Lower Back Pain: Symptoms and Causes
Book An Appointment
Key Takeaways
- Lower back pain can have many causes and requires prompt medical attention to diagnose accurately.
- Acute cases are due to overexerting the back muscles, while chronic cases can be due to infection, fractures, or other serious spinal conditions.
- Nonsurgical methods can help to treat lower back pain and restore your lower back’s flexibility, strength, and range of motion.
- Surgical methods are needed if pain persists even after nonsurgical treatment or to treat more severe complications.
What is Lower Back Pain?
At some point in your lifetime, you will have had lower back pain for a while. Some days, it may come and go pretty quickly; on other days, it can last nearly a week or longer. Lower back pain generally affects your lumbar spine, the lower part of your spine located between the ribs and the pelvis made up of five vertebrae (or bones). You will also find several nerve pairs connected to the lumbar spine. It may also affect the surrounding muscle and tissue near or around the lumbar spine, including the glutes (buttocks), hips or legs.
While most cases of lower back pain are acute and will go away after sufficient rest, many adults will also deal with chronic cases accompanied by sharp pain in the affected area, making it difficult to perform daily activities as usual. Prompt medical attention is needed to ensure a swift, stable recovery for those affected by these chronic episodes of lower back pain.
You can experience pain at any point in your back, but the lower back is the most commonly affected area as it supports most of your body weight.
What are the Symptoms of Lower Back Pain?
Lower back pain symptoms vary but are typically characterised by the pain or discomfort you feel in your lower back, whether idle or moving. Some people may report the pain as dull and throbbing, while others describe it as sharp and stabbing; in many cases, the level of pain fluctuates from time to time. This pain or discomfort may also radiate from the lower back and into neighbouring areas like your glutes, hips, and legs. It may even restrict your ability to perform activities of daily living, cause sleeping difficulties, and increase stress levels.
You may experience the following symptoms as a result of lower back pain:
- Pain that comes and goes in the lower back.
- Increased pain when you bend, sit down or lift items.
- Pain that triggers without warning.
- Stiffness in your lower back.
- Frequent or infrequent muscle spasms.
- Posture difficulties due to the pain (or other symptoms) you experience.
What Causes Lower Back Pain?
Several factors, including the natural process of ageing, can cause lower back pain.
Overexertion
In most acute cases of lower back pain, we tend to overexert ourselves during physical activities, such as gardening or participating in sports events. Muscle strains can occur due to poor posture when moving or lifting objects or even from a fall, which causes our muscles and ligaments to be overstretched or injured. It is always a good idea to pay attention to what our body tells us after a few hours of strenuous physical activity. When we feel tired, it is an excellent time to take a break and let the body rest.
Disk Injury/Degeneration
Between each vertebra, you will find round, flat intervertebral disks that help cushion your spine and act as shock absorbers to allow you to move around. The disk can become damaged due to an injury or because of degeneration.
With the former, there may be a minor or major tear on the disk itself, which can cause varying levels of pain or discomfort; some people with minor tears may report that they do not feel any pain. It may also be due to a disk herniation, where the inner part of the disk pushes against the disk’s outer layer, going against the sensitive spinal nerves and thus causing pain. The pain can also radiate to other areas, such as your legs.
As for disk degeneration, ageing and other risk factors, such as obesity, can cause the disks to wear out slowly and even collapse, causing the vertebrae to rub against one another and cause pain and stiffness. This wear and tear is often called osteoarthritis (spondylosis if it affects the spine) and can lead to more severe complications like vertebrae slippage that can press on your nerves and cause debilitating pain.
Spinal Conditions
Spinal stenosis is characterised by a narrowing of the spinal canal, the space around the spinal cord where our spinal nerves are located. It can happen due to osteoarthritis or injuries to the disk; the body will grow bone spurs to help support and stabilise the vertebrae. These spurs can inadvertently cause the spinal canal to become narrow, and there is a risk that the spurs can impinge on the nerves and cause pain.
Spinal fractures are another concern when any of the vertebrae break after a fall or some other form of traumatic injury (such as getting into an accident). Underlying conditions like osteoarthritis can make it easier to suffer from a spinal fracture, and it can take a considerable amount of time to recover from.
Compression Fracture
As we age, our bones gradually weaken due to osteoporosis. As a result, you can be at risk of compression fractures that further weaken your spine and change your posture. Falls and other injuries can also contribute to a compression fracture.
There are three types of compression fractures:
- Wedge fractures occur on the frontal portion of the vertebra and cause you to stoop forward. Wedge fractures are the most common form of compression fracture.
- Crush fractures have cracks all over the vertebra and may eventually cause the bone to collapse.
- Burst fractures cause smaller bone pieces to scatter as the bone breaks. These bone pieces can be dangerous as they interfere with nearby nerves and tissue.
Scoliosis
Scoliosis is a condition characterised by an abnormal spinal curve that makes your back appear asymmetrical: you may have uneven shoulders, and your body seems to lean in one direction, among other conditions. It can affect teenagers and older people with osteoarthritis, causing pain, stiffness, and weakness in the legs if the deformity impinges on the nerves. The most common form of scoliosis, idiopathic scoliosis, accounts for 80 per cent of all scoliosis diagnoses, but its exact cause is still unknown.
Other complications
Other health conditions can cause lower back pain, so a thorough diagnosis is needed to confirm and address the root cause of your pain.
- Spinal tumours or cancer related to the spine.
- Spinal infections like osteomyelitis, which is caused by staphylococcus bacteria.
- Fibromyalgia (causes pain and tenderness across your body).
- Kidney stones.
- Inflammatory arthritis.
- Pregnancy-related complications, including endometriosis.
- Other conditions that might mimic back pain symptoms, such as prostatitis (a prostate gland disorder caused by inflammation).
