Low Back Pain

A prolapsed (herniated) disc

A prolapsed (herniated) disc occurs when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.

The prolapsed or ruptured disc material can enter the spinal canal, squashing the spinal cord, but more frequently the spinal nerves.

A 'slipped' (prolapsed) disc often causes severe lower back pain. The disc often presses on a nerve root which can cause pain and other symptoms in a leg. 

Facet Arthropathy

The facet joints connect the vertebral bodies to one another, and like the hip and the knee, they can also become arthritic and painful, and can be a source of back pain. The facet joints are located at the back of the spine and counterbalance the intervertebral discs. They help keep the normal alignment of the spinal vertebrae and limit motion.

The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthropathy, which simply means a disease or abnormality of the facet joints.

LOWER BACK PAIN IN YOUNG

Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from a lower back muscle strain or from within the disc space itself - such as a lumbar disc herniation or lumbar degenerative disc disease.

Low back pain that travels to the buttock, leg and foot (sciatica)

Sciatica includes any combination of the following symptoms:
• Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding)
• Pain may be worse in the leg and foot than in the lower back
• Typically felt on one side the buttock or leg only
• Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking
• More severe (burning, tingling) vs. dull, aching pain
• May be accompanied by weakness, numbness or difficulty moving the leg or foot

Sciatica describes the symptoms caused when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet.

In younger adults, sciatica can be caused by a wide range of conditions, most commonly a lumbar herniated disc (may also be caused by degenerative disc disease, isthmic spondylolisthesis, and other conditions).

Chronic lower back pain worsened by certain positions and movements

Symptoms may include any combination of the following:
• Low-level of constant lower back pain punctuated by episodes of severe pain/muscle spasms lasting a few days to a few months
• Chronic pain that can range from nagging to severe
• Back pain worsened by sitting
• Walking, even running, may feel better than sitting/standing
• Changing positions frequently relieves pain

Possible cause: Degenerative disc disease

Lumbar degenerative disc disease can affect patients as young as 20. When the lumbar discs between the vertebrae begin to break down, the damaged disc can cause both inflammation and slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica.

Degenerative disc disease is common and is often successfully treated.

Deep ache in the lower back that worsens when standing or walking

Symptoms may include any combination of the following:
• Pain that radiates into the buttocks and back of the thighs (also called sciatica or radicular pain)
• Pain that worsens when bending backward
• Pain that feels better with sitting, especially sitting in a reclining position
• Tired feeling in the legs, and possibly leg numbness or tingling, especially after walking
• Tight hamstrings, making it difficult to touch toes

Possible cause: Ischaemic spondylolisthesis

Isaemic spondylolisthesis occurs when a vertebra in the low back slips forward on the disc space below it. It is most common at the L5-S1 level and can cause low back pain from instability and nerve root pain due to compression of the nerve root.

Lower back pain and/or buttock or groin pain

Symptoms may include any combination of the following:
• Pain often described as an ache
• Pain may be felt in the hips, groin, thighs as well as the lower back
• Back pain worsened by sitting and may feel better when lying down or reclining
• Changing positions frequently relieves pain

Possible cause: Sacroiliac Joint Disease

Sacroiliac joint disease or dysfunction can occur if there is too much or too little movement in the sacroiliac joint - the joints that connect the sacrum at the bottom of the spine to the hip on each side.

Severe or aching pain in the lower back that starts after activity, sudden movement, or lifting a heavy object

These lower back pain symptoms include any combination of the following:
• Difficulty moving that can be severe enough to prevent walking or standing
• Pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee
• Pain that tends to be achy and dull
• Muscle spasms, which can be severe
• Local soreness upon touch

Possible Causes: Back muscle strain

A back muscle strain or ligament strain is one of the most common causes of acute lower back pain. Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments stretch or develop microscopic tears.

Low Back Pain in Older Adults

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis.

Lower back pain and stiffness that is the most pronounced in the morning and in the evening

Includes any combination of the below symptoms:
• Pain that interrupts sleep
• Pain that is most pronounced first thing in the morning and again toward the end of the day
• Localized tenderness when the affected area of the spine is pressed
• Aching, steady or intermittent pain in the lower back that is aggravated by extended activity
• Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)

Possible cause: Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain. 

Leg pain that occurs primarily when walking and standing upright

Includes any combination of the following:
• Lower back pain relief is achieved quickly after sitting down
• Symptoms fluctuate between severe and mild/none
• Unable to walk far without developing leg pain
• Symptoms develop gradually over time
• Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs (sciatica)

Possible causes: Lumbar spinal stenosis or degenerative spondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.

Sudden onset of back pain, limited flexibility, height loss

Includes any of the following:
• Sudden onset of back pain
• Standing or walking will usually make the pain worse
• Lying on one's back makes the pain less intense
• Height loss
• Limited spinal flexibility
• Deformity and disability

Possible cause: Spinal compression fracture

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture. 

Less Common Causes of Lower Back Pain

While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:
• Piriformis syndrome
• Infection
• Spinal tumor
• Fibromyalgia
• Ankylosing spondylitis
• Coccydynia

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine. The disease is characterized by inflammation and resulting stiffness and pain in the joints along the spine. The knee and shoulder joints may also be affected.

Coccydynia refers to any type of persistent tailbone pain.
The tailbone, located at the very bottom of the spine, is medically known as the coccyx. Coccydynia is typically felt as a localized pain that usually worsens when sitting or with any activity that puts pressure on the bottom of the spine.