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The lower back is an intricate structure of interconnected and overlapping elements:

  • Tendons and muscles and other soft tissues

  • Highly sensitive nerves and nerve roots that travel from the lower back down into the legs and feet

  • Small and complex joints

  • Spinal discs with their gelatinous inner cores.

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Pain from resultant lower back muscle spasms can be severe, and pain from a number of syndromes can become chronic.

While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while adegenerating disc might cause only mild, intermittent discomfort.

Identifying the symptoms, along with an accurate diagnosis of the underlying cause of the pain, is the first step in obtaining effective pain relief.

Lower Back Pain Causes by Age

 Certain causes of lower back pain have a tendency to occur more often in younger individuals versus older adults:

These lower back pain symptoms include any combination of the following:

  • Difficulty moving that can be severe enough to prevent walking or standing

  • Pain that does not radiate down the leg or pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee;

  • Pain that tends to be achy and dull

  • Muscle spasms, which can be severe

  • Local soreness upon touch

Possible causes:

1- Back Muscle Strain

A back muscle strain or ligament strain is one of the most common causes of acute lower back pain. Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments stretch or develop microscopic tears.

With a lower back strain, the severity of the pain ranges from mild discomfort to severe, disabling pain, depending on the extent of strain and the lower back muscle spasms that result from the injury.

Back strains often heal on their own with the help of some combination or rest, ice and/or heat application, anti-inflammatory medications, and/or gradual and gentle stretching and lower back exercises. 

2- Low back pain that travels to the buttock, leg and foot (sciatica)

Sciatica includes any combination of the following symptoms:

  • Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding)

  • Pain may be worse in the leg and foot than in the lower back

  • Typically felt on one side the buttock or leg only

  • Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking

  • More severe (burning, tingling) vs. dull, aching pain

  • May be accompanied by weakness, numbness or difficulty moving the leg or foot

Frequent cause of sciatica: Lumbar herniated disc


Sciatica describes the symptoms caused when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet.

In younger adults, sciatica can be caused by a wide range of conditions, most commonly a lumbar herniated disc (may also be caused by degenerative disc disease, isthmic spondylolisthesis, and other conditions).

Symptoms: Deep ache in the lower back that worsens when standing or walking

Symptoms may include any combination of the following:

  • Pain that radiates into the buttocks and back of the thighs (also called sciatica or radicular pain)

  • Pain that worsens when bending backwards

  • Pain that feels better with sitting, especially sitting in a reclining position

  • Tired feeling in the legs, and possibly leg numbness or tingling, especially after walking

  • Tight hamstrings, making it difficult to touch toes

This is more common with older patients and is often related to canal stenosis and also called claudication.

Possible cause: Isthmic spondylolisthesis

Isthmic spondylolisthesis occurs when a vertebra in the low back slips forward on the disc space below it. It is most common at the L5-S1 level and can cause low back pain from instability and nerve root pain due to compression of the nerve root.The fracture occurs in childhood, but normally does not create a lot of pain until a patient is in young adulthood.Symptoms include pain on bending or changing postures, may be associated with pain radiating to leg or buttocks. 

When to Seek Immediate Treatment for Lower Back Pain

Most cases of low back pain do not require urgent care, but patients should seek a doctor immediately if they experience low back pain as a result of severe trauma, or if low back pain is accompanied by any of the following:

  • Fever and chills

  • Unexplained recent weight loss, or recent weight loss due to trauma

  • Significant leg weakness

  • Sudden bowel and/or bladder incontinence - either difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (cauda equina syndrome)

  • Severe, continuous abdominal pain (abdominal aortic aneurysm)

Daignostic tests

When pain is severe and is not relieved within 6 to 12 weeks, a specific diagnosis becomes more important to determine further treatment. Additional diagnostic tools include:

  • X-ray. Provides information on the bones in the spine; used to test for spinal instability, tumors and fractures.

  • CT scan. Captures cross-section images of the vertebrae and spinal discs; can be used to check for herniated disc or spinal stenosis.

  • Myelogram. Allows identification of problems within the spine, spinal cord and nerve roots. An injection of contrast dye illuminates the spine prior to an x-ray or CT scan.

  • MRI scan. Displays detailed cross-section of the components of the spine. Useful to assess issues with lumbar discs and nerve roots, as well as ruling out causes of lower back pain like spinal infections or tumors.


Treatment for lower back pain depends upon the patient's history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.

If pain persists or worsens, more involved diagnostic and surgical procedures may be recommended.

  • Rest. Ceasing activity for a few days allows injured tissue and even nerve roots to begin to heal, which in turn will help relieve lower back pain. However, more than a few days of rest can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the spine. Patients who do not regularly exercise to build strength and flexibility are more likely to experience recurrent or prolonged lower back pain.

  • Heat and Ice Packs help relieve most types of low back pain by reducing inflammation. Often patients use ice, but some prefer heat. Both may be used alternately.

  • Medications. A wide variety of over-the-counter and prescription medications is available to help reduce symptoms of lower back pain. Many medications reduce inflammation, which is often a cause of pain, while others work to inhibit the transmission of pain signals from reaching the brain. Each medication has multiple unique risks, possible side effects and drug (or food or supplement) interactions, which need to be evaluated by a physician.

  • Exercise for Lower Back Pain. Exercise is a key element of almost any lower back pain treatment plan. Whether completed at home, or with a spine health professional, such as a physical therapist, chiropractor, or physiatrist, a plan will typically include three components: aerobic conditioning, stretching, and strengthening. The exercises are best done through a controlled, progressive program, with the goal of building toward a stronger, more flexible spine.

  • Low Impact Aerobic Exercise. In addition to exercises specific to the lower back, any low impact aerobic exercise, such as walking, is often an ideal exercise for the lower back because it helps bring oxygen to the soft tissues in the back to promote healing. Swimming or water exercise has the same effect and is an excellent option if walking is too painful.

  • Chiropractic Adjustment (also called Chiropractic Manipulation)can help improve spinal function by decreasing pain and inflammation to increase range of motion and physical function.

  • Epidural Steroid Injections deliver steroids directly into the painful area of the lower back to reduce inflammation. The steroids do not heal the components of the back, but often provide enough pain relief to allow patients to move, exercise and heal.- AT OUR CENTRE IT IS DONE BY PAIN EXPERTS. IT IS A DAY CARE PAINLESS PROCEDURE..

  • Surgery for Lower Back Pain is usually considered after pain has not been relieved with nonsurgical methods. Still, surgery is always the patient’s decision, and a qualified spine surgeon will be able to explain the pros and cons of each procedure. For sciatica, laminectomy andmicrodiscectomy have been shown to significantly reduce pain symptoms by relieving the pressure on compressed nerve roots.

  • Fusion surgery, which is used to stop the motion at a motion segment, is a bigger surgery but can be effective at relieving pain due to a painful motion segment.






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