What causes lower back pain?

Almost everyone experiences lower back pain at some point. This is because low (lumbar) back pain has a remarkable number of causes. While improper posture, obesity, a sedentary lifestyle, pregnancy, and heavy lifting often contribute to low back pain, and such pain may also be the result of organic disorders like kidney disease, the vast majority of patients with back pain suffer from musculoskeletal disorders. These disorders can most often be treated without surgery by physiatrists -- doctors who specialize in pain management and rehabilitation.

If you are troubled by low back pain that interferes with your daily routine and quality of life, it is important to seek medical help sooner rather than later since otherwise the condition is likely to worsen. Sudden injuries accompanied by acute low back pain typically prompt patients to seek immediate care, but chronic aches and twinges are also indicators that your back pain should be diagnosed by a professional.

Underlying Causes of Lower Back Pain

The multiple causes of back pain fall into four basic categories: injury, disease, wear and tear, and congenital conditions. Although these categories are separated here for clarity, it should be remembered that they often overlap, for example when an injury occurs because of a pre-existing condition.

It is essential to rule out organic reasons for back pain through blood tests and imaging tests before attempting to address treatment plans. Physiatrists are trained to be careful and thorough diagnosticians so they can determine whether you need a referral to another type of doctor, such as a nephrologist or rheumatologist. They will also recommend a qualified surgeon if they believe surgery is necessary.

Injuries That Cause Back Pain

A frequent reason for sudden, severe back pain, especially among children and young adults, is injury. Injuries that cause back pain may occur during sports participation, exercise, work, recreational activities, doing chores, as a result of slip and fall or car accident, or even as a result of a sudden awkward movement. Lower back pain often results from damage to:

  • Ligaments (muscle tissue joining bones to one another)
  • Tendons (muscle tissue joining bones to muscle)
  • Muscles or nerve roots
  • Vertebrae (bones of the spine) or facet joints that connect them
  • Discs (cushions between the vertebrae)

Common causes of lower back pain are pulled muscles, tendons or ligaments, resulting in sprains and strains. Fortunately, these conditions, though very painful, can be treated nonsurgically.

Disease Conditions That Cause Lower Back Pain

Many disease conditions -- like rheumatoid arthritis and multiple sclerosis (both autoimmune disorders), post-polio syndrome and diabetes -- cause back pain that can be alleviated by a variety of noninvasive methods, such as acupuncture, individualized physical therapy, and Pulsed Electromagnetic Field (PEMF) therapy.

Congenital Conditions That Cause Lower Back Pain

Some individuals are burdened by lower back pain from birth, such as some with the following:

  • Muscular dystrophy, a genetic disorder that attacks the muscles and often causes pain as well as weakness and atrophy.
  • Scoliosis, kyphosis, and lordosis, congenital conditions that involve malformations of the spine. While severe deformities may require surgery, mild abnormalities can be successfully treated by nonsurgical means.
  • Spondylolisthesis, an instability of the spine in which one vertebra may slip onto the bone below, putting pressure on nerves (may be congenital or may develop later in life)
  • Ankylosing spondylitis, a form of inflammatory arthritis that appears to have inherited components.

Wear and Tear Causes of Lower Back Pain

The spine, like other parts of the body, wears out as we age. In some cases, this wear and tear is exacerbated by inherited conditions; in others it is accelerated by serious injuries. Though unfortunately we cannot reverse the aging process, medical experts in pain management and restoration of function can help alleviate pain and increase mobility. Our lower backs are often painful due to:

  • Osteoarthritis as the protective cartilage that cushions the bones wears down
  • Disc herniation when the cushions between the vertebrae bulge and press on nerves
  • Spinal stenosis as the spinal canal narrows due to bone spurs, putting pressure on the spinal cord and/or nerve roots
  • Pinched nerves from herniated discs, spinal stenosis or other causes, that results in tingling and numbness as well as pain
  • Sciatica from pressure on the sciatic nerve, the large nerve running from the lower back down each leg that may also affect the hip, buttocks, and legs
  • Osteoporosis as bones become thinner, more porous and more brittle -- part of the natural aging process but may also occur due to diseases such as bone cancer

In the end, the cause of your lower back pain is less important than relieving it.

Taking Steps to Minimize Your Lower Back Pain Will Change Your Life

Just because lots of people experience lower back pain doesn’t mean you have to. Too many people endure the miserable discomfort and restricted mobility of this malady because they think they have no other choice. Nothing could be farther from the truth. As with other situations that may seem terrible to endure but impossible to correct, this one may have a relatively simple solution.

Reaching Out for Help Is Key

While you may have been told that being stoic is taking the high road, the reality is that not seeking available assistance is self-defeating. Suffering when you have viable options is not courageous; it’s foolish. If lower back pain is keeping you from accomplishing what has to be done and, even worse, keeping you from doing things you enjoy, now is the time to make a change.

Making an appointment with a skilled physiatrist who will be able to diagnose the cause of your back pain and create a treatment plan designed especially for you is an important step. You will probably be surprised to find out how many nonsurgical treatment options there are to restore your mobility and your sense of well-being.

About The Author: Jason Lipetz, MD 

Prior to founding Long Island Spine Rehabilitation Medicine, Dr. Lipetz served as the Director of the Center for Spine Rehabilitation for the North Shore Long Island Jewish healthcare system from 1999-2006. Dr. Lipetz received his specialized and interventional spine medicine training during a fellowship year at the internationally recognized Penn Spine Center of the Hospital of the University of Pennsylvania. After receiving his medical degree with Alpha Omega Alpha honors from Columbia University’s College of Physicians and Surgeons, Dr. Lipetz completed his residency in Physical Medicine and Rehabilitation at the prestigious Kessler Institute for Rehabilitation and the University of Medicine and Dentistry of New Jersey.