Ultimate Guide To Lower Back Pain

Ultimate Guide To Lower Back Pain

Almost everyone will have at least one episode of low back pain.

This can be a nuisance and can be concerning, but it’s good to know that most cases of back pain are not serious and get better.

This guide gives you everything you need to know about low back pain and how to deal with it.

What causes low back pain?

Almost everyone will have an episode of low back pain at some point in their life. Most back pain is a result of an injury, such as a muscle strain, which tends to go away on its own within a few days. However, there are other conditions that can cause ongoing pain, are more serious and require further treatment.

To better understand what can be causing your low back pain, let’s take a look at the anatomy of the lower back.

Lower Back Anatomy 101

Lower Back Anatomy
  • Your body’s spine anatomy is made up of four sections: the cervical spine (neck), thoracic spine (upper back), lumbar spine (lower back) and the sacral region.
  • Your lumbar spine, or lower back, has five vertebrae separated by discs.
  • These vertebrae are numbered L1 through L5
  • There are also muscles, tendons, and ligaments in the lower back that are attached to the bones and support the spine. This allows you to move and gives you the strength for bending down or twisting your torso.
  • In addition to the discs that cushion your vertebrae you have other joints in your spine called facet joints that help to provide support and movement.
  • There are many layers of large muscles found in the lower back, such as the erector spinae, that are responsible for holding up and supporting the spine.
  • The lumbar spine has two sections that carry the most weight at the lowest point: L5-S1 and L4-L5. Because discs in this lower area of the lumbar spine carry the most weight they are more likely to become damaged and are most susceptible to conditions such as herniated discs.

Lower Back Pain All Around The World

Lower back pain is the leading cause of disability worldwide.

It affects approximately 540 million people all over the world.

The World Health Organization (WHO) reports other stats about back pain which are quite alarming.

  • The lifetime occurrence of back pain is around 60 to 70 percent in industrial countries.
  • In the UK, lower back pain is the most common cause of disability in young adults – over 100 million workdays are lost to this condition every year.
  • In Sweden, low back pain has contributed to people missing more work. The number of workdays missed jumped from seven million in 1980 to 28 million in 1987.
  • In the U.S., people miss a total of 149 million days of work every year because of lower back pain.

And in South Africa, approximately 80 percent of people experience severe discomfort and disability as a result of problems that stem from lower back pain.

What Are Common Causes Of Lower Back Pain?

It’s clear that back pain is very common in many countries in the world.

But what causes it?

Let’s take a look at some of the most common lower back pain causes.

Injury (strain or sprain)

Woman Holding For Back

Ligaments connect bone to bone and provide support and stability to the spine while tendons connect muscle to bone and allow you freedom of movement.

A low back sprain is an injury to the ligaments of your low back and a strain is an injury to the tendons. Both are very common injuries that can occur from overuse such as during exercise or lifting.

These are the most common causes of acute low back pain and here are some of the treatments may help you feel better and get back to full activity as soon as possible.

Anti-inflammatory medication

By targeting inflammation, this medications will reduce the pain that you feel.

Most commonly you should start with Non-Steroidal Anti-Inflammatory Medications (NSAIDs) which you can get Over the Counter (OTC).

These are medications such as ibuprofen or naproxen. If you condition does not improve in some cases your doctor might write you a prescription for something a bit stronger to fight inflammation.

Other Medications

In some circumstances your physician may prescribe a stronger medication to relieve your symptoms.

An example is a muscle relaxant that works by inhibiting the receptors found in the central nervous system to decrease muscle spasm and allow you to relax.

A muscle relaxant will usually be prescribed on a short-term basis because they carry quite a few side effects and have addictive potential.

Stronger pain medications, such as opioids, are usually not needed for low back strains.

Ice packs

These work well to reduce inflammation at the site of the muscle injury and they’re also good for treating stiffness.

Using an ice pack directly on the affected area for about 20-minute intervals can provide good relief.

After a muscle injury, you should usually apply cold for the first 48 hours to reduce inflammation, followed by heat which increases blood flow and helps with healing.

Other tips for recovering from a lower back injury

  • Avoid doing any strenuous activities that involve twisting your back or doing any heavy lifting for the first few weeks after your pain begins.
  • Avoid exercising for the first few days. When you resume your daily exercise plan, make sure that you ease into it and build-up to the amount and intensity of exercise that you were doing.
  • You do not want to stop all activity as this can lead to your back getting stiff, so continue to perform stretches to keep your back loose.


Man Holding For Head

In an online survey of back pain that was published in Statista, a majority of people surveyed believed that stress was a leading cause of their back and neck pain.

