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Lower back pain: 7 common causes

low back pain

As a neurosurgeon, I frequently see patients with lower back pain. It’s one of the most common reasons people visit the emergency room, with nearly 40% of pain-related ER visits in adults over 18 attributed to it, according to the Centers for Disease Control and Prevention. As we age, lower back pain becomes more prevalent due to the natural degeneration of the spine. Unlike other tissues, the spine doesn’t regenerate, so wear and tear accumulates and may result in pain. 

Here are seven common causes of lower back pain and what you can do about it.

1. Muscle and ligament strains

Strains or sprains of the muscles and ligaments attached to the spine are a common cause of lower back pain. These injuries can cause inflammation and localized pain. If the inflammation affects nearby nerves, it may spread, causing referred pain. Rest, massage and stretching, and anti-inflammatory medications typically help reduce pain and promote healing.

2. Posture and occupational stress

Poor posture and repetitive movements — especially in jobs requiring awkward positions or lifting heavy objects — can contribute to back pain. Professions like flooring installation, where frequent or prolonged bending and twisting are involved, are especially prone to back strain. Carrying heavy weights for work, certain anaerobic exercises or obesity also places extra stress on the lumbar spine. Pregnant women are at higher risk due to extra weight that is carried and hormonal changes that loosen ligaments. Correcting posture and avoiding repetitive strain can help reduce these risks.

3. Trauma

Fractures, dislocations and injuries from falls or accidents can cause new back pain. These injuries require urgent evaluation, particularly if nerve impingement is suspected. If you experience significant pain after an injury, it’s essential to seek medical attention to rule out fractures or serious conditions.

4. Sciatica

Sciatica refers to pain that radiates from the lower back down the leg, caused by compression of nerve roots that form the sciatic nerve. When nerve roots in the lower spine are pinched, sharp or shooting pain can radiate down the leg. Keeping a pain journal helps track symptoms and allows better communication with your doctor for improved treatment.

5. Disc herniations

A herniated disc occurs when a disc in the spine protrudes through a weakening in its covering and displaces nearby nerves, often after bending, heavy lifting or twisting. Many cases improve with rest, physical therapy and medications. However, some may require surgery if pain does not improve or nerve function becomes impaired.

6. Spinal deformity

Scoliosis involves a sideways curvature of the spine that can compress nerves, causing pain or resulting in back pain due to muscle imbalance from the misalignment. Spondylolisthesis occurs when a vertebra slips out of its neutral position, leading to nerve compression. Both conditions may require treatment such as physical therapy, pain management or surgery for severe cases. Work closely with your health care provider to manage symptoms.

7. Joint disease

Joint disease can contribute to lower back pain through neural compression and the inflammation that occurs from arthritic changes. This includes joint enlargement, ligamentum enlargement, disc calcifications and bone spurs. In other cases, synovial cysts may form due to fluid accumulating in the joint linings, potentially causing focal nerve compression. These conditions can result in specific pain patterns that correlate with the affected areas.

Conservative treatment options
For acute lower back pain (lasting less than three months), many patients do well with conservative treatments. Prolonged bed rest is no longer recommended, as it can lead to muscle stiffness and delayed recovery. Instead, avoid painful movements and gradually increase activity as tolerated.

Medications like anti-inflammatories and muscle relaxants can help manage pain but should be used with potential side effects in mind on a case-by-case basis. For nerve-related pain, medications like gabapentin or Lyrica are effective but require a few days to build up in the system.

Physical therapy (PT) is helpful in improving mobility, flexibility and core strength. It helps prevent stiffness, inactivity and unhealthy weight gain, which can worsen back pain. Aqua-therapy may be beneficial for those with difficulty doing weight-bearing exercises. Similarly, massage therapy, dry needling and other methods may reduce pain.

When to seek more urgent treatment
If conservative treatments don’t provide relief, pain specialists can offer injections like epidural steroid injections to reduce nerve and joint inflammation. Surgery is reserved for cases that failed the previously mentioned measures or if there is nerve dysfunction, such as weakness, numbness or bladder control issues. Ensure conditions like diabetes or heart disease are managed before surgery to improve outcomes.

The goal is to manage your pain and restore your quality of life. Early diagnosis and treatment are crucial for preventing long-term complications. If you’re experiencing back pain, consult with a health care provider to find the best treatment for your needs. 


Learn more about spine care and neurosurgery at Northside.

 

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Dr. Saint-Aaron Morris picture

Dr. Saint-Aaron Morris

Specialties: Neurosurgery

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Dr. Saint-Aaron Morris is a board-certified neurosurgeon, specializing in minimally invasive and complex spine procedures.

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