My patients ask me what causes their lower back pain nearly every day. In the article below I’ll go over the most common causes. It may surprise you to find that not all back pain has a closely related structural issue associated with it.
The cause of lower back pain is largely unknown. Stenosis, disc bulges, herniations, degenerative disc disease, and the like may cause symptoms but it’s also possible for those to be asymptomatic. Certain findings on imaging may increase the chance of lower back pain, such as increased findings of bulging and degeneration with x-ray, however, correlation is weak.
Read on to learn about the most common potential causes of lower back pain that I see in my orthopedic physical therapy clinic.
Most Common Causes of LBP
Most people want two things when they come to work with me; number one, to find out how to make sure they don’t make their back pain worse, and more importantly, how to work to improve their symptoms. And, number two, what is causing their pain, is it dangerous?
Let’s start with the question that you likely clicked on this article for, the causes. Muscle spasms and a centralized ache that spread across the lower back on both the left and the right side is the most common symptoms that I see, other than pain that starts in the back and radiates down to the thigh, knee, and sometimes even the calf or foot.
If pain is localized in the low back and there is a spasm or ache sensation, this is classified as Non-specific low back pain or NSLBP. The reason it is classified as such is due to the impossibility of determining the exact structure that is contributing to symptoms. In a high percentage of cases, we do not know the exact structure that is causing symptoms even if we have an x-ray, CT scan, or MRI images. As I shared above, even people who are asymptomatic (people with no symptoms) can have imaging findings.
Take this image below for example. If we look at imaging findings in the second chart, you’ll notice that as we age, there is a higher and higher percentage of people that will have “abnormal” findings on their low back X-rays and MRIs. These findings are a normal part of aging.
I want to reiterate, that this DOES NOT mean that your pain IS NOT related to the findings it just means that it’s not as clear as we once thought.
So, the big take away, pain can be caused by:
- Disc herniation
- Disc Bulges
- Stenosis
- Spondylolisthesis
- Arthritis (facet and vertebral body)
- Infection
- Fracture
But, particularly the top 5 that were listed, we must take these with a grain of salt as the imaging findings aren’t that accurate in determining how much pain someone has and what is causing it.
Is My Low Back Pain Dangerous?
Great question. Let’s first rule out red flags. I want to preface this section with this statement.
<10% of people will have any of these diagnoses. Depending on the scientific article you read, the range go from 2-5% prevalence.
Have you fallen hard onto your back? There could be a fracture
Do you have a fever and severe back pain? There could be an infection.
Are you having severe pain at night that doesn’t improve with a change in position? This is a cancer screening tool.
Do you have numbness, tingling, weakness in one or both legs, and bowel and bladder changes that is getting worse? This could potentially be cauda equina syndrome
If you answered yes to any of these, you should contact your doctor as soon as possible.
If you answered no, then it is unlikely that your back pain is dangerous and requires immediate medical or surgical intervention.
What Can I Do To Improve My Low Back Pain?
Most people will progressively improve over the course of 2-6 weeks, assuming you stay moving and minimize doing certain activities that aggravate symptoms severely.
You can of course get back to those activities over time but it would be wise to gradually reintroduce those over the course of a few weeks.
In terms of what it means to “stay moving;” get back to your normal activities as soon as possible. It’s fine to take a couple of days off to rest, use ice or heat, whatever feels best, 20 mins on, 20 mins off, and it’s even advisable to take some Tylenol or other NSAID (non-steroidal anti-inflammatory medication), as long as you’ve been cleared by your doctor to do so.
If you usually go and workout at the gym, go back to the gym. Decrease the intensity of your workouts, decrease the volume (how long/how many reps), and just try to do exercises that keep your pain levels within tolerable ranges. This is the most important part is to check in with yourself during the workout, 1 hour after the workout, and 24 hours post.
This way you can see if what you’re doing aggravated your back, or not.
If you don’t workout in the gym, but you mainly walk, run, hike, cycle, or something else, the same logic applies. Get back to doing what you were doing before but in a reduced capacity for a couple of weeks as your symptoms reduce. This could mean reducing the duration of the activity by 50% and seeing if you have more, less, or the same symptoms after 24 hours.
When Should I seek Help From a Professional?
If it’s been 2-6 weeks, you’ve tried to stay active, and your symptoms are continually worsening or staying stagnant, this is when I would recommend going to see your physical therapist, physician, or other healthcare providers that you trust.
