Lower Back Pain: Cause and Fix

Is your lower back acting up and causing you trouble? Have you been dealing with this pesky pain for quite a while now? Are you seeking to understand the underlying causes of your lower back pain? Are you seeking effective ways to alleviate and relieve your lower back discomfort? Nowadays, many people suffer from low back aches.

Low backache, also known as lower back pain, is a common condition characterized by discomfort or pain in the lower back area, specifically between the ribcage and the pelvis. The pain can vary in intensity, duration, and location, ranging from mild and achy to severe and sharp.

Low back ache can be acute, meaning it lasts for a short duration, usually a few days to a few weeks, or it can be chronic, persisting for over three months. It can affect people of all ages and is one of the leading causes of disability worldwide.

The pain may be localized in the lower back, but it can also radiate into the buttocks, hips, and legs, depending on the underlying cause. Some common symptoms associated with low back ache include stiffness, limited range of motion, muscle spasms, loss of sensation, and difficulty standing or walking for prolonged periods.

Various factors can contribute to low back aches, including muscle strain, injuries, herniated discs, degenerative conditions, poor posture, obesity, and sedentary lifestyles. Psychological factors such as stress and anxiety can also play a role in exacerbating the pain.

What is low back pain?

LBA is often used as a condition or disease, but it is not a disease. LBA is a symptom and is a vague term. It is also called lower back pain. It hampers the quality of life.

Why does the lower back hurt?

The low back aches could be due to many reasons ranging from muscular stiffness due to overload on back muscles to trauma or disease like PIVD, spondylosis, etc.

Dehydrating before, during, or after a workout can lead to severe lower back pain. The fluid-filled cavities in each disc support and nourish the spine. However, dehydration reduces the amount of fluid, leading to stress, inflammation, and pain.

What is the mechanism of low back pain?

When there is an injury or postural changes or disease of the spine, the muscle of the lower back goes into protective spasm or stiffness, which limits the movement at the affected area. Due to overcompensation or over-stress on muscles, pain is induced.

For more detail about the Anatomy of the Lower Back Check, Finding Relief: The Why’s of Lower Back Pain and the How’s of Physical Therapy in Conditions

Why does the left side lower back hurt?

1. Muscle Strain: Overexertion, lifting heavy objects incorrectly, or sudden movements can strain the muscles in the lower back on the left side, leading to pain.
2. Lumbar Disc Herniation: When a disc between the vertebrae in the lower back bulges or ruptures, it can press on nearby nerves, causing pain that may be felt on the left side.
3. Sciatica: Compression or irritation of the sciatic nerve, which runs down the back of each leg, can cause radiating pain down the left buttock and leg.
4. Kidney Stones: If a kidney stone gets trapped in the left ureter (the tube connecting the kidney to the bladder), it can cause severe left-sided back pain.
5. Kidney Infections: Infections in the left kidney can lead to localized pain in the left lower back region.
6. Musculoskeletal Conditions: Conditions like osteoarthritis or spondylitis affecting the left side of the lumbar spine can result in chronic back pain.
7. Scoliosis: Left-sided scoliosis, an abnormal sideways curvature of the spine, may cause discomfort on the left side of the lower back.
8. Pelvic Conditions: Issues with the left pelvic organs (ovaries, fallopian tubes, etc.) in women or the prostate in men can refer to pain in the lower back.
9. Piriformis Syndrome: The piriformis muscle in the buttocks can compress the sciatic nerve, leading to pain in the lower back and down the left leg.
10. Sacroiliac Joint Dysfunction: Problems with the joints connecting the sacrum and the pelvis can cause left-sided lower back pain.
11. Stress and Tension: Emotional stress and tension can contribute to muscle tightness and pain in the lower back.

Why does the right-side lower back hurt?

