Lower back pain is a common issue that affects many young adults. Whether you're lifting something heavy, sitting for long periods, or participating in sports, lower back pain can sneak up on you. In this guide, we'll break down the anatomy of the lower back, explore the common causes of pain, how to recognise the symptoms, and look at treatment options to help you feel better.
General Anatomy of the Lower Back
The lower back, also known as the lumbar region, is made up of bones, muscles, ligaments, and nerves that work together to support the upper body and allow movement. Here are the main components:
- Lumbar Vertebrae: These are the five large bones in the lower part of the spine. They provide structural support and protect the spinal cord.
- Intervertebral Discs: Located between the vertebrae, these discs act as cushions, absorbing shock and allowing for movement. They are like the "shock absorbers" of the spine.
- Nerves: The spinal cord runs through the vertebrae, and nerves branch off to the legs and other parts of the body. When these nerves are irritated or compressed, it can cause pain.
- Muscles: The muscles of the back, such as the erector spinae, help with movement and stability. They support the spine and assist with bending, twisting, and lifting.
- Ligaments and Tendons: These are strong connective tissues that help stabilise the spine and connect muscles to bones.
When something goes wrong in this complex system, it can lead to lower back pain.
Common Causes of Lower Back Pain
There are many potential causes of lower back pain. Some are related to posture, while others are due to injury or underlying medical conditions. Let’s take a look at some of the most common causes:
1. Muscle Strain
A muscle strain happens when the muscles in the lower back are overstretched or torn. This can occur from lifting something heavy, sudden twisting movements, or poor posture. The muscles or ligaments supporting the spine can become overstretched, leading to pain and stiffness.
2. Herniated or Bulging Disc
A herniated disc occurs when one of the intervertebral discs between the vertebrae slips out of place or ruptures, pressing on nearby nerves. This can cause sharp pain in the lower back and may radiate down the legs. It is often caused by age-related wear, poor posture, or sudden trauma. The term ‘slipped disc’ often refers to a wide range of pathologies related to the intervertebral disc as shown in the diagram below.
3. Sciatica
Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back down to the legs. It is often caused by a herniated disc or bone spurs pressing on the nerve. The pain typically affects one side of the body and can be sharp or burning.
4. Spondylolisthesis
In spondylolisthesis, one of the vertebrae in the lower back slips forward over the vertebra beneath it. This can cause instability and pressure on the nerves, leading to pain in the lower back and possibly the legs. It often happens as a result of age, injury, or a birth defect. The slip can cause impingement to the central cord and patients may develop symptoms of spinal stenosis (tightness), such as buttock and leg pain when walking short distances.
5. Degenerative Disc Disease
As we age, the intervertebral discs can start to lose their cushioning ability, a condition called degenerative disc disease. This can lead to chronic pain, as the discs become thinner and less flexible. The pain can worsen after long periods of sitting or standing.
6. Spinal Stenosis
Spinal stenosis occurs when the spaces in the spine narrow, putting pressure on the spinal cord and nerves. This condition is more common in older adults but can also occur in younger people due to injury or structural issues. It can cause lower back pain, numbness, and weakness in the legs.
7. Sacroiliac Joint Dysfunction
The sacroiliac (SI) joint connects the lower spine to the pelvis. Dysfunction in this joint can lead to lower back pain, especially when sitting, standing, or climbing stairs. It can be caused by injury, pregnancy, or arthritis.
Lower Back Pain Symptoms
The symptoms of lower back pain can vary depending on the underlying cause, but common symptoms include:
- Dull or sharp pain in the lower back, which may worsen with movement.
- Stiffness or difficulty moving, especially after prolonged periods of sitting.
- Pain that radiates to the legs (as with sciatica or a herniated disc).
- Numbness or tingling in the lower back, legs, or feet (often associated with nerve compression).
- Weakness in the legs or difficulty standing or walking (can occur with more severe conditions like spinal stenosis or herniated discs).
