Lower back pain can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:

  • The large nerve roots in the low back that go to the legs may be irritated
  • The smaller nerves that supply the low back may be irritated
  • The large paired lower back muscles (erector spinae) may be strained
  • The bones, ligaments or joints may be damaged
  • An intervertebral disc may be degenerating

Lower back strain is acute pain caused by the muscles and/or ligaments in the lower back. Lower back pain caused by a muscle strain is fairly common and can be quite severe.

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Many lower back problems also cause back muscle spasms, which don’t sound like much but can cause severe pain and disability.

While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort.

Identifying the symptoms and getting a diagnosis that pinpoints the underlying cause of the pain is the first step in obtaining effective pain relief.

Common Lower Back Pain Causes in Adults

Certain causes of lower back pain have a tendency to occur more often in younger individuals versus older adults:

Younger adults (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease) or from a back muscle strain or other soft tissue strain.

Older adults (over 60) are more likely to suffer from pain related to joint degeneration (such as osteoarthritis or spinal stenosis) or from a compression fracture.

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When to Seek Immediate Treatment for Lower Back Pain

Most cases of low back pain do not require urgent care, but anyone should see a doctor immediately if low back pain is a result of trauma, or if pain is accompanied by any of the following symptoms:

  • Fever and chills
  • Unexplained recent weight loss
  • Significant leg weakness
  • Sudden bowel and/or bladder incontinence‚ÄĒeither difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (cauda equina syndrome)
  • Severe, continuous abdominal pain (abdominal aortic aneurysm)

In cases where immediate treatment is a required, physicians will investigate possible serious causes of the pain, including any type of spinal infection, tumor or fracture.

Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from a lower back muscle strain or from within the disc space itself – such as a lumbar disc herniation or lumbar degenerative disc disease.

This article details a description of typical symptoms and their possible causes in younger adults.

Symptoms: Severe or aching pain in the lower back that starts after activity, sudden movement, or lifting a heavy object.

These lower back pain symptoms include any combination of the following:

 

  • Difficulty moving that can be severe enough to prevent walking or standing
  • Pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee
  • Pain that tends to be achy and dull
  • Muscle spasms, which can be severe
  • Local soreness upon touch

Possible Causes: Back muscle strain

A back muscle strain or ligament strain is one of the most common causes of acute lower back pain. Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments stretch or develop microscopic tears.

With a lower back strain, the severity of the pain ranges from mild discomfort to severe, disabling pain, depending on the extent of strain and the lower back muscle spasms that result from the injury.

Symptoms: Low back pain that travels to the buttock, leg and foot (sciatica)

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Sciatica includes any combination of the following symptoms:

  • Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding)
  • Pain may be worse in the leg and foot than in the lower back
  • Typically felt on one side the buttock or leg only
  • Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking
  • More severe (burning, tingling) vs. dull, aching pain
  • May be accompanied by weakness, numbness or difficulty moving the leg or foot

Frequent cause: Lumbar herniated disc

Sciatica describes the symptoms caused when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet.

In younger adults, sciatica can be caused by a wide range of conditions, most commonly a lumbar herniated disc (may also be caused by degenerative disc disease, isthmic spondylolisthesis, and other conditions).

Symptoms: Chronic lower back pain worsened by certain positions and movements.

Symptoms may include any combination of the following:

  • Low-level of constant lower back pain punctuated by episodes of severe pain/muscle spasms lasting a few days to a few months
  • Chronic pain that can range from nagging to severe
  • Back pain worsened by sitting
  • Walking, even running, may feel better than sitting/standing
  • Changing positions frequently relieves pain

Frequent cause: Degenerative disc disease

Lumbar degenerative disc disease can affect patients as young as 20. When the lumbar discs between the vertebrae begin to break down, the damaged disc can cause both inflammation and slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica.

Degenerative disc disease is common and is often successfully treated.

Symptoms: Deep ache in the lower back that worsens when standing or walking

Symptoms may include any combination of the following:

  • Pain that radiates into the buttocks and back of the thighs (also called sciatica or radicular pain)
  • Pain that worsens when bending backward
  • Pain that feels better with sitting, especially sitting in a reclining position
  • Tired feeling in the legs, and possibly leg numbness or tingling, especially after walking
  • Tight hamstrings, making it difficult to touch toes
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Possible cause: Isthmic spondylolisthesis

Isthmic spondylolisthesis occurs when a vertebra in the low back slips forward on the disc space below it. It is most common at the L5-S1 level and can cause low back pain from instability and nerve root pain due to compression of the nerve root.

The fracture occurs in childhood, but normally does not create a lot of pain until a patient is in young adulthood.

Symptoms: Lower back pain and/or buttock or groin pain

Symptoms may include any combination of the following:

  • Pain often described as an ache
  • Pain may be felt in the hips, groin, thighs as well as the lower back
  • Back pain worsened by sitting and may feel better when lying down or reclining
  • Changing positions frequently relieves pain

Frequent cause: Sacroiliac Joint Disease

Sacroiliac joint disease or dysfunction can occur if there is too much or too little movement in the sacroiliac joint – the joints that connect the sacrum at the bottom of the spine to the hip on each side.

The above are typical causes of lower back pain in younger adults, but not all. Younger adults can also be affected by arthritis and other conditions that are typical causes of back pain in older adults. Symptoms for each type of condition will vary based on a number of factors, such as the severity of the pathology, and the individual’s unique anatomy and perception of pain.

By Peter F. Ullrich, Jr., MD, Orthopedic Surgeon (retired)