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Causes of Lower Back Pain

The lower back, or lumbar spine, is one of the most commonly injured parts of the body. Most people experience back pain at some time in their lives, but it usually gets better on its own or with nonsurgical treatment. The most common cause of back pain is a muscle strain, but other issues can also be to blame, such as herniated discs or spinal stenosis.

The lumbar spine contains five stacked vertebrae that are separated by intervertebral discs and a series of facet joints. The bones in the lower back are held together by ligaments, which connect tissue around each bone to other tissues.

Acute back pain is generally defined as a single episode of back pain that lasts up to four weeks and does not involve symptoms such as numbness or weakness in the legs or arms. If your back pain does not go away within this time period, it is considered chronic and may require more aggressive treatments, such as analgesics or steroid injections.

Some serious potential causes of low back pain include infection, a tumor or a spinal condition called cauda equina syndrome (which involves leg weakness and loss of bowel or bladder control). Other possible problems are compression fractures of the spine — in which one or more bones break because of weakening and thinning of the spine’s vertebrae, as occurs with osteoporosis.

Less serious causes of back pain can be caused by normal aging, such as physical changes that occur in the spine and other areas of the body over time. For example, muscles and ligaments tend to tighten with age, and the discs in the spine lose their ability to cushion the vertebrae.

There is also a lot of overlap in the nerve supply to the spinal structures, and it is sometimes difficult to determine what part of the spine is causing the pain. For this reason, it is important to pay attention to the pattern of the pain and any red flags such as fever, numbness or weakness.

Most people with lower back pain can improve with nonsurgical treatment, including exercise and pain relievers. It is recommended to start with over-the-counter NSAIDs, such as ibuprofen. Other medications that can be used for severe pain are tramadol and duloxetine. For chronic back pain, other therapies that can be used in combination with exercise include multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi and yoga, motor control exercises and electromyographic biofeedback. Medications that contain opioids should be reserved for patients who do not respond to nondrug treatments, such as acetaminophen and other NSAIDs, and in whom the benefits outweigh the risks. Using analgesics with caution and being careful when lifting, twisting and bending are the best ways to protect your back. Also, try to push rather than pull things across the floor if you can, so that your legs and hips do most of the work, instead of your back. This will help to prevent future episodes of lower back pain.

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