Differential Diagnoses
When evaluating lower back pain, it’s essential to rule out other conditions that might cause similar symptoms. Here are a few conditions that can be confused with lower back pain:
- Kidney Stones or Kidney Infections: Pain from kidney stones or infections can often be felt in the lower back and may be mistaken for muscle or disc-related pain.
- Abdominal Aneurysm: A ruptured or leaking abdominal aneurysm can cause back pain, especially in older adults. This condition requires immediate medical attention.
- Pelvic Infections: Infections in the pelvic organs, such as the uterus or ovaries, can cause pain that radiates to the lower back.
- Osteoarthritis: Degenerative joint conditions, such as osteoarthritis, can affect the spine and cause lower back pain, although it’s typically associated with older adults.
Investigations for lower back pain
Not every patient with back pain requires radiological investigations. The orthopaedic surgeon will first take a medical history, followed by a thorough clinical examination to determine the cause and severity of your symptoms. If the doctor feels that the condition may recover with conservative techniques such as physiotherapy, rest and some medication, a radiological investigation may not be required.
If, however, there are yellow flags such as prolonged or worsening pain, weakness and/or numbness, the doctor may arrange for an X-ray or MRI scan of your lumbar spine. This will help determine the cause(s) of your lower back pain and help the doctor decide which is the best course of treatment for you.
Treatment Options for Lower Back Pain
Most cases of lower back pain can be managed with conservative treatments, but if the pain persists, more advanced options may be necessary. Here are some common treatments:
1. Rest and Ice/Heat Therapy
Resting for a day or two after an injury can help. Ice can reduce inflammation in the first 48 hours after an injury, while heat therapy (using a heating pad) can relax tense muscles and improve blood circulation.
2. Over-the-Counter Pain Relief
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce inflammation and relieve pain. Always follow the recommended dosage and consult a doctor if the pain persists.
3. Physical therapy and physiotherapy
A physical therapist can teach you exercises to stretch and strengthen the muscles in your back. Strengthening the core muscles that support the spine can help prevent future back pain. If you develop lower back pain with specific sports, the physical therapist will assess your biomechanics and train your movements so that you may return to sports safely.
4. Massage Therapy
Massage can help relax the muscles, improve circulation, and reduce pain. It’s often helpful for muscle strains or tightness in the lower back.
5. Posture Correction
Improving posture, especially when sitting or standing for long periods, can prevent lower back pain. Make sure your workspace is ergonomically friendly, with a supportive chair and desk at the right height.
6. Medications
In some cases, stronger medications, such as muscle relaxants or prescription painkillers, may be recommended for short-term relief. For nerve-related pain, medications like gabapentin may be prescribed.
7. Surgery
Surgery is usually only considered when conservative treatments have failed and there is severe pain or disability. Surgical options include removing a herniated disc or decompressing nerves in cases of spinal stenosis. It is therefore crucial to obtain an accurate diagnosis first, as well as undergo several months of conservative treatment before surgery is required. There are some instances where surgery is an emergency, such as cauda equina syndrome and a significant drop in muscle strength (weakness) of the lower limbs. This means that the nerves are severely compressed and have to be released sooner rather than later. Delay in surgical decompression may lead to permanent nerve injury, leading to difficulty controlling bowel and bladder function, and weakness of lower limbs, causing problems walking.
Prevention Tips
Preventing lower back pain involves maintaining good posture, staying active, and avoiding heavy lifting. Here are some tips:
- Exercise regularly to maintain the strength of your back and core muscles.
- Use proper lifting techniques—bend at the knees, not the back.
- Take breaks from sitting or standing for long periods.
- Wear supportive shoes, especially if you stand for long hours.
Conclusion
Lower back pain is a common issue, but understanding its causes and how to treat it can help you recover faster and prevent it from coming back. Whether it’s from muscle strain, a herniated disc, or something else, knowing what to do when pain strikes is important. If your pain persists, don’t hesitate to consult a healthcare provider who can help diagnose the underlying cause and suggest the best treatment plan. With the right care, most people recover from lower back pain and can return to their regular activities.