1. Muscle Strain: Overuse or improper use of the muscles in the lower back, such as lifting heavy objects or sudden movements, can lead to muscle strain or sprain.
2. Lumbar Disc Herniation: When one of the intervertebral discs in the lumbar spine (lower back) bulges or ruptures, it can press on nearby nerves, causing pain that may radiate to the right side.
3. Kidney Problems: Kidney stones or kidney infections can cause pain in the lower back on one side. The right kidney is slightly lower than the left, so right-sided pain may be more prominent in some cases.
4. Sciatica: Compression or irritation of the sciatic nerve, which runs down the back of each leg, can cause pain that starts in the lower back and may be more noticeable on one side.
5. Arthritis: Osteoarthritis or other forms of arthritis affecting the spine can cause pain and stiffness, which may be more prominent on the right side.
6. Sacroiliac Joint Dysfunction: The sacroiliac joints connect the lower spine to the pelvis. Dysfunction or inflammation in these joints can lead to lower back pain, often felt more on one side.
7. Spinal Stenosis: The narrowing of the spinal canal in the lower back can put pressure on the nerves and cause pain that may be felt on the right side.
8. Injuries or Trauma: Accidents, falls, or sports injuries can cause localized pain in the lower back on the right side.
9. Pregnancy: Lower back pain in pregnant women is quite common, the growing uterus can put pressure on the lower back and lead to right-sided pain.
10. Gynecological Issues: Conditions affecting the right ovary or fallopian tubes, such as ovarian cysts or ectopic pregnancies, can sometimes cause lower back pain on the right side.

Why does the lower back hurt suddenly?

The sudden pain in the lower back could be due to muscle and ligament strain or sprain, fall or accident, disc herniation, or spondylolisthesis.

How to know the cause behind the lower back ache?

For evaluation of the cause behind LBA:

• Investigations
• X-RAY – curvature, space between vertebrae, and osteophytes.
• MRI – soft tissue (disc, spinal cord, nerve impingement)
• CT SCAN
• NCV – sciatic nerve conductivity

EVALUATION AND HISTORY

1. For evaluation of the cause behind LBA:

INVESTIGATIONS:

• X-RAY – curvature, space between vertebrae, and osteophytes.
• MRI – soft tissue (disc, spinal cord, nerve impingement)
• CT SCAN
• NCV – sciatic nerve conductivity

Physical Examination

Detailed History:

• Pain assessment: severity, intensity, duration
• Tenderness
• Location of pain
• Posture
• Radiation of pain up to which area: buttocks, hip, thigh, knee, lower leg.
• Muscle strength of lumbar muscle, piriformis, glutes, and core muscles.
• Joint ROM – flexion, extension, lateral flexion, and rotation.
• Special tests of the lumbar spine for mobility and flexibility.
  1. Modified Schober’s test.
  2. Gillette test
  3. Slump test
  4. Quadrant test
  5. Piriformis stretch test

• Dermatome and myotome assessment
• Gait

How to get rid of lower back pain?

 At home:

Rest, OTC pain relievers, heat or ice, analgesic ointment, and mild stretches if the pain is mild and not severe.

With medicine and rehabilitation:

• Medicine:- NSAIDS- Diclofenac, Ibuprofen.
• Epidural injection- corticosteroids, chymopapain injections.
• Surgical – discectomy, spinal fusion, etc.

Eight tips to ease some pain and keep your back healthy:

