Learn about its causes, symptoms, diagnosis, and treatment options.

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Things worth knowing about "lower back pain"

Lower back pain is one of the most common health complaints worldwide. Learn about its causes, symptoms, diagnosis, and treatment options.

What is Lower Back Pain?

Lower back pain, also known medically as lumbalgia or lumbar pain, refers to pain localized in the region of the lumbar spine -- the lower section of the spine between the ribcage and the pelvis. It is one of the leading causes of disability globally and affects people of all ages. The pain can range from a dull, persistent ache to a sharp, sudden sensation that limits movement.

Lower back pain is classified by duration: acute (up to 6 weeks), subacute (6 to 12 weeks), and chronic (more than 12 weeks).

Causes

In the majority of cases, lower back pain is classified as non-specific, meaning no clearly identifiable structural cause can be found. Common contributing factors include:

Muscle strain and overuse
Prolonged sitting and physical inactivity
Poor posture during daily activities or at work
Excess body weight
Psychological stress and emotional strain

Specific causes involve an identifiable underlying condition:

Herniated disc (disc prolapse): Disc material protrudes and compresses nearby nerves.
Spinal stenosis: Narrowing of the spinal canal, which can compress the spinal cord or nerve roots.
Spondylolisthesis: A vertebra slips forward over the one below it.
Facet joint arthritis
Osteoporosis with vertebral fractures
Inflammatory conditions such as ankylosing spondylitis
Rarely: tumors, infections, or internal organ conditions (e.g., kidney disease)

Symptoms

Symptoms can vary widely depending on the underlying cause. Common signs include:

Dull, aching, or sharp pain in the lower back
Morning stiffness in the spine
Pain radiating into the buttocks, hips, or legs (sciatica)
Numbness or tingling sensations in the legs
Reduced range of motion when bending or twisting
Muscle tightness and spasms

Warning signs (Red Flags) that require immediate medical attention:

Paralysis or significant muscle weakness in the legs
Bladder or bowel dysfunction (e.g., incontinence)
Pain following an injury or fall
Unexplained weight loss and night sweats
Pain that worsens when lying down

Diagnosis

Diagnosis begins with a thorough medical history and physical examination. Depending on the suspected cause, further investigations may include:

X-ray of the spine: To rule out fractures or misalignment
Magnetic Resonance Imaging (MRI): Detailed visualization of discs, nerves, and soft tissues
Computed Tomography (CT): Preferred for assessing bony structures
Blood tests: To exclude inflammatory or systemic conditions
Electromyography (EMG): To assess nerve function when leg symptoms are present

Treatment

Treatment depends on the cause and duration of symptoms. A key principle in modern guidelines is: staying active is better than bed rest. Prolonged inactivity is not recommended.

Conservative Treatment

Physiotherapy: Targeted exercises to strengthen core muscles and improve spinal mobility
Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac; muscle relaxants for severe spasms
Heat or cold therapy: To relieve muscle tension and reduce pain
Manual therapy / Osteopathy: Joint mobilization and soft tissue techniques
Acupuncture: May be beneficial for chronic low back pain
Psychological therapy: Particularly for chronic pain with psychosocial components (e.g., cognitive behavioral therapy)

Surgical Treatment

Surgery is rarely needed and is typically reserved for cases with severe neurological involvement. Common procedures include:

Microdiscectomy (removal of herniated disc material)
Laminectomy (widening of the spinal canal)
Spinal fusion (stabilization of vertebral segments)

Prevention

Many cases of lower back pain can be prevented or reduced in frequency with the following measures:

Regular physical activity (e.g., swimming, cycling, yoga)
Strengthening core and back muscles
Ergonomic workspaces and proper lifting techniques
Maintaining a healthy body weight
Stress management and adequate sleep

References

Koes BW, van Tulder M, Lin CW, et al.: An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal, 2010; 19(12): 2075-2094.
World Health Organization (WHO): Musculoskeletal conditions. Fact Sheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Chou R, et al.: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 2007; 147(7): 478-491.

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