Also known as the lumbar spine, the lower back is prone to numerous causes of pain and discomfort. Lower back pain may indicate any one of a wide variety of problems, such as spinal injuries, disc disorders, or degenerative spine conditions. However, it may also point to more serious conditions, which is why proper evaluation and treatment are imperative.
Here Centers for Neurosurgery, Spine and Orthopedics (CNSO) discusses common lower back pain causes and how CNSO spine specialists and neurosurgeons determine the best treatment.
Understanding Lower Back Pain and Its Symptoms
Lower back pain is one of the leading reasons people visit a healthcare provider – not just in the United States but around the world. Globally, lower back pain is the top cause of disability, with an estimated 619 million people affected.
The most common location for pain is the back. This is because bone mass and joint cushioning in the spine diminish with age. This can affect the spinal cord and nerves and compromise mechanical functionality in the spine.
Depending on the cause and other factors, symptoms of lower back pain may vary from mild and manageable discomfort to severe pain that disrupts daily life. People living with lower back pain may experience the following:
- Burning sensations
- Difficulty maintaining proper posture
- Muscle spasms
- Pain, weakness, tingling, or numbness radiating down one leg or both legs
- Pain that is tender to the touch
- Popping or clicking
- Shooting or stabbing pain
- Stiffness
- Swelling
- Symptoms that increase in severity when walking, standing, lifting, twisting, bending, or performing other movements
In many cases, lower back pain gradually dissipates with home treatment remedies, such as rest, over-the-counter pain relievers, ice or heat, and stretching. However, chronic pain may indicate the presence of a more serious problem. People with acute or chronic pain should see a board-certified back specialist especially if they notice any of the following warning signs:
- New bladder or bowel problems
- Pain accompanied by a fever
- Radiating pain in the legs, especially below the knee
- Rapid weight loss with no explanation
- Severe symptoms that show no improvement after resting
- Unexplained pain lasting for longer than two to three weeks
Lower Back Pain Causes
Some cases of lower back pain result from motor vehicle accidents, work-related back injuries, or spinal cord injuries or fractures. Meanwhile, others point to a degenerative spine condition or spinal deformity. Lower back pain may also indicate the presence of a spinal tumor, making prompt medical attention imperative for those experiencing concerning symptoms.
Causes of lower back pain include:
- Bone spurs: These are bony overgrowths that develop on the skeletal joints, usually in response to nemoral wear and tear or trauma to the cartilage overlying a joint. These bone spurs can project into joints or nearby structures, like nerves, resulting in pain.
- Cauda equina syndrome: This common spine emergency must be addressed within 24 hours. At the spinal cord’s base, a group of nerve roots and small nerves is called the cauda equina, which is responsible for sensory supply and motor function in the legs and bladder. When the cauda equina becomes compressed, a loss of function occurs, causing bladder and bowel dysfunction, leg weakness, and other symptoms. Rapid treatment is necessary to prevent permanent muscle paralysis in the legs, bladder, and bowel sphincters.
- Disc disorders: Though some people may not experience pain, others with bulging discs, slipped discs, or herniated discs will have pain. If discs bulge, slip, or herniate in the lumbar region of the spine, they place pressure on nearby nerves, resulting in lower back pain.
- Failed back syndrome: Sometimes, previous back surgeries become ineffective over time, causing problems in the same or surrounding areas of the spine. This is referred to as failed back syndrome, and the condition is often associated with pain.
- Ligament/muscle strain: When muscles or ligaments in the lower back become strained from overuse or injury, it may result in pain and other uncomfortable symptoms. Physical therapy will resolve these conditions without the need to have an operation.
- Myelopathy: This refers to the symptoms accompanying spinal cord compression, which can occur in the lower back and elsewhere along the spine.
- Osteoporosis: As bones weaken and become porous with age, vertebrae can be prone to breaks, causing pain and other issues.
- Pinched nerve: While they can happen everywhere in the body, pinched nerves most often occur in the spine’s nerve roots and result in pain.
- Radiculopathy: If abnormal pressure is placed on a nerve, the nerve may not transmit signals to the brain properly. Lumbar radiculopathy can result in pain, tingling, numbness, and weakness that radiates into the lower extremities.
- Sacroiliitis: This condition affects the sacroiliac joints, which are located at the intersection of the pelvis and lower spine. Sacroiliitis means inflammation of the sacroiliac joints, which results in pain and discomfort during physical activity.
- Sciatica: This term refers to any pain, weakness, tingling, or numbness that radiates down the sciatic nerve, which transmits signals from the brain and into the spine, gluteus, muscles, hamstrings, and most muscles below the knees.
- Scoliosis: This condition is marked by an abnormal curvature in the spine. Adolescent scoliosis is hereditary, while adult scoliosis can result from several causes.
- Spinal arthritis: In the spine, arthritis is defined as inflammation of the joints between the vertebrae. Pain can be the result of joint cushioning wearing down over time. This condition is also known as spondylosis.
- Spinal stenosis: This occurs when the spinal column narrows, causing compression on the spinal cord. This results in bilateral symptoms of myelopathy and/or bilateral radiculopathy. When occurring in the lower back, it is referred to as lumbar spinal stenosis.
- Spondylolisthesis: If spinal bones do not properly align, vertebrae may move forward or backward out of place. This often leads to severe lower back pain that may radiate down one or both legs.
Risk Factors for Lower Back Pain
In addition to these common causes, some risk factors can increase the likelihood of developing lower back pain. These include:
- Age: Although people of all ages can have back pain, it is more prevalent in older people, beginning in the 30-to-40 age group. This is because discs, which cushion the spine’s bones, become weak and diminish with age, resulting in back pain.