Chronic stress can cause muscles to tighten up. The muscles in the lower back often become tight as a result of stress throughout the body which can cause or magnify your back pain.

In addition, this tightness uses energy the muscles need to keep the spine in an upright position. If your muscles are tightened throughout the day they become tired which leads to a worsening cycle of back pain and spas.

Even just sitting in a chair with bad posture for many hours throughout the day can put a strain on the lower back muscles and spine.

To relieve muscle tightening from tension, alleviating stress is a must. Exercise and stretching the back muscles can help relieve this tension.

Several times per day you should gently stretch the muscles of your low back moving through a full range of motion. This can help treat an acute flare-up of low back pain but also can help prevent the pain from coming back or from ever starting.

Consulting with a physical therapist can also be useful to teach you better posture and back exercises to prevent stress from affecting your lower back. Your physician can help refer you to a physical therapist as part of an overall treatment plan for your back pain.

Inflamed Joints

The facet joints in the spine can also become injured and inflammed, which can lead to the muscles in the lower back contracting and spasming.

To relieve facet joint pain, doctors will likely recommend that you engage in light physical activity, physical therapy, and get into the habit of maintaining proper posture.

Anti-inflammatory medications such as non-steroidal anti-inflammatories (NSAIDs), can also be used for facet pain.


This is a condition in which the disc and facet joints experience wear and tear and is frequently linked to aging.

This involves the cartilage that usually cushions the spine wearing down. Everyone experiences some degree of arthritis as they age but not everyone has symptoms of pain or tightness. Pain and inflammation are common from arthritis.

Osteoarthritis can strike one level or multiple levels of the lumbar spine. Osteoarthritis can also result in spinal stenosis, which is a narrowing of the spinal canal and can lead to pressure on nerves.

When nerves are pressed on as they leave the spinal canal they frequently cause symptoms of pain, weakness, or numbness radiating to the legs.

Herniated Disc

Illustration Of Henrniated Disc

When the discs in the spine wear down and become thinner, their gelatinous central part pushes out, often hitting against nerves that are either in or exiting your spinal canal. This is called a herniated disc.

A herniated disc means that the disc has pushed away from its normal position cushioning the spine and is in an early degenerative stage. When a herniated disc is displaced, it sometimes presses on nerves which produce even more pain.

Herniated discs are most commonly found in the neck (cervical spine) and lower back (lumbar spine).

A single injury can cause a herniated disc, but discs can also rupture as part of a degenerative process as we age.

The degree of pain one feels depends on whether or not the disc is pressing against a nerve. If there is no pressure on nerves low back pain might be the only (if any) symptom you feel.

If the nerve is involved, you might experience pain as well as numbness and weakness radiating in the direction of the nerve, often going down the leg toward the foot. This can happen in one or both legs.

How Herniated Discs Are Treated

Your doctor will tell you to rest and avoid strenuous activity for a few days or weeks to reduce nerve inflammation in the spine. Complete bed rest is rarely recommended as this can actually cause your back muscles and tissues to get stiff and weak, making the problem worse.

A herniated disc is also usually be treated with nonsteroidal anti-inflammatory drugs if there’s only moderate pain.

If the symptoms continue or worsen over time, an epidural steroid injection might be considered if the doctor thinks directing the medicine straight to the affected area will help to provide more relief.

Physical therapy might also be recommended. Surgery for a herniated disc is only considered if other treatments haven’t been successful.

Nerve Problems

Illustration Of Sciatica Pain

There are also nerve-related problems that can cause lower back pain. Example are conditions such as radiculopathy or sciatica.

This is when the nerves in the back area become irritated or impinged. This causes sharp pain and can also lead to sensations of numbness and weakness in the leg.

Radiculopathy is when nerves are pushed on in the spinal canal just as they are leaving the spinal cord.

Sciatica is caused by pressure on the sciatic nerve further down the leg, usually in the area of the sacroiliac (SI) joint. The SI joint is the back side of your pelvis in the area of your buttocks.

The sciatic nerve is the longest nerve in the body!

A doctor will likely suspect that your lower back and leg pain is caused by sciatica or radiculopathy if the pain radiates down your legs.

If you have leg pain, numbness, or weakness that lasts more than a few days it is best to see a physician who can distinguish the cause of your pain and come up with a treatment plan to make sure it doesn’t worsen.

Spinal Stenosis

In some cases, lower back pain is a sign of spinal-canal narrowing, otherwise known as spinal stenosis. This narrowing of the spinal canal can be something you are born with or can be the result of degenerative changes over time.