1. Strengthen your core muscles: Your lower back is under the stress of supporting your entire upper body. Surrounding muscles in your back need to be toned to support your spine and reduce pressure on your lower back. Our core muscles are rarely used during everyday activities, so they need to be toned through specific, targeted exercises. Take a few minutes each day to do a couple of simple core exercises.
2. Stretch daily: Many back problems are caused by tight muscles. If your back muscles are tight, they put added stress on your entire spine, including your joints. Get into a habit of daily stretches to promote your spinal health.
3. Avoid sitting with poor posture: If your sitting posture is poor, the discs in your lower spine are loaded even more than when you’re standing. If you must sit for long periods, remember to get up and walk around every so often.
4. Take walks: Walking is a very safe and sound exercise. Brisk walking at work or outside will help you to maintain a healthy weight and keep pressure off your back.
5. Lift correctly: When you lift something heavy, it’s very easy to twist the wrong way. This can lead to muscle spasms and pain. Use proper body mechanics by engaging your leg muscles, not your back, when you pick up heavier items. Get help if the item is too much for you to lift alone.
6. Reduce pressure on your back when you sleep: Sleeping flat on your back puts pressure on your spine. Elevate your knees slightly by placing a pillow under them. If you’re a side sleeper, put a pillow between your knees to reduce pressure on your back.
7. Watch your weight: Extra weight puts a strain on your back. To deal with extra weight, your spine can become tilted and stressed unevenly. The back may lose its proper support and develop an unnatural curvature of the spine over time.
8. Quit smoking: Smoking restricts blood flow to the discs that cushion your vertebrae. This could lead to quicker disc degeneration. Smoking also reduces calcium absorption and new bone growth. This increases the risk of a fracture due to osteoporosis, a condition where bones become weak and brittle.
9. Get enough sleep to relax your body.
10. Diet, meditation and mindfulness, lifestyle modifications, doing an activity that makes you happy, improving your sleeping posture, etc.

PHYSICAL THERAPY

• For pain relief – heat therapy, ice, and TENS (Transcutaneous electrical nerve stimulation).
• For inflammation – Ice, ultrasound, IFT (Interferential therapy).

• EXERCISES
  1. Stretching of back muscles, piriformis, glutes, quads, hams, and calf.
  2. Strengthening of core and back muscles.
  3. PNF stretching
  4. Theraband exercises
  5. Weight loss exercises

• Manual therapy:-Hands-on techniques such as joint mobilization, soft tissue massage, and manipulation are used to improve joint mobility and reduce muscle tension.
• Postural Correction: Physiotherapists educate patients on proper posture and body mechanics during daily activities to prevent further strain on the back.
• Ergonomic Advice: Patients receive guidance on proper ergonomics at work and home to create a back-friendly environment.
• Aquatic Therapy or Hydrotherapy: In some cases, aquatic exercises in a pool may be recommended as the buoyancy reduces stress on the spine while providing a gentle workout.
• Biofeedback: Biofeedback techniques may be used to teach patients how to control and relax specific muscles to alleviate pain.
• Gradual Return to Activities: Patients are guided on how to gradually resume daily activities and exercise routines to prevent re-injury.
• Home Exercise Program: Physiotherapists design a tailored home exercise program to encourage continuity of care and long-term management.
• Education: Patients are educated about their condition, potential triggers, and strategies to manage and prevent future episodes of low back aches.

Complementary therapies

Several types of complementary therapy may be helpful for relief from low back pain. These include:

• Acupuncture, in which therapists insert hair-thin sterilized needles into precise points in the body to release blocked energy
• Spinal manipulation, in which chiropractors apply pressure directly to the body to correct spinal alignment
• Therapeutic massage to relax aching muscles
• Movement therapies, such as yoga and tai chi, can help stretch and strengthen back muscles

What is the specific reason for lower back pain in females?

Lower back aches (LBA) in females can have various causes, many of which are similar to those in males. However, there are certain factors unique to females that may contribute to or be associated with LBA.

