A comprehensive overview of lower back pain: Symptoms, causes, and best treatments
Lower back pain is the most common musculoskeletal problem worldwide, and the leading reason people stay off work, become less active, and stop exercising.
So, if you develop lower back pain that gets in the way of the things you love, this article will fill you in on what you need to know and do about it.
It covers the types, symptoms, common causes, and evidence-based ways of treating lower back pain to help get you pain-free and back on track as soon as possible.
Anatomy of back pain
Research shows our backs are more robust, structurally sound, and less susceptible to injury than we believe.
Understanding your lower back structure and function can help you understand why certain movements and positions may hurt more than others when you have back pain, which can help you know what to do about it.
Your lower back structure
Your lower back consists of the following:
- Bones (vertebrae)
- Intervertebral discs
These structures interconnect and work together to form an agile and resilient spine capable of many actions.
How your lower back works
Your lower back is built to handle weight, movement, and pressure without harm. It supports the weight of your upper body and allows you to move in a variety of ways, including:
- Bending forward (Flexion)
- Bending backward (Extension)
- Twisting or turning (Rotation)
Movement and exercise are how your spinal tissues get nourishment, grow strong, and stay healthy.
But, just like you can sprain an ankle or strain a thigh muscle, your lower back can become hurt if pushed beyond its limits too quickly or too often.
It can also usually heal and recover like any other body part. Recovery and treatment depend on the type of back injury you have.
Types of lower back pain
Specific vs. non-specific low back pain
Categories of non-specific low back pain
Experts often categorize non-specific back pain into 3 subtypes according to how long your pain has been present:
- Acute pain - lasts less than 6 weeks
- Sub-acute - lasts 6 to 12 weeks
- Persistent pain - lasts over 12 weeks
Most cases of back pain get better within 12 weeks, but sometimes pain can persist.
Why does back pain persist?
Understanding pain and how it works can help you understand why pain sometimes persists.
Pain protects you from danger
Pain is your body's built-in alarm system that protects you from danger. It's created by your subconscious brain, which controls your automatic functions, like breathing and digestion, to get your attention and help keep you from actual and potential harm.
- Actual harm is physical damage that has already occurred, such as a broken bone or bruise.
- Potential harm is something your brain anticipates, like a new injury or the worsening of an existing one.
In an ideal world, your pain would decrease as your injury heals, but research shows this doesn’t always happen.
We now know this is because pain is linked to our threat system.
Pain is linked to your threat system
When you have symptoms of low back pain, your brain will search your beliefs, thoughts, and past experiences to decide what potential harm your current bout of back pain may cause and adjust your pain levels accordingly.
If your brain keeps thinking you're at risk of making your injury worse or that your injury may have a really bad effect on a specific aspect of your life, it can amplify your pain, and a repetitive cycle of pain creation can begin. Unfortunately, that means pain can often persist long after an injury has healed.
A good example is if you have an exciting holiday or important event coming and are worried that you may miss it if your back is badly injured. In that case, your brain may increase your pain.
But the opposite is also true.
One research study found that being given a favorable diagnosis of their condition immediately and dramatically reduced the participants’ pain levels.
You can change your pain
If you are interested in understanding more about other factors that can cause back pain to persist, this article may be helpful.
How to diagnose low back pain
Have a thorough assessment
Lower back pain can be diagnosed with a variety of assessments and tests, such as:
- A detailed history of your symptoms
- A physical examination
- Lab tests, if necessary
- Imaging and scans like X-Rays or MRIs (rarely necessary or helpful)
Have a back scan if necessary
When scans are necessary
Scans can be helpful if you have red flag symptoms with lower back pain. Red flags are specific symptoms of low back pain, indicating something more serious could be causing your pain and should be addressed urgently.
They can help determine when back pain is serious if they are assessed within the context of your pain history and physical examination.
The most common red flag symptoms are:
- Difficulty urinating, even with a full bladder
- Loss of bladder or bowel control (struggle to make it to the toilet in time)
- Numbness or tingling in your genitals or buttock area
- Impaired sexual function, such as loss of sensation during intercourse or erectile dysfunction
- Loss of power in your legs
- Pain referring down the back of both legs
- Sensation changes in both legs (like tingling, pins and needles, numbness)
- Back pain with a fever or feeling unwell
If you have lower back pain with any of these signs, it may indicate a serious low back injury and requires immediate attention. So, speak to a doctor to ensure you get the proper treatment and care.
Why scans aren't always useful
Lower back pain without red flags usually doesn't warrant a scan. Here's why.
1. Pain doesn't always mean damage
Good evidence suggests the intensity of lower back pain doesn't correlate (match) with the structural changes in back scans.
That means people with similar scan findings often have entirely different pain pictures. Some experience severe pain, while others have mild or no pain at all.
2. Scans can't show all causes of lower back pain
If you get back pain when running, bending, or doing other activities, chances are it's due to factors that won't appear on an MRI.
