Low Back Pain

Overview

Low back pain is discomfort or pain felt in the lower part of the back, the area between the bottom of the ribs and the top of the legs. It is one of the most common reasons people see a doctor or miss work, and most adults will have it at some point in their lives.

The reassuring news is that most low back pain is not caused by anything serious and gets better within a few weeks. It usually involves the muscles, joints, ligaments, and discs of the spine rather than a dangerous underlying disease. Even when no specific cause is found, which is common, the pain typically settles. A small number of cases do have a serious cause, so it is important to know the warning signs that need urgent attention.

Symptoms

Low back pain can feel different from person to person and may come on suddenly or build up gradually.

• A dull ache or stiffness in the lower back
• Sharp or shooting pain, sometimes triggered by a particular movement
• Muscle tightness or spasm
• Pain that is worse with certain positions or movements and eased by others
• Pain that sometimes spreads into the buttock or down a leg
• Reduced flexibility and difficulty standing up straight

When pain travels down the leg below the knee, often with numbness or tingling, it may be due to sciatica from an irritated nerve.

Causes

In many cases of low back pain, no single precise cause is identified, and this is normal. Common contributors include:

• Muscle or ligament strain: from lifting, twisting, or sudden movement.
• Disc problems: such as a herniated disc or age-related disc wear.
• Joint and wear-related changes: including spondylosis and arthritis of the spine.
• Poor posture and inactivity: weak supporting muscles and prolonged sitting.
• Narrowing of the spinal canal: spinal stenosis, more common with age.

Serious causes such as infection, fracture, or cancer are uncommon but important to recognize.

Risk Factors

• Heavy lifting, bending, or twisting at work
• Prolonged sitting and a sedentary lifestyle
• Being overweight
• Poor physical fitness and weak core muscles
• Older age
• Smoking
• Previous back problems
• Stress, anxiety, or low mood

Diagnosis

For most people with recent low back pain and no warning signs, no tests are needed, because the pain usually improves and scans rarely change treatment.

• History and examination: understanding the pain and checking movement, strength, sensation, and reflexes, and looking for any warning signs.
• Imaging: X-rays, MRI, or CT scans are reserved for persistent pain, nerve symptoms, or signs of a serious cause, since changes seen on scans are common and do not always explain pain.
• Blood tests: occasionally used if infection or inflammation is suspected.

Treatment

Most low back pain improves with simple self-care, and staying active is one of the most important steps. Prolonged bed rest is not recommended and can slow recovery.

• Keep moving: continue normal activities as much as the pain allows.
• Pain relief: anti-inflammatory medicines or other painkillers used as directed; heat can help.
• Exercise and physiotherapy: stretching, strengthening, and posture work, especially for recurring or persistent pain.
• Manual therapies: such as physiotherapy-based techniques for some people.
• Addressing mood and stress: which strongly influence persistent pain.
• Injections or surgery: considered only in selected cases, such as significant nerve compression that does not respond to other care.

Prevention

You can lower your risk of low back pain and reduce flare-ups by keeping your back strong and healthy:

• Stay physically active and build core and back strength
• Lift with your knees, keep loads close, and avoid twisting
• Maintain good posture when sitting and standing
• Keep a healthy weight
• Take breaks and move regularly if you sit for long periods
• Do not smoke

When to See a Doctor

See a doctor if back pain is severe, does not improve after a few weeks, or keeps coming back. Seek urgent or emergency care if you have low back pain with any of the following warning signs, which can point to a serious cause:

• Numbness around the groin, buttocks, or inner thighs
• Loss of bladder or bowel control or difficulty passing urine
• Weakness, numbness, or tingling in one or both legs
• Severe pain after a serious fall or injury
• Pain with unexplained weight loss, fever, or feeling generally very unwell

Related Topics

Frequently Asked Questions

References

1. National Institute of Neurological Disorders and Stroke (NINDS). Low back pain.
2. Mayo Clinic. Back pain.
3. MedlinePlus, U.S. National Library of Medicine. Low back pain.
4. American College of Physicians. Low back pain guidance.