Lower Back Pain

Introduction

Lower back pain refers to discomfort or stiffness in the lower part of the spine that can affect daily activities, mobility, and overall quality of life. It can be caused by poor posture, prolonged sitting, muscle strain, spinal problems, injury, or ageing. Symptoms can vary from mild aches to severe pain that can impact your daily life, such as walking, bending, lifting, standing, and sleeping.

The lower back (lumbar spine) carries a lot of weight and allows movement in different directions. If there is any irritation or damage to the muscles, ligaments, joints, discs or nerves in this area, you may experience lower back pain.

Most cases of lower back pain will improve with appropriate treatment, regular movement and targeted exercises. If symptoms persist or are severe, you may need to see a medical professional to identify the cause and best treatment.

In this article, we will look at the causes, symptoms, types, diagnosis, treatments, prevention, and best exercises for lower back pain.

What is Lower Back Pain?

Lower back pain is pain or discomfort felt in the lumbar spine. This is the section of the spine between your lower ribs and pelvis. The lumbar spine contains 5 vertebrae (L1-L5), discs, muscles, ligaments, joints and nerves.

The lumbar spine is important for helping with posture, weight bearing and movements such as bending, twisting and lifting.

Lower back pain can occur all of a sudden after lifting a heavy object or gradually due to repeated strain, weak muscles, long periods of sitting or degenerative changes.

Lower back pain can affect the lower back area or radiate to the buttock, hips and legs. If the pain radiates down the leg due to nerve irritation, you may have a condition such as sciatica.

Types of Lower Back Pain

There are different types of lower back pain depending on how long you have had the issue and the cause.

Acute Lower Back Pain

This is when the pain occurs suddenly and usually lasts for a few days up to several weeks. This can happen after lifting something heavy, doing something new, twisting suddenly, or straining your back muscles.

Most acute cases will improve with conservative treatment.

Subacute Lower Back Pain

This type of pain will last longer than acute pain but usually will improve within 6-12 weeks. You may notice your symptoms slowly improving, but you may still feel stiffness and discomfort with certain movements.

Physiotherapy and an exercise programme can help to improve mobility.

Chronic Lower Back Pain

This is when the pain has been present for longer than 12 weeks. It can be associated with spinal conditions, repeated muscle strain, degenerative changes or multiple causes.

If you have chronic back pain, you may benefit from a combination of physiotherapy, strengthening exercises, activity modifications and medical treatment.

Common Causes of Lower Back Pain

Many structures in and around the lumbar spine can cause lower back pain. Below are some common causes:

Muscle Strain

Muscle strain in the lower back can occur when the muscles become stretched or strained. This can occur after lifting heavy objects, sudden movements, repeated bending, or overexertion.

The muscles can become painful, tight, and sore, making it uncomfortable to bend, twist, or stand for long periods.

Poor Posture

Sitting or standing in an awkward position for long periods can cause increased strain on your muscles and lower back structures.

Poor posture such as slouching, leaning forward whilst using a computer, and not having good back support can cause discomfort.

Long Periods of Sitting

Sitting for several hours at a desk, driving, or using electronic devices can cause stiffness in the lower back and hips.

Taking regular breaks and sitting in the right position can help reduce unnecessary strain.

Herniated Disc/Slipped Disc

A herniated disc occurs when the soft centre of an intervertebral disc pushes through a weakened outer layer.

If the disc is irritating or compressing a nerve nearby, you may experience lower back pain, tingling, numbness, or weakness in one leg.

Sciatica

Sciatica is pain caused by irritation or compression of the sciatic nerve or nerve roots.

The pain normally starts in the lower back or buttock and radiates down one side of the back. Some people will also experience a burning sensation, pins and needles, or numbness.

Lumbar Spinal Stenosis

Lumbar spinal stenosis occurs when the passageway within the lower back (lumbar spine) becomes narrower, potentially putting pressure on nearby spinal nerves. This can cause pressure on surrounding nerves.

Common symptoms include lower back discomfort, pain in legs, numbness, and weakness. Symptoms may get worse when standing or walking for long periods and improve when sitting or leaning forward.