- Lifting incorrectly: Lifting with the back instead of the legs can result in injury and back pain. Always lift with the legs and avoid strain by staying within your weight limits for lifting.
- Psychological health: Mental health conditions such as anxiety and depression can increase the risk for back pain. This is because stress can lead to tense muscles that cause back pain.
- Being overweight or obese: Those carrying around excess weight are more prone to lower back pain, as there is extra stress on the spine, joints, and discs.
- Sedentary lifestyle: Sitting too much and not getting enough exercise makes back and abdominal muscles weak, potentially leading to back pain.
- Smoking or excessive alcohol consumption: Smoking is known to decrease spinal blood flow and raise the likelihood of developing osteoporosis. When smokers cough excessively, herniated discs can result. Meanwhile, drinking too much alcohol can also lead to an increased risk of back pain.
- Workplace or occupation: Some workers are more prone to back pain than others due to their profession. For instance, those standing on hard flooring for long periods or lifting constantly can experience back pain.
Diagnosing Lower Back Pain
Individuals experiencing lower back pain should be referred to a spine specialist such as a neurosurgeon, orthopedic spine surgeon, or pain management doctor. CNSO’s spine experts are here to correlate a patient’s symptoms with imaging studies, such as an X-ray or magnetic resonance imaging (MRI). Once CNSO makes the final confirmed diagnosis, the board-certified team collaborates to form the best possible treatment plan. CNSO also offers second opinions for patients who have been to other specialists.
Lower Back Pain Treatment Options
CNSO offers numerous surgical and non-surgical treatment options for patients living with lower back pain. CNSO always takes a conservative approach to care, beginning with physical therapy and pain management and moving to surgery only when necessary. To ensure appropriate care, the comprehensive CNSO team includes neurosurgeons, orthopedic spine surgeons, interventional pain management specialists, physiatrists, rehabilitation specialists, and certified physical therapists.
Pain Management
At CNSO, pain management involves a customized approach for everyone, consisting of non-surgical procedures and opiate-free medications or if the injury is severe, the temporary use of opiates. Because there are many lower back pain causes, CNSO uses a multi-specialty approach to treatment. A patient’s treatment plan may include:
- Epidural steroid injections: CNSO pain management doctors apply a local anesthetic before injecting small doses of steroidal medication near spinal nerves in the epidural space. This helps to decrease swelling and inflammation in the spinal cord and surrounding nerve roots. As a result, pressure is reduced on the surrounding bone structures, where nerves (the source of the pain) are located.
- Joint injections: These are performed as in-office procedures by CNSO pain management doctors. Once the area is numbed with a local anesthetic, medication is injected into the affected joints to reduce inflammation and relieve pain.
- Medial branch block: If physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) have failed, patients may be eligible for this 10-minute nerve block procedure. After using a local anesthetic to numb the area, CNSO pain management doctors then use fluoroscopic guidance to deliver numbing medication into the medial nerve branch. If successful after two attempts over several weeks, the patient may also be a candidate for radiofrequency ablation.
- Sacroiliac joint injection: Treating the sacroiliac joints, which attach the sacrum to the hips, this quick procedure can be repeated up to three times per year. CNSO pain management doctors start by numbing the area with a local anesthetic before injecting the medication. This injection is sometimes referred to as a sacroiliac joint block.
- Transforaminal injections: After applying a local anesthetic, CNSO pain management doctors place small doses of steroids and anesthetics into the affected nerve roots. These injections help to block pain in the lumbar spine, offering long-lasting relief from symptoms and encouraging patients to comfortably participate in physical therapy.
- Trigger point injections: This option is ideal for patients with muscle spasms or knots in the lower back. Trigger point injections are done quickly in the office, with the whole process lasting about two minutes. After using a topical anesthetic, the CNSO pain management doctor injects an anesthetic mixture into the muscle to relax it and reduce spasms.
Physical Therapy
For patients with lower back pain, CNSO’s physical therapy treatments are designed to strengthen back and abdominal muscles. This is to help support the spine’s joints and keep the spine stable. CNSO physical therapists also strive to help patients regain as much strength, flexibility, and range of motion as possible, whether they’ve had surgery or not. A course of physical therapy will look different from patient to patient, and it can consist of the following hands-on modalities:
- Electrical stimulation
- Ice and heat
- Joint manipulation
- Massage
- Myofascial release
- Passive and active stretching
- Soft tissue manipulation
- Targeted exercises for key muscle groups
- Transcutaneous electrical nerve stimulation (TENS)
- Ultrasound manipulation
Spine Surgery
Patients with lower back pain who have not had success with physical therapy or pain management treatments may be eligible for spine surgery at CNSO. While CNSO considers back surgery to be the last resort for people with lumbar spine pain, surgery can deliver long-lasting results and enhance the lives of patients. CNSO multi-specialty surgeons collaborate to form the most ideal treatment plan before, during, and after a patient’s procedure. Surgical recovery will require a recovery period involving physical therapy and pain management solutions.
Relieve Back Pain With Help From the Spine Specialists at CNSO
As New Jersey’s most comprehensive center, CNSO understands how lower back pain can impact the daily lives of patients. People seeking comprehensive and coordinated care, as well as an accurate diagnosis and state-of-the-art treatment plan, should turn to CNSO. To learn more about lower back pain treatment at Centers for Neurosurgery, Spine & Orthopedics, request an appointment today at one of CNSO’s office locations.
