The lumbar spine provides lower back support, which links the pelvis, sacrum and upper back. 

Five large vertebrae (L1-L5) support the upper body’s weight and move the lower back. The lumbar spine supports the majority of the weight of the body.

It is the biggest and strongest part of the vertebral column [1]. Additionally, it allows for a lot of mobility, including rotation, flexion, extension and lateral bending.

The lumbar spine plays a crucial role in weight-bearing and movement, making it prone to injury and discomfort. Good posture, exercise, stretching and getting medical attention at the first sign of discomfort or pain can support and protect it.

Numerous significant muscles, ligaments and nerves are also located in the lower back, including:

• The lower back’s muscles, which support the spine and aid in movement, include the erector spinae, quadratus lumborum and psoas muscles.

• The lower back’s ligaments, linking the vertebrae and support the spine’s stability.

• Three muscles in the lower back that support the spine and aid in movement: erector spinae, quadratus lumborum and psoas.

• The lower back’s structure supports the upper body’s weight, allows movement and protects the spinal cord and nerves.

The lower back supports the upper body’s weight and gives the torso stability and movement. For movements such as bending, twisting and lifting, it bears the majority of the body’s weight.

The lumbar spine shields both the spinal cord, which runs through the center of the vertebrae, and the nerves that extend from it to various parts of the body. These nerves regulate the lower body’s movement and feeling, including that of the legs, foot and pelvic organs. The lumbar spine also supports and protects the organs in the abdomen and pelvis, like kidneys, liver and reproductive organs.

Lower back pain

A frequent problem that affects millions of individuals worldwide is lower back discomfort. Injury, bad posture, muscular strain and underlying medical issues are just a few of the causes.

Most of the time, conservative treatments for lower back pain include rest, cold or heat therapy, over-the-counter painkillers and physical therapy exercises. To rule out underlying medical disorders that could need more complicated treatment, it’s crucial to contact a doctor if the pain persists or is accompanied by other symptoms.

Maintaining excellent posture, exercising frequently, stretching frequently and refraining from repeated motions or activities that strain the lower back are preventative practices that may help lessen the risk of lower back discomfort.

The presence of pain or discomfort in the lower back area is a sign of lower back pain [2]. There may be stiffness, restricted movement or other symptoms in addition to the pain, which can range from a dull aching to a severe or stabbing feeling.

You might need to do a self-evaluation or get a professional medical opinion to determine whether you have lower back discomfort. 

Typical warning signs and symptoms

• Lower back pain or discomfort, particularly between the ribs and the hips.

• Stiffness or restricted movement in the lower back, which makes it challenging to move or carry out daily tasks.

• Lower back pain that spreads to the thighs, legs or buttocks.

• Tingling or numbness in the toes, foot or legs.

• Leg weakness makes it challenging to stand, walk or climb stairs.

• Pain that gets worse with specific motions or tasks, such bending, lifting,or staying seated for a long time.

• Cramps or spasms in the lower back muscles.

• Stress-related pain, anxiety-related pain or any emotional pain.

It’s critical to consult a doctor if you encounter any of these symptoms in order to identify the underlying issue and obtain the proper care. To treat your symptoms and assist you in managing your lower back pain, your doctor may advise conservative treatments like rest, physical therapy and painkillers.

Different types of lower back pain

Lower back discomfort can come in several distinct forms, each with its own causes and signs. Below are a few of the most typical lower back pain patterns:

Mechanical back pain

The most typical form of lower back pain is mechanical back pain, commonly referred to as non-specific back pain. It is brought on by the gradual deterioration of the spine and the structures that support it over time and it can be brought on by rapid movements or lifting large things. 

Depending on the degree and location of the illness, the symptoms of mechanical back pain might change. A dull, throbbing ache in the lower back is a common symptom and there may also be stiffness or restricted movement [3]. With activity or exercise, the discomfort may subside. It may be stronger in the morning or after extended sitting or standing.

Multiple factors, such as the following, can contribute to mechanical back pain:

• Improper body mechanics or posture.

• Excessive usage or repeated stress.

• Obesity or leading a sedentary existence.

