WHEN SHOULD I WORRY ABOUT...

Lower Back Pain Causes: 8 Reasons for Sudden & Chronic Pain

May 19, 2021 - Katie McCallum

Sometimes, you know exactly why your back is hurting. Maybe you lifted something awkwardly and felt the pain right away. Or maybe your doctor has been warning you for years that your bad posture would lead to lower back pain.

But other times, the source of back pain can feel like a mystery.

"Your lumbar spine, located in your lower back, plays a crucial role in supporting the weight of your upper body. It's also responsible for everyday movements, such as bending, twisting and coordinating the muscles in your hips, pelvis legs and feet," says Dr. Kenneth Palmer, orthopedic surgeon specializing in spine surgery at Houston Methodist. "Due to heavy use, the bones, muscles, ligaments, disks and nerves found in your lumbar spine are quite susceptible to both injury and wear and tear over time — causing pain in the lower back."

Lower back pain symptoms include:

  • Dull ache in your hips and/or pelvis
  • Muscle spasms or tightness
  • Sharp, tingling pain that starts in your lower back and travels down one leg (also known as sciatica)
  • Pain that worsens with sitting and quickly improves while walking
  • Pain that is noticeably worse in the morning

"Typically, a person experiences some combination of these symptoms, which can develop suddenly or over time. In some cases, lower back pain can feel like it comes and goes — flaring up now and then, but generally getting progressively worse over time," explains Dr. Palmer.

In addition, Dr. Palmer points out that lower back pain symptoms can vary by person, as well as the underlying cause of the pain.

Speaking of the various causes of lower back pain...

The most common causes of lower back pain are a strain or sprain

Whether you notice it or not, your lumbar spine gets put to work throughout the entire day.

Amid all of this work and motion, a lower back sprain or strain can result from an acute injury, such as one experienced while falling, lifting something too heavy or playing sports. A sprain or strain can also develop over time due to repetitive movements or poor posture.

"Straining a muscle or spraining a ligament are the most common causes of lower back pain," says Dr. Palmer. "While they can be serious, these common causes of lower back pain aren't long-lasting — taking anywhere from a few days to heal or, at most, a few months."

Your doctor can help you determine the particular course of self-care that can help heal your lower back pain.

"The treatment for a pulled back muscle or strained back ligament is fairly simple and can include pain and anti-inflammatory medications, muscle relaxers, ice to help reduce inflammation, heat to promote healing, and avoiding strenuous activity until the pain recedes," explains Dr. Palmer. "The best course of care will depend on the severity of your injury as well as your overall core and lower body strength."

If your lower back pain persists despite treatment, it may be time to consider other causes of lower back pain.

Common causes of chronic lower back pain

"Chronic lower back pain is less likely to be caused by injury to your muscles and ligaments and more likely to be due to issues with the lumbar disks, nerves, joints or vertebrae," says Dr. Palmer. "There are several potential causes of chronic pain in the lower back."

In general, osteoarthritis (the most common type of arthritis) and degenerative disk disease (the natural wear and tear of spinal disks) are the underlying cause of many types of chronic lower back pain. However, lower back pain can also be caused by accident-related trauma and acute stress.

Herniated disk

"An adult's thoracic and lumbar spine is made up of about 17 bones (vertebrae) stacked on top of one another. Between each set of vertebrae lies a cushiony disk, which helps absorb the pressure placed on these bones," explains Dr. Palmer.

Each disk is made up of an outer rind and an inner gel.

A herniated lumbar disk occurs when the inner gel of one of the five disks in your lumbar spine slips or squishes beyond the outer rind, allowing this inner gel to press on surrounding nerves — causing pain. This slippage can be due to trauma or gradual, age-related wear and tear.

Facet joint damage

The joints connecting the five vertebrae that make up your lower back, called the facet joints, experience large loads of compressive force and stress. Over time, breakdown of the cartilage in your facet joints can lead to lower back pain.

"Whether due to poor posture or repeated overuse, facet joint damage is often caused by osteoarthritis and can lead to inflammation, stiffness, muscle spasming and pain," explains Dr. Palmer. "In addition, when damage to a facet joint impinges a nearby nerve, it can lead to sciatica."

Compression fracture

"A spinal compression fracture occurs when a vertebra in your lumbar spine essentially collapses in on itself. This is often due to osteoporosis, but can also be the result of trauma," says Dr. Palmer.

This collapse can cause severe pain, and individuals suffering a lumbar compression fracture often experience sudden pain and limited spinal mobility.

Spinal stenosis

Lumbar spinal stenosis occurs when the spinal canal in your lower back narrows, placing pressure on nearby nerve roots. It can be caused by the formation of bone spurs, thickening of a nearby ligament or degeneration of a lumbar disk or joint.

"When nerve roots become compressed, it can be very painful," says Dr. Palmer. "And spinal stenosis doesn't just cause lower back pain, it can result in sciatica, pain that radiates down the lower extremities."

Spondylolisthesis

If a lumbar vertebra slips forward — over the top of the vertebra below — it places a lot of compressive force on the lumbar disk that is separating the two vertebrae. As the lumbar disk deteriorates, it can cause lower back pain. Additionally, if the lumbar disk flattens from this force, it can lead to nerve compression and sciatica.

"One of the more common type of spondylolisthesis, isthmic spondylolisthesis, is caused by a fracture in the small piece of bone, called the pars interarticularis, found adjacent to the facet joint. The fracturing event often happens when a person is young, although the pain isn't felt until later in life," says Dr. Palmer. "Spondylolisthesis can also result from degenerative or congenital causes."

Scoliosis

Your spine has a natural curvature, which takes the shape of an 'S' when viewed from the side — with your upper back curving backward and lower back curving forward. If your spine curves sideways when viewed from behind, however, it's called scoliosis — a spinal deformity that can lead to back pain.

"When the spine takes an improper curvature, it makes degeneration of the lumbar joints and disks more likely," warns Dr. Palmer. "In the majority of cases, scoliosis doesn't require treatment, but severe curvature can place significant stress on the lower back and lead to pain."

When to see a specialist for lower back pain

If you're experiencing lower back pain that's not responding to rest and self-care, it's time to consider seeing a spine specialist.

"A spine specialist will likely perform a physical exam as well as one or more imaging scans to diagnose the root cause of your lower back pain. Depending on your diagnosis, he or she will then design a treatment plan aimed at alleviating your pain and preventing it from disrupting the everyday activities you enjoy," says Dr. Palmer.

Next Steps:

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