Lower Back Pain Symptoms, Diagnosis, and Treatment

spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment

The lumbar spine, or low back, is a remarkably well-engineered structure of interconnecting

bones, joints, nerves, ligaments, and muscles all working together to provide support,
strength, and flexibility. However, this complex structure also leaves the low back
susceptible to injury and pain.

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Injury to any of the structures in the lumbar spine can lead to low back pain.
Watch: Lumbar Spine Anatomy Video

To help understand this complicated topic, this article presents a model for understanding
symptoms, physical findings, imaging studies and injection techniques to come to a precise
diagnosis.

See Getting an Accurate Back Pain Diagnosis

Once an accurate diagnosis of the cause of the lower back pain is attained, treatment
options can be selected based on today’s best medical practices.

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The Lumbar Spine, What Can Go Wrong

The low back supports the weight of the upper body and provides mobility for everyday
motions such as bending and twisting. Muscles in the low back are responsible for flexing
and rotating the hips while walking, as well as supporting the spinal column. Nerves in the
low back supply sensation and power the muscles in the pelvis, legs, and feet.

See Back Muscles and Low Back Pain

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Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The
body also reacts to injury by mobilizing an inflammatory healing response. While
inflammation sounds minor, it can cause severe pain.

There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and
other spinal structures, and it can be difficult for the brain to accurately sense which is the
cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a
pulled muscle – both creating inflammation and painful muscle spasm in the same area.
Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of
pain helps determine the cause.

See Pulled Back Muscle and Lower Back Strain

In This Article:

Range of Lower Back Pain Symptoms

Low back pain can incorporate a wide variety of symptoms. It can be mild and merely
annoying or it can be severe and debilitating. Low back pain may start suddenly, or it could
start slowly—possibly coming and going—and gradually get worse over time.

Depending on the underlying cause of the pain, symptoms can be experienced in a variety
of ways. For example:

Pain that is dull or achy, contained to the low back

Stinging, burning pain that moves from the low back to the backs of the thighs,
sometimes into the lower legs or feet; can include numbness or tingling (sciatica)
Muscle spasms and tightness in the low back, pelvis, and hips
Pain that worsens after prolonged sitting or standing
Difficulty standing up straight, walking, or going from standing to sitting

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In addition, symptoms of lower back pain are usually described by type of onset and
duration:

Acute pain. This type of pain typically comes on suddenly and lasts for a few days or
weeks, and is considered a normal response of the body to injury or tissue damage.
The pain gradually subsides as the body heals.
Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is
usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged.
At this point, a medical workup may be considered, and is advisable if the pain is
severe and limits one’s ability to participate in activities of daily living, sleeping, and
working.
Chronic back pain. Usually defined as lower back pain that lasts over 3 months, this
type of pain is usually severe, does not respond to initial treatments, and requires a
thorough medical workup to determine the exact source of the pain.1

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

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Types of Low Back Pain
There are many ways to categorize low back pain – two common types include:

Mechanical pain. By far the most common cause of lower back pain, mechanical
pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints,
sacroiliac joints), or bones in and around the spine. This type of pain tends to be
localized to the lower back, buttocks, and sometimes the top of the legs. It is usually
influenced by loading the spine and may feel different based on motion
(forward/backward/twisting), activity, standing, sitting, or resting.
Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged
or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into
the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and
can be associated with numbness or weakness (sciatica). It is typically felt on only
one side of the body.
See Radiculopathy, Radiculitis and Radicular Pain

There are many additional sources of pain, including claudication pain (from stenosis)
myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory
conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates
from another part of the body and presents in the lower back (such as kidney stones, or
ulcerative colitis).

It is also possible for low back pain to develop with no definitive cause. When this happens,
the primary focus is on treating the symptoms (rather than the cause of the symptoms) and
the patient’s overall health.

For subacute and chronic lower back pain, a thorough diagnosis is important to lay the
foundation for appropriate treatment and rehabilitation. Lower back pain treatment reduces
the likelihood of recurrent back pain flare-ups and helps prevent the development of chronic
lower back pain.

References:
1. National Institute of Neurological Disorders and Stroke. Pain: Hope Through
Research. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-
Through-Research/Pain-Hope-Through-Research. June 9, 2017.

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