Back pain can point to spinal stenosis if the pain, weakness, and numbness moves from the lower back into both legs after you’ve been standing for a long time or when you’ve walked a short distance.

Spinal stenosis affects eight to 11 percent of the population and is most commonly found in baby boomers who are over 50, as reported by the American Academy of Orthopaedic Surgeons.

Spinal stenosis can also arise over time as a result of other spinal conditions, such as osteoarthritis. Multiple factors can cause a decrease in the amount of space the nerves have to exit your spine.

Back Pain From Sport Injuries

It’s common that participating in sports can lead to lower back problems.

The good news is that most of these back injuries improve within a few weeks to months.

But what about the sports injuries that don’t show signs of improvement? Let’s take a look at some reasons why your acute low back pain may not be improving.


Radiology Image

If you play a sport that requires you to do a lot of repetitive extension movements such as football, diving, cheerleading, or volleyball, this can result in a specific type of spine fracture.

This type of stress fracture is called spondylolysis, which results in a crack in the rear portion of the spinal column.

It can occur as a result of repeated strain and typically shows up as at first as lower back pain.

Fractures can be treated with rest and the use of a back brace to keep the spine upright and aligned, allowing the fracture can heal. Depending on the type of fracture and how it heals surgery is sometimes required.

Acute back pain in a younger person should be checked right away.

When To See A Doctor For Sport-Related Back Injuries

If you’re feeling lower back pain after an intense workout or game, you might wonder if you should just take OTC medications and rest a bit or schedule a visit with your doctor ASAP.

If you’re experiencing any of the following symptoms, you should definitely not wait to consult with your doctor.

  • Your pain is getting worse
  • Your pain has been around for longer than one month
  • Your pain is moving into your legs
  • Your pain is causing your limbs to feel weak
  • You’ve got changes in your bladder or bowel habits
  • You’re having trouble with balance
  • You’re having difficulty walking properly
  • You’re having fevers or starting to feel generally ill

Prevent Sports Injuries To Your Lower Back

Woman Stretching On Bench

In order to prevent injuries in the future, make sure you do the following:

  • Always use the right form when you lift weights so that you don’t put unnecessary strain on your spine.
  • Always warm-up and stretch before your exercise or participate in any sporting activity.
  • Avoid unhealthy lifestyle habits such as smoking, as this can be a risk factor for lower back pain.
  • Work on strengthening your core muscles. This is an important part of reducing your lower back pain risk. Building your core leads to better spinal alignment. Having strong abs also removes pressure from your lower back.
  • If you start to feel discomfort while exercising don’t ignore the pain. Stop the activity as soon as you start feeling any pain.

What About “Referred Pain?”

If you’ve ever heard of referred pain, you’ll know that is when the pain starts in one part of the body and then migrates to another part.

Lower back pain might not always originate in the back. If there is another health problem somewhere else in the body, this pain can end up radiating into the back.

Referred pain can sometimes be described as secondary pain.

For instance, health conditions affecting the abdomen can lead to back pain.

These include kidney infections or disease, bladder infections, ovarian disorders, appendicitis, aneurysms, or pregnancy, which can all impact the back.

If your back pain is coming from somewhere other than the back then you may experience symptoms elsewhere in the body that can point to the cause of your pain.

If you have lower back pain and other symptoms, it’s best to check in with your doctor right away.

How Can You Treat Low Back Pain?

As we have discussed there are many different treatment options for low back pain, depending on the cause.

However, there are some general guidelines to follow that will offer pain relief and prevent the symptoms from worsening.

Make Sure You Sleep Correctly

Woman Sleeping

Sleeping in an uncomfortable position with your spine out of alignment can put pressure on your back and make your pain worse.

Lack of sleep can also make your back pain worse, so it’s crucial to get enough sleep and ensure you are getting high-quality rest.

If you sleep on your side, place a pillow between your knees to keep your spine in a neutral position.

If you sleep on your back, put a pillow behind your knees.

Maintain Good Posture During The Day

Bad posture can cause you to slump over. Sitting with your spine not aligned can result in pressure and pain in your back.

This can cause or worsen back pain. Seeing a physical therapist can help with bad posture if you are struggling to correct it on your own.

A physical therapist will teach you how to sit and stand with the right spinal alignment to take the pressure off your back. This takes some practice but is worth focusing on for your overall spine health.

Physical therapists can also teach you exercises and stretches to strengthen your core and spinal muscles.

Having strong abdominal muscles prevents unnecessary stress on your spine and can help to prevent injury.