For example, a scan won't show if your pain is from weak or tight muscles or increased tissue sensitivity due to stress. We will discuss this in more detail later.
3. Scans can lead to worse pain outcomes
Studies reveal that showing someone structural changes on their back scan can negatively impact their recovery, even if the changes seen in the scan are unrelated to their pain.
That’s because scans usually don’t help clarify the situation (as discussed above) and are generally scary because they reinforce the idea that something may not be perfect in your back.
The key to rehab is focusing on the low back pain symptoms and risk factors within your control, not the structural changes outside your control.
Common symptoms of low back pain (non-specific)
Non-specific low back pain is not considered serious but can significantly impact your quality of life.
Common low back pain symptoms include pain that:
- You can feel across your whole lower back, or more on one side, or refers to your buttocks
- Varies from dull and aching to sharp or stabbing
- Worsens when you move into or out of certain positions
- Changes in intensity with different activities (but you may be aware of it all day)
- Worsens or improves with exercise
- Is affected by your stress levels
What can cause low back pain?
Various factors can cause pain in your lower back by tiring out your back structures and irritating or overloading them:
- Doing too little activity
- Doing too much of an activity without adequate strength and endurance for it
- Repetitively doing daily tasks like bending, twisting, lifting, or prolonged sitting
- Doing sudden or unexpected movements
- Poor trunk and pelvis muscle strength - usually due to a period of being less active (i.e., after surgery, pregnancy, childbirth, or recovery from illness)
- Mental and physical fatigue - from stress, hormone changes, poor quality sleep, or not enough training recovery time
Treating lower back pain (non-specific)
Having no definite diagnosis can leave you frustrated and uncertain of what to do about your pain. Fortunately, lower back pain without red flags usually responds very well to conservative treatment, even without a clear cause.
The best treatment for low back pain
Studies show that broad, generic strategies are ineffective for treating non-specific lower back pain. Instead, a treatment plan should be tailored to your needs and include a combination of the following:
1. Relative rest
This is about modifying or taking a break from aggravating activities and striking the right balance between rest and exercise to help settle your pain while promoting recovery.
2. Changing unhelpful habits
To help ease low back pain, try different ways of doing everyday activities and avoid being in one posture for prolonged periods or those that hurt you. Regardless of how “good” they’re said to be for you. Instead, aim to be more relaxed and comfortable when moving or still.
This involves changing the way you think about posture and movement. For example, instead of “posture correction,” think “postural comfort and ease.”
For example, sitting upright with your shoulders pulled back can become painful after a while - leaning against the back of a chair for passive back support and relaxing when sitting is okay.
3. Learning about pain
Remember, your pain is real. However, if you've had pain for some time, it's probably coming from a pain loop in your nervous system, not from damaged tissues in your back.
Learning about pain puts your lower back pain into perspective. In addition, it can help you understand what other factors in your daily life (like work or life stress) may contribute to your pain and what you can do about it.
Evidence indicates stress and anxiety are pain triggers and can make your pain feel worse. So, part of learning about pain is knowing how to manage stress and anxiety and finding ways to improve your overall mental well-being.
4. A tailored exercise program
An individualized program combining graded lower back, core, and whole-body exercises to help strengthen your back muscles, improve your balance, and increase your general fitness can help.
Experts recommend choosing exercises and activities you enjoy and will stick to for positive long-term success is best.
Other treatments may also help reduce low back pain symptoms. Some may be worth considering, and others are best avoided.
Other treatments to consider
When treating lower back pain, some modalities can help relax your muscles and reduce your pain in the short term, but their effects are usually short lived and they do not prevent future injury.
- Heat therapy (heat packs, warm baths, steam baths, sauna)
- Medication for lower back pain (prescribed by a doctor)
Treatments to avoid (according to the latest research)
- Complete rest: It can make you feel stiffer and more uncomfortable in the long run - research shows people do better when they stay active during recovery.
- Electrotherapy (like ultrasound therapy): Limited evidence supports it; other pain relief treatments are more effective
Preventing lower back pain
Once your pain subsides and you resume your usual activities, there are a few steps you can take to reduce the risk of future low back pain episodes:
- Keep active, avoiding long periods of inactivity during the day
- Maintain good back muscle strength and joint mobility
- Stay fit with regular aerobic exercise
- Avoid sudden increases in training volume or intensity
- Monitor your fatigue levels
- Take care of your mental well-being
In most cases, lower back pain is not a serious condition and can improve with a tailored, comprehensive rehabilitation program that:
- Teaches you about your back and the potent connection between your brain and your pain,
- gradually helps improve your strength, flexibility, and general fitness, and
- equips you to manage all the low back pain symptoms and risk factors within your control.
The lower back treatment plan in the app provides a tailored, easy-to-follow program focusing on these three components to help get you pain-free and running confidently again.