How is a Lower Back Pain Diagnosed?
Diagnosing with a Physical Examination
Your doctor will perform a physical examination to ascertain where you are experiencing lower back pain and what it might be. In addition to taking your medical history, they will carefully assess your back and check for tenderness or discomfort; be sure to let your doctor know if you experience any pain. The doctor will typically focus on the centre of your back or spinal region and the areas beside your spine (para-spinal regions).
The doctor may need to run additional tests to get a proper diagnosis before prescribing the right treatment for you.
Using the Straight Leg Test
For this test, the doctor will instruct you to lie on the examination table and raise your leg (on the affected side where you are experiencing pain) to 30 to 60 degrees. The doctor will then gently raise the leg further past 60 degrees. If you experience any pain, whether or not it radiates down your leg, it indicates that a nerve may be impinged by the vertebrae (bone spurs, perhaps) or a herniated disk.
A variant of the straight leg test involves raising the leg to 30 to 60 degrees, followed by the doctor gently flexing your foot upwards.
Using the Tripod Test
In this test, the doctor will have you sit on the examination table. The doctor then carefully raises one of your legs; if you feel any pain, you may instinctively find yourself leaning back with the arms resting on the table to support your leaning posture, creating a “tripod”. Moving to this tripod position indicates a positive result, possibly due to nerve impingement or irritation.
Using the L4 Motor Test
This test is part of a series of neurological tests in cases where someone has severe or prolonged pain or if doctors consider that there may be a neurological dysfunction in the lower back. While lying on the examination table, you must bend your knee slightly and carefully kick your leg out while the doctor applies gentle pressure. This test is repeated for both legs to allow the doctor to compare the two and look for signs of weakness in the affected leg.
Using the Walking Test
To look for specific nerve dysfunctions, your doctor will instruct you to walk from one point to another—first on your heels and, later, on your toes. If the doctor notes difficulty or inability to raise your toes in the heel walk or if one heel is lower than the other while you are tiptoeing, that indicates a positive test.
Using the Sensory Test
The doctor will use their finger, a monofilament or a tongue depressor to perform a sensory test on specific parts of your lower body. This test aims to look for numbness on one side of your body compared to the other. As they press down on these areas, you must tell the doctor if you feel any sensation wherever they are pressing.
Using the Reflex Test
Similar to the sensory test, the doctor will use a reflex tool to test your reflexes at specific points on your lower body.
Diagnosing with Imaging Tests
Additional tests can help to confirm the diagnosis, especially if the physical exam does not give a satisfactory result. These tests could also help differentiate your condition from other conditions that share similar symptoms.
- X-ray scan: The X-ray can provide a clear image of your bones, allowing the doctor to look for any bone damage caused by injury, changes due to ageing-related factors, and possible deformities.
- Bone density test: This test helps your doctor identify if you may have osteoporosis. Typically, the higher your bone mineral content, the denser your bones are; the denser your bones are, the stronger they are.
- Magnetic resonance imaging (MRI): This test may be needed if your doctor needs to examine the soft tissue in and around your lower back to look for signs of damage to the intervertebral disks, possible infections, and other issues not linked to the vertebrae.
What are the Treatments for Lower Back Pain?
How to Prevent Lower Back Pain
Preventing lower back pain from interrupting your daily schedule is key, even if you have never had lower back pain. Given that ageing is also a risk factor contributing to lower back pain, every little you can do to prevent it can do plenty of good to your well-being.
- Improve your standing and sitting posture.
- Try not to stay in one position for long periods.
- Get regular exercise; aerobic exercise can keep your abdomen strong and flexible.
- Maintain a healthy weight and have a healthy diet.
- Avoid overexerting your body during manual labour.
- If lifting heavy objects, adopt a proper lifting posture; lift with your legs.
- Avoid sudden, rapid twists and movements with your back.
- Apply heat pads to your lower back for 5 to 10 minutes if it feels stiff or achy.
- Maintain a healthy, well-balanced diet.
Getting Professional Medical Attention
It is always a good idea to have your lower back pain examined promptly to avoid complications with your mobility and independence. Here at Avant Orthopaedics, our professional orthopaedic specialists are ready to support you with comprehensive medical support to get you back on your feet. Contact us to book an appointment and receive personalised care, where we will diagnose your condition and recommend the best course of action.
Our Orthopaedic Doctor for Lower Back Pain
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
Frequently Asked Questions (FAQ)
Yes, but you should never overexert your lower back to prevent further complications. Speak at length to a physiotherapist who can recommend a good starting routine to work with. As your condition improves, you can steadily increase your workout, per your physiotherapist’s advice.
For many people, their lower back pain can come and go at varying durations: sometimes, they will have short bouts of pain, followed by radiating pain for almost an entire day, not long after. Typically, this may be due to an impingement of nerves in your lumbar spine or an injury to other parts of your lower back; these can flare up at any time without warning or after specific movements you make. It would be ideal to seek medical attention promptly if this happens.
There is no time like the present: if you are experiencing acute or chronic lower back pain without warning, contact us immediately for a thorough examination.
Related Conditions
Sciatica is a condition where you experience pain along the sciatic nerve. The sciatic nerve originates near the base of your lumbar spine (in the lower back) and is the largest nerve in your body. It contributes to both motor and sensory functions for your legs and feet. Prompt treatment of sciatica is important because early intervention can help reduce pain and prevent symptoms from worsening.
Tailbone pain, or coccydynia, is discomfort at the base of the spine that may occur after a fall, prolonged sitting, or childbirth. It can cause sharp or aching pain, especially when sitting, standing up, or leaning back. Treatments range from lifestyle changes, cushions, and medications to physical therapy and, in rare cases, surgery.
