Low Back Pain: Causes and Conditions
Low back pain is a widespread and often debilitating condition affecting the lower portion of the spine. It is one of the most common musculoskeletal complaints and ranks as the second most frequent reason patients visit doctors.
What Causes Low Back Pain?
Most cases of acute low back pain are mechanical in nature—resulting from a disruption in the normal structure and movement of the spine, muscles, intervertebral discs, or nerves. Below are common categories and causes:
1. Congenital Conditions: These are structural abnormalities present at birth, which may affect spinal development and function:
- Scoliosis – An abnormal sideways curvature of the spine.
- Lordosis – An exaggerated inward arch of the lower back.
- Kyphosis – An excessive outward curve of the spine, leading to a hunched posture.
- Spina Bifida – Incomplete development of the spinal cord or its protective covering, potentially causing malformed vertebrae, nerve damage, and even paralysis.
2. Injuries: Sudden trauma or overuse can damage tissues or bones in the lower back:
- Sprains and Strains – Overstretched or torn ligaments, tendons, or muscles.
- Muscle Spasms – Involuntary contractions often caused by strain or overexertion.
- Traumatic Injuries – Resulting from sports, car accidents, or falls, which can compress the spine or cause disc herniation.
3. Degenerative Conditions: Wear and tear from aging or overuse can lead to chronic back problems:
- Intervertebral Disc Degeneration – Loss of disc cushioning due to aging.
- Spondylosis – General spinal degeneration affecting joints, discs, and bones.
- Arthritis of the Spine – Includes osteoarthritis, rheumatoid arthritis, and spondylitis (inflammation of the vertebrae).
4. Nerve and Spinal Cord Issues: Disorders that affect nerve function or spinal alignment:
- Nerve Compression or Inflammation – Can cause localized or radiating pain.
- Sciatica (Radiculopathy) – Pressure on the sciatic nerve causes shock-like pain from the lower back through the buttock and down the leg.
- Spinal Stenosis – Narrowing of the spinal canal, placing pressure on the spinal cord or nerves.
- Spondylolisthesis – Slipping of one vertebra over another, often pinching nearby nerves.
- Herniated or Ruptured Discs – When spinal discs bulge or break open, irritating nearby nerves.
- Osteoporosis – Loss of bone density, increasing the risk of vertebral fractures and back pain.
5. Non-Spinal Causes: Conditions outside the spine can also contribute to low back pain:
- Kidney Stones – Sharp, intense pain usually on one side of the lower back.
- Endometriosis – Uterine tissue growing outside the uterus may cause referred back pain.
- Fibromyalgia – A chronic condition characterized by widespread pain and fatigue.
- Tumors – Either in the spine or elsewhere in the back, these can press on spinal structures.
- Pregnancy – Increased weight and hormonal changes can cause back discomfort, which typically resolves after childbirth.
Understanding the cause of low back pain is essential for choosing the right treatment. If you’re experiencing persistent or severe back pain, it’s important to consult a healthcare professional for diagnosis and appropriate care.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
Alleviating Low Back Pain
In some instances, completely eradicating low back pain may not be feasible, so the focus should be on improving function and reducing pain. It is important to inform your client that pain reduction and improved function may not be immediate and may take several months to become evident.
Avoid the following movements so as not to exacerbate pain in the low back:
- Rapid twisting, forward flexion or hyperextension
- Unsupported forward flexion
- Simultaneously lifting legs while lying prone or supine
- Twisting at the waist with feet turned
In physical training:
- Be aware of proper posture and alignment
- learn how to adopt and maintain a neutral spine
- learn to be aware of lumbar spine, abdominal bracing and glute activation
- Monitor discomfort and regress or cease exercise, if necessary
Exercises to Strengthen the Core and Alleviate Back Pain
Start with one set and increase to two to three sets as tolerated and as function improves the recommended range for muscular endurance is 12-16 reps depending on your fitness level and low back pain. Start with fewer repetitions when inexperienced until you can work up to the muscular endurance repetition range.
Wall Roll: Improves torsional control and encourages abdominal bracing through co-contraction
- Assume plank position with both elbows planted on a wall
- Abdominals are braced
- While on the balls of the feet, pivot, pulling one elbow off the wall
- Avoid any motion at the spine while the movement occurs
- Work up to approximately 10 repetitions
Clamshell Exercise: Retrains the gluteals, which is important for improving back health
- Lie on the side, and anchor the thumb on the anterior superior iliac spine
- Reach around with the fingertips and position them to land on the gluteus medius
- Keeping the heels together, open the knees like a clamshell
- The position of the fingertips on the gluteus medius should allow the client to feel glute activation
Side Bridge: Targets lateral muscles, which are important for optimum spinal stability
- On the side of the body, place elbows under the shoulder
- Elevate hips and knees off the ground
- Perform regression with knees on the ground if this is too much for your client
- Hold for 20 seconds
Bird Dog: Safely and effectively develops spinal extensors
- Begin on all fours, hands under shoulders and knees under hips
- Extend opposite arm and leg (hold position as tolerated by client)
- Work up to holding extended position for seven to eight seconds on each side
Glute Bridge: Improves core stability via glute activation
- Lie supine, elevate hips off the ground
- Activate glutes as hips are elevated
- Hold for three to five seconds