Don’t Stay In Bed

When you’ve got bad back pain, it’s tempting to want to call it a day and go to bed. But this can actually make your pain and other symptoms worse.

If you stay in bed for longer than two days your muscles start to weaken and your spine gets stiff.

Gentle exercise and stretching are important to relieve back pain, so try activities such as yoga, walking, or swimming.

Avoid running or more strenuous activities at first as that can make your back pain worse.

Use Ice And Heat

Putting Ice On Backs

If your back is sore, try putting ice on it for up to two days. Apply ice, such as in the form of an ice pack, to the affected area several times a day for 20 minutes each time.

After two days switch to using heat. Apply a warm pad to the area, again for only 20 minutes several times each day.

The cold treatment works to decrease blood flow to the area to reduce swelling and inflammation, which is crucial immediately after an injury.

The application of heat then increases blood flow which helps sore muscles and tissues to heal.

Treat It With Medication

If OTC medication isn’t enough or you’re not getting relief from home remedies, then you should consult with your doctor.

Your doctor may prescribe you medication that’s a bit stronger to relieve your symptoms.

Medications can include:

Muscle Relaxants

These relieve lower back pain by decreasing muscle tension.

They work by influencing the central nervous system, and they’re most suitable for acute back pain and spasm.

They are not as effective at relieving chronic or long term conditions.


Five Bottles Of Medications

Your doctor might prescribe prescription-strength NSAIDs or even steroid anti-inflammatories for your pain. If your symptoms are not improving in some cases your physician may even prescribe opioids.

Opioid medications are commonly prescribed drugs but they have significant side effects.

Opioids carry an addiction risk along with many other side effects, so they’re not always beneficial.

In fact, studies have found that opioid medications are frequently less effective at pain relief for acute pain conditions than NSAIDs.

Spinal Injection

If medications and other treatments haven’t helped you, your doctor might recommend a spinal injection. This is usually an injection of a corticosteroid, which is the strongest form of anti-inflammatory medicine, that relieves swelling around joints or irritated spinal nerves.

One of the most common corticosteroid back shots is called and epidural injection.

This low back injection delivers medicine directly to the area around where the nerves are exiting the spinal cord. By treating the inflammation at the source it relieves symptoms radiating to the legs.

These shots can be used to treat radiculopathy, which is the medical term for symptoms that radiate from the nerve roots exiting the spinal canal into the lower legs.

In some circumstances steroid injections can also be used to treat other conditions that cause back pain, such as tendinitis or arthritis.

Steroid injections are almost never the first line of treatment because there are risks with these shots.

Although it is rare, steroid injections can injure blood vessels or nerves.

In addition, there’s usually a limit to how many injections you can get within the course of a year. Having too many in one area of the body can lead to damage of bone, cartilage, or other soft tissues, including the skin at the site of the injection.

Alternative Treatments To Low Back Pain

Traditional treatments are not the only solution to help relieve your lower back pain. You can also try alternative ones.

Here are some of the most effective treatments to consider.


Acupuncture is a treatment that began in China over 2,000 years ago.

Acupuncture involves inserting needles into the body at certain specific points that are connected by pathways to create an energy flow.

By stimulating these points on the body, it is theorized that energy flow can be improved, and this is thought to offer pain relief.

In addition, there is a theory that acupuncture works through what is known as neurohormonal pathways.

By inserting a needle into certain points in the body, this stimulates the nerve that sends signals to the brain.

The brain responds by releasing beta-Endorphins that create feelings of wellness in certain areas of the body.

These can make the person feel better and potentially increases their pain threshold.

But can acupuncture work on lower back pain?

The research shows some promising results.

A study published in the Journal of the American Medical Association found that when 20,000 people with chronic pain were given real acupuncture treatments, no acupuncture, or fake acupuncture treatments individuals treated with the real acupuncture had a 50 percent improvement in their chronic pain.

The points that are stimulated for lower back pain include the feet, low back, hands, behind the knees, stomach, and hips.

Several treatments have been shown to be more effective than just one for low back pain so you may need to go back several times to get relief.


This mind-body therapy is highly beneficial for back pain because it helps you to gain greater awareness of your body and improves movement.

It can also help you to notice where you’re tightening your muscles leading to strain and pain.

When you do yoga poses daily you can also gain stress-relieving benefits that help you better manage your pain.

But does yoga really work to alleviate back pain?

A study that was published in the journal Annals of Internal Medicine monitored participants to see what effects yoga or physical therapy would have on their pain over the course of 12 months.