Degenerative Disc Disease

As we age, the discs in our spine will begin to change. They will start to lose some of their water content and become less flexible.

This can cause them to struggle to absorb forces from everyday activities. Some people will experience pain and stiffness, but there can also be degenerative changes with no symptoms.

Osteoarthritis

Lumbar osteoarthritis is a degenerative condition that gradually affects the joints in the lower part of the spine. Over time, wear and tear can cause stiffness, discomfort, and reduced flexibility.

Symptoms may become more pronounced following prolonged rest or when performing specific physical activities.

Sacroiliac Joint Dysfunction

The sacroiliac joints join the sacrum at the bottom of the spine to the bones of the pelvis.

Irritation or changes in movement can cause pain in the lower back, buttock, or one side of the pelvis.

Weak Core Muscles

The core muscles (abdominals, back and pelvis) help to support the spine and control trunk movements.

If these muscles are not strong enough or have poor endurance, it can make certain activities harder to perform and can cause repeated discomfort.

Osteoporosis and Fractures

Osteoporosis weakens the bones, increasing the risk of vertebral compression fractures.

This can cause sudden back pain, especially after a fall, lifting activity, or sometimes even small movements if the bones are fragile.

Other Medical Conditions

Sometimes lower back pain can be associated with other non-musculoskeletal conditions such as kidney stones, kidney infections, inflammatory conditions, or certain abdominal/pelvic conditions.

If you have pain with other unusual symptoms, then you should consult a medical professional.

Risk Factors

Some lifestyle choices and medical conditions can increase your risk of developing lower back pain.

Common risk factors include:

• Long periods of sitting
• Poor posture
• Overweight
• Weak abdominal/back muscles
• Repeated heavy lifting
• Incorrect lifting technique
• Repeated bending and twisting
• Previous back injuries
• Age-related changes to the spine
• Smoking
• Physically demanding jobs
• Poor sleep and stress

Having one or more of these risk factors does not mean you will experience lower back pain, but making changes where possible can help improve your spine health.

Symptoms

Symptoms can vary depending on what structures are affected and the cause of your pain.

Common symptoms include:

• Achey or sharp pain around the waist
• Tight muscles
• Difficulties bending forwards/backwards
• Pain when standing for long periods
• Discomfort when getting out of bed
• Stiffness in the lower back
• Pain when lifting or carrying
• Muscle spasms in the lumbar area
• Pain radiating to the buttocks/thighs
• Numbness, tingling or weakness in the legs if nerves are affected.

Some people will experience mild discomfort that improves with movement. Others may find it difficult to walk, sit or sleep.

When to See a Doctor

Most lower back pain is not caused by a serious medical condition. However, if you are experiencing any of the below symptoms, you should seek urgent medical attention.

• New bladder/bowel control issues
• Numbness in the genital, anal area or inner thigh (saddle area)
• New or progressive weakness in one or both legs.
• Severe back pain after a major accident/injury.
• Back pain with a fever or feeling very unwell.
• This can be a sign of serious conditions such as cauda equina syndrome or infection.

You should also seek a medical assessment if you are experiencing persistent, worsening back pain, unexplained weight loss, or have a history of cancer or significant osteoporosis.

Diagnosis

A physio or doctor will usually assess your symptoms, medical history, physical condition and mobility to identify potential causes.

They may ask:

• Medical History
• When did the pain start?
• Did it start suddenly or gradually?
• Where exactly is the pain?
• What makes it worse or better?
• Is the pain radiating to your legs?
• Have you had any previous injuries or spinal conditions?
• Are you experiencing any numbness, tingling, or weakness?

Physical Examination

This will help to assess your mobility.

They may perform:

• Range of motion tests to the lumbar spine.
• Strength testing.
• Postural assessment.
• Tenderness and muscle spasms.
• Hip mobility.
• Neurological testing of the lower limbs.
• Walking and balance.

Special Tests

Depending on your symptoms, the physio may perform some specific tests to assess nerve irritation, joint function, muscle strength and mobility.