• Strain or sprain of a muscle.

• Degenerative alterations to the spine, such as disc degeneration or arthritis.

Rest, cold or heat therapy, over-the-counter pain medication and physical therapy exercises to increase strength and flexibility are frequently used as treatments for mechanical back pain. With these conservative treatments, the illness will often improve within a few weeks to a few months. To rule out underlying medical disorders that could need more complicated treatment, it’s crucial to contact a doctor if the pain persists or is accompanied by other symptoms.

Herniated Disc

A herniated disc is a disorder in which a rip in the disc’s outer layer allows the soft, gel-like substance inside a spinal disc to protrude through. This ailment is also referred to as a slipping disc or burst disc. This may result in lower back discomfort as well as other signs and symptoms include tingling or numbness in the legs, weakness or sharp pain that travels down the leg.

Depending on where the injury is and how severe it is, a herniated disc may present with a variety of symptoms. Some typical signs include:

• Pain that is sudden or shooting in the legs, buttocks or lower back.

• Legs or feet that are numb or tingly.

• Walking difficulties or leg weakness.

• Cramps or spasms in the lower back muscles.

• Lower back’s limited range of motion.

Numerous things, including aging-related wear and tear, unexpected trauma or recurrent stress on the spine, can result in a herniated disc. A person’s risk increases if they are overweight or engage in occupations that require heavy lifting or twisting actions.

Rest, physical therapy and pain-relieving methods including over-the-counter or prescription painkillers, cold or heat therapy and corticosteroid injections are frequently used in the treatment of herniated discs [4]. To remove the injured section of the disc and release pressure on the nerves, surgery may be required in some circumstances.

Sciatica

Sciatica is a particular type of lower back pain caused by compression or irritation of the sciatic nerve, which runs from the lower back down to the legs. It is characterized by lower back discomfort, numbness or tingling that travels to the legs, frequently on one side of the body [5].

Depending on the location and seriousness of the illness, sciatica symptoms might change. Some typical signs include:

• Lower back or buttock pain that travels down the leg.

• Legs or feet that are numb or feel tingly.

• Walking difficulties or leg weakness.

• Cramps or spasms in the lower back muscles.

• Lower back’s limited range of motion.

Numerous conditions, including a herniated disc, spinal stenosis or degenerative disc degeneration, can result in sciatica. Age, obesity and leading a sedentary lifestyle are other risk factors.

Physical therapy, rest, over-the-counter painkillers, cold or heat therapy and corticosteroid injections are common sciatica treatments. Sciatic nerve surgery may be necessary in some cases to relieve strain. If you have ongoing sciatica symptoms, you should visit a doctor right away since sciatica left untreated can result in chronic nerve damage.

Spinal stenosis

Symptoms of spinal stenosis include lower back pain, paralysis, tingling and numbness in the legs, as well as entrapment of nerves in the lower back [6]. Numerous reasons, such as congenital anomalies or degenerative changes to the spine such as arthritis or disc degeneration, may contribute to the narrowing of the spinal canal.

The degree and location of the problem might affect the symptoms of spinal stenosis. Some typical signs include:

• Lower back or leg pain that becomes worse with exercise and gets better with rest.

• Legs or feet that are numb or tingly.

• Walking difficulties or leg weakness.

• Loss of bladder or bowel control (a symptom of cauda equina syndrome, a dangerous illness).

Usually, an imaging test like an X-ray or an MRI accompanies a physical examination to detect spinal stenosis.

Rest, physical therapy and pain management methods including over-the-counter or prescription pain medication, cold or heat therapy and corticosteroid injections may all be used as treatments for spinal stenosis. Surgery can be required in more severe situations to release pressure on the lower back’s nerves. If you have ongoing symptoms of spinal stenosis, you should consult a doctor right once since, if left untreated, spinal stenosis can result in irreversible nerve damage.

Osteoarthritis

A degenerative joint condition known as osteoarthritis can affect every joint in the body, including the lower back joints. The cartilage that cushions the joints begins to break down, which causes discomfort, stiffness and limited movement in the afflicted area.