People who had been experiencing chronic back pain showed improvement similar to those treated with physical therapy, both for pain relief and improved activity levels.

The good news is that people in both groups were less likely to need pain medication after three months.

When Is Back Surgery Required For Pain?

It’s good to know that back surgery is not usually needed for most patients with back pain.

It is usually only required for persistent disabling pain that does not improve with the other non-surgical treatments we have discussed.

Here are some of the common options for back surgery. Each of these depends on your specific condition and you should always have a full discussion with your spine surgeon before even considering surgery.

Spinal Fusion

Illustration Of Spinal Fusion

This is when two vertebrae in the spine are fused together to form a single unit. This can treat instability or motion in the spine and is often done as a second procedure if a discectomy and/or laminectomy has not relieved symptoms.

This procedure has more risks, but it’s indicated for conditions such as spondylolisthesis. Spondylolisthesis is a condition where the vertebrae are no longer aligned and have slipped out of place.

In some cases the vertebrae may be unstable. This can be caused by many factors. Some people are born with this instability while for others it develops as a result of a traumatic injury or because of degeneration over time.

The bones are fused to together with rods and screws that provide the spine with greater stability. Sometimes additional bone graft or metal is placed to further strengthen the spine and allow it to heal.

Unfortunately spinal fusion doesn’t always completely remove the pain and there are many risks with this procedure, so it should typically only be done when other treatments have not worked.


Pain, numbness, or weakness radiating to your legs can be a sign you have a disc herniation pushing on a nerve. When this does not improve with non-surgical treatment or injections, a discectomy can frequently relieve the symptoms.

If radiating pain persists or worsens despite conservative care, you might consider a discectomy to relieve pain by removing the portion of the disc pressing on nearby nerves.

A discectomy involves removing the portion of the disc that is herniated or pushing back and pressing on nerves. It usually involves a small incision on the back and then carefully pulling the disc off the nerve and cutting the disc out.

Some research has shown that conservative therapy, such as NSAIDs and exercise, can be as beneficial as surgery, so it really depends on the severity and duration of your pain and how much it is limiting you.


Illustration Of Cervical Laminectomy

Stenosis is narrowing of the spinal canal. A laminectomy is a surgical procedure that is commonly used to open space for the nerves that can cause various types of pain, such as pain when standing.

During a laminectomy, a portion of the lamina or bony plate of the vertebra is removed so that the spinal nerves have more space.

A laminectomy can also be done to remove some bone or soft tissue that is compressing a nerve due to spinal stenosis. Laminectomies are frequently done along with discectomies to allow more space for nerve to exit the spinal cord without being compressed.

Related Questions

Can back pain be genetic?

Some people are more susceptible to chronic lower back pain than others because genetically they have more nociceptive fibers (sensitive receptors) that send pain signals to the brain than other people do.

Others may be born with specific conditions or defects in their spine that cause them more pain from an early age.

So while there are many factors that can lead to back pain, genetics can definitely play a role and make you more susceptible to this condition.

Why is back pain such a common ailment?

Discs and cartilage act like a shock absorber between bones that allow our joints to move freely. As we age, our discs and cartilage lose their elasticity, which means that the vertebrae in the back don’t have enough cushion.

This leads to arthritis and inflammation that causes pain at the joint and pain and spasm in the soft tissues around the spine including the muscles, tendons, and ligaments.

This degeneration of disc material can be caused by a single traumatic injury but for most people it is a result of wear and tear degeneration that happens over a period of years.

This happens to everyone as they age, however your lifestyle also plays a role. Bad posture, sedentary lifestyles, not exercising, being overweight, not maintaining flexibility, and generally not taking care of your body can all contribute to a less-than-healthy spine and back.

What’s the outlook for back pain?

Although it can be worrying to experience, 90 percent of acute back pain goes away within two weeks. Many of the other 10 percent of people will recover within 12 weeks. So relatively few people go on to have chronic disabling back pain.

As we have discussed there are many actions you can take to speed up healing by leading a healthy lifestyle and following the treatments we have discussed.


Low back pain can make going about your daily activities much more difficult.

You might also worry about what could be causing the pain. Whether you’re an athlete or not, you want to bounce back from your pain as quickly as possible.

That’s where diagnosing your back pain quickly to determine its cause can help you and can lead to the optimal treatment.

Sometimes home remedies are enough to relieve your pain, such as with the use of heat treatments or ice packs. This is especially the case when you’ve hurt your back muscles, such as with low back sprains or strains.

It can also be beneficial to try some alternative therapies, such as acupuncture or yoga, which have been shown to alleviate back pain in some cases.

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