Examples include straight leg raise (SLR) and other neurological tests.

Investigations

Investigations are not usually required for simple lower back pain.

However, if your symptoms suggest a particular cause or are likely to alter your treatment, a doctor may recommend some investigations.

• X-ray – Can help identify fractures, changes in alignment and certain bony abnormalities.
• MRI – Can give detailed images of the discs, nerves, ligaments and other soft tissues in the spine.
• CT Scan – Can give detailed images of the bones in the spine. Can be useful to assess certain fractures or issues.
• Blood tests – May be advised if there is suspected infection, inflammation or other medical conditions.

Treating Lower Back Pain

Your treatment will depend on the cause, severity, length of time and symptoms you are experiencing. Most simple cases can be managed without surgery.

Physiotherapy

A physio can create an individual treatment plan to manage your lower back pain.

• They will look at your symptoms, strength, flexibility and restrictions.
• Therapeutic exercises
• Core strength
• Back muscle strengthening
• Stretching
• Postural correction
• Movement re-training
• Walking and functional training
• Education on looking after your back

Heat.

• A warm pack can help to reduce muscle tightness.
• This can be helpful for patients experiencing muscle stiffness.
• Place a warm pack (not too hot!) on your affected area for around 15-20 minutes. Place a towel in between.

Cold.

• A cold pack can help with any discomfort you are experiencing due to recent injury/ muscle irritation.
• Wrap ice in a towel. Apply for around 10-15 minutes. Do not apply directly to skin.

Medications

Depending on your condition, your doctor may prescribe painkillers and anti-inflammatory medication.

Some common medications are specific NSAID’s. They are not suitable for everyone and can cause side effects to your stomach, kidneys and heart.

Only take medication as advised by a medical professional.

Hands-on Physiotherapy.

Some Physios will utilise hands-on techniques to help improve mobility and reduce symptoms.

• Joint mobilisations
• Soft tissue techniques
• Massages
• Muscle relaxation

This is usually a better option when combined with an exercise programme.

Stay Active

• Avoid staying in bed for long periods of time.
• Try to stay as active as you can within your comfort level. Gentle walking and changing positions regularly can help avoid stiffness.

Postural & Ergonomic Adjustments

• Making adjustments to your workstation and how you move throughout your daily life can help to reduce unnecessary stress on your lower back.
• Sit in a supportive chair with your feet supported and your screen at the right height.
• Do not stay in one position for too long.

Surgery

Most people do not need surgical intervention.

In some cases where there is severe nerve compression, certain spinal conditions, or symptoms persist and have not improved with appropriate conservative treatment, surgery may be considered.

This will depend on the diagnosis, neurological findings, and general health.

Best Exercises for Lower Back Pain

Exercise can be an important factor in managing your lower back pain. Performing the correct exercises can help improve mobility in the spine, strengthen the muscles, improve flexibility, and help build confidence with your daily activities.

Below are some exercises that could be beneficial to individuals with simple lower back pain.

Please note that exercises should depend on the cause of your pain and what symptoms you are experiencing. If any exercises cause a significant increase in pain, new leg symptoms, or numbness/weakness, then stop.

1. Pelvic Tilt

Benefits:

Helps increase awareness and control of pelvic and lower back movement.

Instructions:

• Lie on your back.
• Keep your knees bent.
• Keep arms relaxed by your side.
• Engage your abdominal muscles.
• Tuck your pelvis under to flatten your lower back against the ground.
• Hold for 3-5 seconds.
• Slowly return to start.
• Repeat 10-15 times.

2. Knee to Chest

Benefits:

Gently stretches muscles surrounding lower back and bottom.

Instructions:

• Lie comfortably on your back.
• Bend your knee and bring it up to your chest.
• Hold your knee gently with both hands.
• Hold in this position.
• Hold for 15-20 seconds.
• Slowly lower your leg and repeat on the opposite side.
• Repeat 3-5 times.

3. Cat Cow Stretch

Benefits:

Improves gentle movement of the spine.