Depending on the location and severity of the disease, osteoarthritis symptoms might change. Some typical signs include:

• Stiffness or pain in the lower back.

• Lower back’s limited range of motion.

• Lower back muscle weakness or spasms.

• When the lower back is moved, there are clicking or popping noises.

• Pain that is better with rest but becomes worse with action.

• Legs or feet that are numb or tingly.

Physical examination, medical history and imaging tests like an X-ray or an MRI are frequently used to diagnose osteoarthritis.

Osteoarthritis can be treated with rest, physical therapy and pain-relieving medications (over-the-counter or prescribed), cold or heat treatment and corticosteroid injections. Surgery can be required in more serious situations to replace the injured joint [7].

Maintaining a healthy weight, exercising often, stretching and refraining from repeated motions or activities that put stress on the joints are preventative practices that may help lower the risk of osteoarthritis.

Spondylolisthesis

A spinal disorder known as spondylolisthesis occurs when one vertebra slides forward over the vertebra below it. In addition to causing lower back pain and stiffness, this can also result in nerve compression, which can cause paralysis or tingling in the legs.

Spondylolisthesis symptoms might change depending on where and how severe the ailment is. Some typical signs include:

• Lower back pain that could be made worse by exercise and made better by rest.

• Lower back stiffness or restricted range of motion [8].

• Lower back muscle weakness or spasms.

• Legs or feet that are numb, tingly or feeble.

• Loss of bladder or bowel control (a symptom of cauda equina syndrome, a dangerous illness).

Numerous things, including congenital anomalies, trauma or aging-related degenerative changes in the spine, can lead to spondylolisthesis.

Rest, physical therapy and pain relief methods including over-the-counter or prescription painkillers, cold or heat therapy and corticosteroid injections are frequently used in the treatment of spondylolisthesis. For the afflicted vertebrae to be realigned and the spine to be stabilized in more severe situations, surgery could be required.

Maintaining proper posture, exercising regularly, stretching and avoiding activities that put an excessive amount of stress on the lower back are preventative practices that may help lessen the chance of spondylolisthesis.

Less common causes of lower back pain

There are other less frequent factors that may contribute to lower back discomfort in addition to the more prevalent ones, such as:

• Infection: In rare instances, a bacterial or viral infection of the spine or surrounding tissues may be the source of lower back discomfort.

• Ankylosing spondylitis: A kind of arthritis that mostly affects the spine, ankylosing spondylitis results in pain, stiffness and restricted movement in the lower back. This particular kind of arthritis typically impacts the spine, however it can also affect other joints and other organs. The lower back, hips and other joints may experience discomfort, stiffness and restricted movement as a result of this chronic inflammatory illness.

Ankylosing spondylitis often appears in early adulthood and is thought to be brought on by a mix of hereditary and environmental causes. Men are more likely than women to have it.

• Fibromyalgia: is a chronic pain syndrome that can cause severe pain in the lower back as well as other parts of the body. It can result in generalized body pain, including discomfort in the lower back, as well as other symptoms including exhaustion, sleep disruptions and cognitive challenges. There is presently no treatment for this complicated and poorly known illness. 

Although the precise etiology of fibromyalgia is unknown, a confluence of genetic, environmental and neurological factors is thought to be responsible. It is more prevalent in women than in males and it frequently appears following a psychological or physical trauma.

• Paget’s disease: Osteitis deformans, another name for Paget’s disease, is a chronic bone condition marked by aberrant bone development and remodeling. This can cause discomfort, especially in the lower back and other weight-bearing bones, as well as bone abnormalities, fractures and soreness. 

With Paget’s disease, the body’s bone tissue breaks down and replaces itself at an unusually rapid rate, resulting in bone fractures. Paget’s illness, which is more prevalent in persons over 50, is thought to result from a confluence of hereditary and environmental factors.

• Kidney stones: Kidney stones can cause severe lower back pain. Kidney stone pain can be severe, stabbing or throbbing and can be felt in the sides or lower back. Other symptoms like fever or chills may also coexist with the pain, which may come and go.

