An Overview of Low Back Pain

There are a variety of causes of low back pain. Most benefit from conservative treatment; a few do not.

What are causes of low back pain?

There are a variety of causes of low back pain, which may include:

Nonspecific low back pain: This is back pain for which the exact cause is unknown. It may be related to stress on the muscles or ligaments (low back strain or sprain) or to normal aging or disease.
Herniated disc: (ruptured or slipped disc).
Spinal stenosis: A narrowing of the spinal canal, which can cause low back pain and put pressure on the spinal canal or spinal nerves.*
Spondylolisthesis (slipped vertebra): A forward slipping of one vertebra onto the one below, which can put pressure on the spinal nerves. It’s caused by injury, repetitive stress or degenerative changes.*
Compression fracture: A break in a vertebra. It can occur with injury or without injury. A compression fracture can occur without trauma in a vertebra that’s been weakened by disease such as osteoporosis. Osteoporosis is a condition characterized by decreased bone density.
Inflammatory arthritis: such as ankylosing spondylitis (an autoimmune disease of the spine that can fuse the vertebrae together making the back stiff).
Facet joint pain (syndrome): Degenerative changes in the facet joints, which are difficult to diagnose accurately. The facet joints help keep the spine in alignment and also allow it to bend and rotate.
Sacroiliitis: An uncommon inflammation of the sacroiliac joint. It can be caused by inflammatory arthritis, Crohn’s disease, colitis, trauma or infection. It can be diagnosed with an X-ray, MRI or bone scan.
Sacroiliac joint dysfunction/syndrome: A controversial condition that’s difficult to diagnose. Many experts believe that pain in the area of the sacroiliac joint is referred to the area from the lumbar back or from the hip. Others believe that pain in the area of the sacroiliac joint is caused by degenerative changes in the sacroiliac joint itself. Because the exact cause of sacroiliac pain hasn’t been clearly defined, there’s no consensus on how to diagnose or treat it. There are no changes in the sacroiliac joint that can be seen with radiological testing used to diagnose sacroiliac joint dysfunction.

Other causes of low back (and sometimes sciatica) that may require other, more aggressive treatments include:

Malignant (cancerous) tumors
Infection, such as an abscess (collection of pus)
Traumatic fractures
Low back pain referred from other organs, such as gastrointestinal, reproductive or urinary organs

Treatment options

Many people who have low back pain get better with conservative treatment and never need surgery. Within three months, about 90 percent of people who have low back pain recover and 75 percent of people who have sciatica are significantly better.

Conservative treatment should be tried before thinking about surgery.

Conservation treatments include:

Staying active
Heat or cold applications
Physical activity/physical therapy
Medication

Surgery. There’s rarely a need to make a quick decision to have back surgery. If a serious cause is detected, such as a tumor, infection, injury, certain fractures or significant nerve or spinal cord compression, surgery may be recommended first. Otherwise, surgery usually isn’t necessary because most people improve with conservative treatment.

By Optum Contributing Writer

Sources

Agency for Healthcare Research and Quality. Noninvasive treatments for low back pain: Clinician summary. Accessed July 7, 2017.
American Academy of Orthopaedic Surgeons. Herniated disc in the lower back. Accessed June 22, 2017.
National Institute of Neurological Disorders and Stroke. Low back pain. Accessed 6/22/17.
American Psychological Association. Coping with a diagnosis of chronic illness. Accessed June 22, 2017.

Last Updated: July 17, 2017