1. Gynecological Conditions: Certain gynecological issues can cause LBA, such as:
   • Endometriosis: A condition where the tissue lining the uterus grows outside it, leading to pain and inflammation.
   • Ovarian Cysts: Fluid-filled sacs that form on the ovaries can sometimes cause pain in the lower back.
   • Uterine Fibroids: Non-cancerous growths in the uterus may press on the surrounding structures and cause discomfort.
   • Pelvic Inflammatory Disease (PID): Infection and inflammation of the female reproductive organs can lead to LBA.
2. Pregnancy: During pregnancy, the growing uterus and hormonal changes can put added strain on the lower back, leading to LBA.
3. Menstrual Cramps: Some women experience lower back pain as a part of their menstrual cycle, particularly during menstruation.
4. Hormonal Changes: Fluctuations in hormones, especially during menstruation, pregnancy, or menopause, can contribute to LBA.
5. Osteoporosis: Women are more susceptible to osteoporosis, a condition characterized by weak and brittle bones, which can lead to compression fractures in the spine and cause LBA.
6. Posture and Body Mechanics: Differences in female anatomy, such as wider hips, may influence posture and body mechanics, potentially contributing to LBA.
7. High Heel Use: Wearing high heels regularly can alter the alignment of the spine and lead to LBA.
8. Weight Distribution: Fat distribution in the body differs between males and females, and excess weight around the abdomen can strain the lower back.
9. Pelvic Instability: Some women may experience pelvic joint instability during pregnancy or after childbirth, leading to LBA.
10. Psychological Factors: Emotional stress, anxiety, and depression can affect pain perception and exacerbate LBA in females.

When should you be worried about lower back pain?

Mostly the low back pain resolves on its own within a few days or weeks when it is in the acute phase. When pain does not resolve after 12 weeks, even after treatment, then it is chronic, and one should be then extra cautious about it.

When you see these signs, immediately seek medical help:

• Sudden loss of sensation in one or both legs, the groin or genital area, and/or the anal region.
• Inability to walk
• Inability to control bowel movements
• Loss of consciousness
• Sudden, intolerable pain in the lower back and/or legs
• Back pain that radiates to the abdomen in front
• Difficulty in passing urine or • uncontrollable bladder movements
• Back pain that follows a fall, sports injury, or RTA (Road traffic accident).
• Occurs with unintended weight loss.
• Occurs with swelling or redness on the back.

What activity or exercise leads to lower back pain and why?

Techniques while performing any activity:

Lifting something heavy makes it very easy to twist the wrong way. This can lead to muscle spasms and pain. Use proper body mechanics by engaging your leg muscles, not your back, when you pick up heavier items. Get help if the item is too much for you to lift alone.

After workout:

• Our body’s natural inflammatory response to exercise causes subtle strain on the muscles and connective tissues. You may have observed that back DOMS (lower back pain) develops gradually after exercise. It may develop within 6 to 8 hours after a workout, reaching a peak at around 24 to 48 hours and finally diminishing in approximately 72 hours.
• Many people face lower back pain after a workout due to overexertion. It can lead to injury if you attempt too much weight or do exercises with improper form. When attempting any new exercise or activity, it’s important to begin slowly and gradually increase resistance.

When Lower Back Pain After Workout Becomes a Concern?

It is essential to know that not all forms of lower back pain are typical. Feeling a sharp pain after your workout or persistent pain in a specific area is not normal. This form of acute pain during and immediately after your workout can be a symptom of a back injury. Further, with such damages, the pain tends to persist 72 to 96 hours post-exercise. In addition to general discomfort, accompanying signs may aggravate the pain and the condition. For instance, some recognizable symptoms include tenderness, pain spreading to other body regions, weakness, and inflammation.

Why does the lower back hurt after sleeping?

Sleeping flat on your back, high pillows, or soft mattresses puts pressure on your spine. Elevate your knees slightly by placing a pillow under them. If you’re a side sleeper, put a pillow between your knees to reduce pressure on your back.

How long does back pain last?

• Back pain caused by strain from overexertion usually subsides over days or weeks.
• Back pain caused by the weight of pregnancy will usually be relieved after the baby’s delivery.
• People who are obese may need to lose weight before back pain eases.
• Back pain caused by pyelonephritis is often relieved within days of starting antibiotics.
• People with more severe forms of back pain caused by problems with the vertebrae or spinal nerves may have more persistent back pain that lasts for months and may last for years.

Real Stories of Lower Back Ache