Instructions:

• Begin in a four-point kneeling position.
• Ensure your hands are under your shoulders and knees under your hips.
• Round your back gently upwards to the ceiling and lower your head.
• Move into the opposite position by gently arching your back and raising your head.
• Repeat movements slowly between both positions.
• Repeat 10-12 times.

4. Child’s pose

Benefits:

Provides gentle stretching for your back and hips.

Instructions:

• Begin on your hands and knees.
• Slowly tuck your hips back behind your heels.
• Stretch out your arms forward.
• Allow your chest to gently come down towards your thighs.
• Let your neck relax and ensure you are breathing normally.
• Hold in this position comfortably.
• Hold for 15-30 seconds.

If required, you can place a pillow under your stomach or between your thighs and calves. Do not do this stretch if it makes your symptoms worse.

5. Bird Dog

Benefits:

Strengthens core, back and hip muscles to improve trunk stability.

Instructions:

• Begin in a 4-point kneeling position.
• Ensure your back is in a comfortable neutral position.
• Extend your right arm forward and left leg backwards.
• Do not twist or arch your lower back.
• Hold for 3-5 seconds.
• Return to start and repeat on opposite side.
• Repeat 8-10 times.

6. Glute Bridge

Benefits:

Strengthens gluteal muscles and improves hip and trunk control.

Instructions:

• Lie on your back with knees bent.
• Ensure feet are flat and approximately hip-width apart.
• Engage your abdominal and glutes.
• Slowly raise your hips so your shoulders, hips, and knees are in a comfortable line.
• Hold for 3-5 seconds.
• Lower your hips down to the floor.
• Repeat 10-12 times.

7. Abdominal Bracing

Benefits:

Improves engagement of abdominal muscles and trunk control.

Instructions:

• Lie on your back with knees bent.
• Ensure shoulders are relaxed and breathing normally.
• Gently engage your abdominal muscles as if bracing for a gentle push.
• Do not hold your breath or force your back flat.
• Hold for 5-10 seconds.
• Release and repeat.
• Repeat 10 times.

8. Pelvic Clock

Benefits:

Encourage gentle movement of the pelvis to increase awareness of lower back position.

Instructions:

• Lie on your back with knees bent.
• Imagine your pelvis is in the middle of a clock face.
• Gently rock your pelvis forwards and backwards.
• Move your pelvis gently from side to side.
• Repeat slowly.
• Repeat 10 times in each direction.

9. Hamstring Stretch

Benefits:

Improves flexibility of thigh muscles.

Instructions:

• Lie on your back with both legs straight.
• Lift one leg towards the ceiling.
• Grasp the back of your thigh or use a towel around your foot.
• Straighten your knee gently until you feel a comfortable stretch.
• Hold in this position.
• Slowly lower your leg and repeat on the opposite side.
• Hold for 15-30 seconds per side.

10. Walking

Benefits:

Helps with maintaining general fitness and encourages movement. Improves physical endurance.

Instructions:

• Walk at a comfortable pace.
• Keep a relaxed posture.
• Take small steps if your back is uncomfortable.
• Gradually build up walking time as your symptoms allow.
• Do not overexert yourself if your pain worsens.
• Start with 5-10 minutes and gradually increase.

Exercises to avoid/modify during lower back pain.

Not all exercises will be suitable for everyone with back pain. Some may aggravate symptoms, especially if you are having an acute flare-up or if there is nerve irritation.

Depending on your condition, you may need to modify the following exercises:

• Heavy deadlifts.
• Heavy barbell squats.
• Forward bending with load.
• Sudden twisting movements.
• Jumping.
• Heavy sit-ups.
• Leg raises that cause over arching of lower back.
• Exercises that cause sharp shooting pain down the leg.

These exercises will not always be detrimental to your back. Whether they are suitable depends on your symptoms, ability, and technique.

A physio can help identify what exercises to modify and help you get back to them.

Home remedies for lower back pain.

In addition to receiving the correct medical treatment, there are some things you can do at home to help with mild lower back pain.

Stay active.

Try not to lie in bed for long periods of time. Gentle walking and light activities can help keep you moving.

