What are The Causes of Lower Back Pain?

Are you having low back pain and not sure why? Let's talk about it!

Hello everyone, I’m Doctor Bathla, and welcome to The Pain Minute blog. So, you're having back pain and not sure what it could be? Did you know that low back pain is one of the leading reasons anyone visits their doctor? 

Almost 80% of people will have significant low back pain at some point in their life. In this blog, we will review different potential causes for low back pain. Although we won’t really discuss treatment in this blog, I do have other blogs that deal with treatment as well.

The low back is very complicated. It essentially carries the weight of the entire upper body and acts as a major structural stabilizer of your body. The low back generally refers to the 5 lumbar vertebrae and its components. Those components can be muscles, ligaments, and tendons. Ultimately, the purpose of the low back is to provide structure and provide protection to the spinal cord.

The 5 vertebrae of the lumbar spine are spaced from each other by a disc. The disc provides cushioning and shock absorption between the discs. It also creates a space for the nerves of the spinal cord to leave the spinal canal. Muscles, tendons, and ligaments serve the purpose of adding structural rigidity to the spine and allows the spine to serve as an “anchor point” for other muscles and joints of the body.

The good news is that most low back pain will resolve on its own within 90 days. In fact, almost 80% of it will. For the pain that does not resolve on its own, thankfully there are effective medical treatments that we can perform. Although back pain is rarely caused by any urgent or life-threatening condition, you should always seek medical help if the pain lasts more than a week or is very severe.

One of the more common causes of low back pain is what we call Myalgia or pain caused by muscles. This generally is a muscle strain or a pulled muscle which may cause your back to lock up. This could be related to trauma but is more often due to overuse. Often rest and stretching are the best treatment options and this will generally resolve within a few days without any intervention.

Another potential cause can be Degenerative Disc Disease. As we age, normal wear and tear on the disc can cause a breakdown and wear down of the disc. This can often result in a thin flat disc and thus improper spacing and cushioning of the vertebrae. It can also result in painful tearing of the discs.

A Herniated Disc (also known as a bulging or slipped disc) is a disc that slipped out of its normal place. This can become more problematic when the disc actually then pushes on a nerve root and causes pain, numbness, or weakness into the legs -- resulting in radicular pain or more commonly known as “Sciatica”.  This is when the nerve roots that ultimately form the sciatic nerve are pinched and cause severe shooting pain down the legs.

The low back is essentially a series of joints and like any other joint in the body, you can get Arthritis.  Arthritis in the low back is known as Spondylosis. This is when the facet joints or the joints of the spine get inflamed and arthritic. Arthritis can also lead to painful; bone spurs. This generally will result in pain with movement of the back, specifically bending back, and is relieved when bending forward. One of the characteristics of arthritic joints is that they become larger due to the inflammation. This is known as joint hypertrophy or in our case, Facet Hypertrophy. This enlarged joint can then push into other structures of the low back leading to other painful conditions such as sciatica or spinal stenosis.

Spinal Stenosis is a condition where the spinal canal or the bony canal surrounding and protecting the spinal cord tightens on the spinal cord. This can result in painful pressure on the spinal cord and its terminal nerves. People often describe pain with walking but no pain once they are sitting down. These patients often lean on shopping carts.

Often times, one vertebrae can slip relative to one another so they are no longer aligned properly. This is known as Spondylolisthesis. This is generally caused by continued stress on the low back and can be commonly seen in weightlifters and gymnasts who apply a lot of pressure on their vertebrae. This causes a structural instability of the low back which can lead to pain in the low back and into the legs.

Patients may have a severe sudden onset of pain from a fall which resulted in a Spinal Fracture. This is particularly common in patients with osteoporosis. It is important to note that a comprehensive medical workup is very important in any person with a spinal fracture even though there are known trauma.

Some less common causes of low back pain can be Sacroiliac Pain where we have inflammation of the sacroiliac joint or the structures surrounding it.

Piriformis Syndrome can be a strain and inflammation of the piriformis muscle with subsequent pressure on the sciatica nerve. Interspinous Ligament Strain, where you have a strain of the posterior ligament of the spine is generally caused by overuse and Discitis. Discitis is a bacterial infection of the discs. Less commonly, we do diagnose more serious causes of low back pain such as Spinal Tumors. Therefore, any persistent and/or severe low back pain does warrant a comprehensive medical workup.

So, there you have it! A comprehensive list of the major causes of low back pain. Please look into my library of videos to find a more specific video for each condition and its treatment. If I don’t have a video yet, rest assured that it is coming! I love to read comments so please leave any pain management-related question in the comment section of my YouTube channel, The Pain Minute.

Sincerely, 

Baljinder Bathla, M.D.