Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
This tutorial has been continuously, actively maintained and updated for 14 years now, staying consistent with professional guidelines and the best available science. The first edition was originally published in September 2004, after countless hours of research and writing while I spent a month taking care of a farm (and a beautiful pair of young puppies) in the Okanagan.
As the structure of the back is complex and the reporting of pain is subjective and affected by social factors, the diagnosis of low back pain is not straightforward. While most low back pain is caused by muscle and joint problems, this cause must be separated from neurological problems, spinal tumors, fracture of the spine, and infections, among others.
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Many people find this article because they are searching for information on “lower right back pain” or “pain in lower right back,” so I’ve made a point of including extra information exactly about this question.
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Bony encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body, commonly as a result of arthritis), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation). Treatment of these afflictions varies, depending on their severity, and ranges from rest and exercises to epidural cortisone injections and surgical decompression by removing the bone that is compressing the nervous tissue.
I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.
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Spinal stenosis : If you have this, your spinal canal has narrowed. That adds pressure on your spine and nerves. As a result, your legs and shoulders probably feel numb. This happens to many people older than 60.
One-factor repeated measures ANCOVAs (baseline VAS measure as covariate) were used to identify any effect of condition (standing, lumbar support and standard chair) on VAS scores for each group separately (healthy individuals patients with LBP).
The magnitude of the burden from low back pain has grown worse in recent years. In 1990, a study ranking the most burdensome conditions in the U.S. in terms of mortality or poor health as a result of disease put low back pain in sixth place; in 2010, low back pain jumped to third place, with only ischemic heart disease and chronic obstructive pulmonary disease ranking higher.
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While the spine can maintain a natural curvature without lower back support provided by the seatback, the natural tendency for most people when sitting for a long period is to slouch forward. This slouching posture pushes the lower back out, so that the natural inward curve goes in the opposite direction – outward toward the chair – straining the structures in the lower back.
Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface. Advice given in the past used to be to sleep on a firm mattress. However, there is no evidence to say that a firm mattress is better than any other type of mattress for people with low back pain. Some people find that a small firm pillow between the knees when sleeping on the side helps to ease symptoms at night.
^ Jump up to: a b Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW (12 September 2012). Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews. 9: CD008880. doi:10.1002/14651858.CD008880.pub2. PMID 22972127.
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Herniated or slipped discs: If your doctor mentions this, the soft tissue in the discs between your joints has come out. It’s usually caused by wear and tear. Herniated discs can cause pain in your lower back or hip because the nerves there are pressed.
You don’t need to take my word for anything — you can just take the word of the many low back pain medical experts that I quote,11 and the hard evidence that their opinions are based on. At the same time, I am realistic about the limits of the science, much of which is pretty junky.12 My own credentials are somewhat beside the point. My decade of professional experience as a Registered Massage Therapist does help me understand and write about low back pain, but what really matters is that I refer to and explain recent scientific evidence, but without blindly trusting it.
^ Jump up to: a b Dowell, Deborah; Haegerich, Tamara M.; Chou, Roger (2016). CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR. Recommendations and Reports. 65 (1): 1–49. doi:10.15585/mmwr.rr6501e1. ISSN 1057-5987.
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Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome. Causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord. There are multiple surgical options to treat back pain, and these options vary depending on the cause of the pain.
“The Pain Perplex,” a chapter in the book Complications, by Atul Gawande. Gawande’s entire book is worth reading, but his chapter on pain physiology is certainly the best summary of the subject I have ever read, and a terrific reminder that good writing for a general audience can be just as illuminating for professionals. Anyone struggling with a pain problem should buy the book for this chapter alone, though you are likely to enjoy the whole thing. Much of the chapter focuses on one of the most interesting stories of low back pain I’ve read, and it is a responsible and rational account — although Gawande, like most doctors, seems to be unaware of the clinical significance, or even existence, of myofascial trigger points.
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Twenty eight male participants (14 healthy individuals and 14 patients with LBP) between the ages of 21–50 were asked to participate in the study. Healthy individuals consisted of those who were free of LBP for the six months previous to the study, whereas patients with LBP had a history of LBP for at least three consecutive days over the last three consecutive weeks prior to testing. Individuals with a known neurological disorder, scoliosis or other deformity, inflammatory or degenerative arthropathy, connective tissue disease, or a history of spinal surgery were excluded from the study. Individuals with current or previous neck pain in the past three weeks were also excluded. Participants were asked to avoid engaging in any type of resistive exercise for the 48 hours prior to testing. All participants signed the informed consent form. The procedures used were in accordance with the institutional research ethics board. The clinical trial was registered at ClinicalTrials.gov (NCT00754585). Data were collected in the Biomechanics and Elastography laboratory at the Canadian Memorial Chiropractic College (CMCC).
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Emerging technologies such as X-rays gave physicians new diagnostic tools, revealing the intervertebral disc as a source for back pain in some cases. In 1938, orthopedic surgeon Joseph S. Barr reported on cases of disc-related sciatica improved or cured with back surgery. As a result of this work, in the 1940s, the vertebral disc model of low back pain took over, dominating the literature through the 1980s, aiding further by the rise of new imaging technologies such as CT and MRI. The discussion subsided as research showed disc problems to be a relatively uncommon cause of the pain. Since then, physicians have come to realize that it is unlikely that a specific cause for low back pain can be identified in many cases and question the need to find one at all as most of the time symptoms resolve within 6 to 12 weeks regardless of treatment.
Injections may also be used to numb areas thought to be causing the pain. Botox (botulism toxin), according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm. These injections are effective for about 3 to 4 months.