Heat/Cold packs.

Use a warm pack if you have stiffness or a cold pack for short-term relief if you have recently injured your back. Use whichever gives you the most comfort.

Sleeping position.

• Some people find sleeping on their side with a pillow between their knees helps.
• If you prefer sleeping on your back, putting a pillow under your knees can help ease tension in your lower back.

Sitting position.

• Sit in a chair that supports your back and has your feet resting comfortably on the floor.
• Try to change positions frequently.

Healthy weight.

Being overweight can put extra strain on your spine when doing everyday activities. Eating a healthy diet and being physically active can help your musculoskeletal system.

Stress.

• Increased stress and lack of sleep can increase pain sensitivity.
• Using relaxation techniques, regular sleeping patterns and the correct physical activity can help improve your wellbeing.

How to prevent lower back pain.

Following the tips below can help keep your spine healthy.

• Exercise regularly to strengthen your back and abdominal muscles.
• Be active.
• Avoid sitting for long periods.
• Take regular breaks whilst working at a desk.
• Use correct lifting techniques.
• Keep heavy items close to your body.
• Avoid twisting suddenly when lifting heavy items.
• Sleep in a comfortable position.
• Improve hip and leg flexibility.
• Maintain a healthy weight.
• Don’t smoke.
• Build up your exercise intensity.

Correct lifting techniques.

Incorrect lifting can put extra strain on your lower back, especially when lifting heavy or awkward items.

• Stand close to the item.
• Stand with feet comfortably apart.
• Bend hips and knees.
• Keep the item close to your body.
• Gently engage your abdominal muscles.
• Lift with control.
• Avoid twisting your trunk.
• Turn your feet.
• If the item is very heavy, ask for help or use appropriate lifting equipment.

How long does lower back pain take to recover?

The amount of time it takes to recover from lower back pain will depend on the cause, severity, physical ability, and treatment.

• Type of lower back pain: Length of time.
• Acute A few days to 6 weeks.
• Subacute 6-12 weeks.
• Chronic Over 12 weeks.

Many simple cases will improve within a few weeks. However, some people can suffer from recurrent symptoms.

Gradually returning to your normal activities, strengthening exercises, and good self-management can help.

FAQs.

Conclusion.

Lower back pain can impact your movement, activity, and general quality of life. It can occur due to muscle strain, sitting for long periods, poor movement patterns, disc issues, spinal degeneration or nerve irritation.

It is important to know the cause of your lower back pain to ensure you receive the correct treatment. Physiotherapy, exercises, walking, changing your posture and receiving the correct medical treatment can help reduce your discomfort and improve your spinal function.

Regularly strengthening your abdominal, back and hip muscles can help support your lumbar spine and improve your control. Ensure you choose exercises based on your symptoms and physical ability.

If you are suffering from severe, persistent lower back pain or experiencing any numbness, weakness or changes to your bladder/bowel, please seek the correct medical assessment.

References:

• World Health Organization (WHO) – Low Back Pain
  https://www.who.int/news-room/fact-sheets/detail/low-back-pain
• National Institute for Health and Care Excellence (NICE) – Low Back Pain and Sciatica: Assessment and Management
  https://www.nice.org.uk/guidance/ng59
• World Health Organization (WHO) – Guidelines for Non-Surgical Management of Chronic Primary Low Back Pain
  https://www.who.int/publications/i/item/9789240081789
• American Physical Therapy Association (APTA) – Clinical Practice Guidelines for Low Back Pain
  https://www.jospt.org/doi/10.2519/jospt.2021.0304
• U.S. Department of Veterans Affairs and Department of Defense – Clinical Practice Guideline for Low Back Pain
  https://www.healthquality.va.gov/guidelines/Pain/lbp/
• National Library of Medicine (PubMed Central) – VA/DoD Clinical Practice Guideline: Diagnosis and Treatment of Low Back Pain
  https://pmc.ncbi.nlm.nih.gov/articles/PMC6848394/
• North American Spine Society – Diagnosis and Treatment of Low Back Pain
  https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/Guidelines/LowBackPain.pdf