• Endometriosis: Endometriosis is a condition that causes pain and other symptoms when the tissue that lines the uterus (endometrium) starts to protrude outside of the uterus. While endometriosis may affect any part of the body, it most frequently affects the pelvic area and can result in lower back discomfort, pain during menstruation, pain during sexual activity and pain with bowel movements.

• Tumors: Lower back discomfort can also result from tumors in the spine or tissues nearby, along with other symptoms such a fever, lack of appetite or neurological signs.

Even while these uncommon reasons for lower back pain are less often than the more prevalent causes, they can nevertheless happen and may call for a particular approach to therapy. If you have persistent lower back pain, it is necessary to consult a healthcare professional to identify the underlying reason and the best course of action.

Diagnosis

Imaging studies, physical examinations and medical histories are frequently used in conjunction to determine the underlying cause of lower back pain. Here are some of the diagnostic procedures a medical professional would use:

• Medical history: A healthcare professional would often inquire about the cause, duration and type of any pain, as well as any circumstances that may make it worse or lessen it.

• Physical examination: Normally, a healthcare professional would carry out a physical examination to evaluate the afflicted area’s range of motion, strength and reflexes as well as any indications of inflammation or other abnormalities.

• Imaging testing: To help view the structures in the lower back and see any abnormalities or injuries, imaging tests like X-rays, CT scans or MRI scans may be prescribed.

• Blood tests may be prescribed to help rule out underlying medical issues such infections or autoimmune diseases that may be causing the lower back discomfort.

A healthcare professional may be able to pinpoint the underlying cause of the lower back pain and provide suitable treatment choices based on the findings of these diagnostic tests. Depending on the source and severity of the problem, treatment may include a mix of physical therapy, medication and pain management measures.

Lower back pain treatment

The underlying reason, intensity and length of the pain all influence how you manage lower back pain. Here are some typical medical options:

• Managing pain: Over-the-counter painkillers like acetaminophen, ibuprofen or naproxen can help slash inflammation and discomfort. For more severe pain, prescription painkillers or muscle relaxants may be advised. Other methods of pain treatment include massage, acupuncture or heat or ice therapy.

• Physical therapy: A physical therapist can assist in creating an exercise regimen to help strengthen the lower back muscles, increase flexibility and lessen discomfort. Additionally, they could suggest stretches or other body mechanics exercises to enhance posture.

• Lifestyle adjustments: Making lifestyle adjustments including exercising regularly, keeping a decent posture and steering clear of activities that put too much stress on the lower back helps prevent or lessen lower back discomfort.

• Corticosteroid: Including other pharmaceutical injections into the afflicted region may assist to lessen pain and inflammation.

• Surgery: In more serious situations, surgery may be required to stabilize the spine or address structural problems.

If you have persistent lower back discomfort, it’s crucial to go to a doctor since untreated disorders might result in lasting nerve damage or other issues. Your healthcare professional can suggest suitable treatment alternatives and assist in identifying the underlying cause of your lower back discomfort.

You should see a medical professional, such as a chiropractor, physical therapist or primary care doctor, if you have ongoing lower back discomfort. To identify the underlying source of the pain, they can conduct a physical examination and may request diagnostic procedures like X-rays or MRI scans.

For additional assessment and treatment, you could occasionally be sent to a specialist such as a spine surgeon or pain management expert.

Get emergency medical care if your lower back pain is severe or accompanied by other symptoms including fever, loss of bladder or bowel control or escalating limb weakness.

Lower back discomfort should be taken carefully since untreated disorders might result in long-term nerve damage or other issues. Your lower back pain’s underlying cause can be identified by a healthcare professional, who can also suggest the best course of therapy to help you feel better and live a better life.

[1] https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-Spinal-Stenosis
[2] https://my.clevelandclinic.org/health/diseases/7936-lower-back-pain
[3] https://pubmed.ncbi.nlm.nih.gov/18973732/
[4] https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/
[5] https://www.ncbi.nlm.nih.gov/books/NBK507908/
[6] https://www.niams.nih.gov/health-topics/spinal-stenosis
[7] https://www.niams.nih.gov/health-topics/osteoarthritis
[8] https://www.nhs.uk/conditions/spondylolisthesis/