What is Low Back Pain?

Low back pain is pain, stiffness, soreness, or discomfort involving the lumbar spine, which is the lower part of the back. The lumbar spine includes vertebrae, intervertebral discs, facet joints, ligaments, muscles, spinal nerves, and nearby soft tissues.

Low back pain may stay in the lower back, or it may travel into the buttock, hip, thigh, leg, or foot. When pain travels down the leg because a nerve root is irritated or compressed, it may be called lumbar radiculopathy or sciatica. Low back pain may also be related to degenerative disc disease, herniated disc, spinal stenosis, spondylolisthesis, facet joint disease, sacroiliac joint pain, or other lumbar spine conditions.

De Novo Brain & Spine evaluates adult patients with low back pain when symptoms suggest a spine-related condition, nerve compression, spinal stenosis, instability, fracture, tumor, traumatic injury, or persistent pain that may require neurosurgical review.

Common Signs and Symptoms

Low back pain symptoms depend on the underlying cause, location of irritation, and whether spinal nerves are involved.

Common signs and symptoms may include:

• Aching, sharp, burning, or stabbing pain in the lower back
• Back stiffness or reduced range of motion
• Pain that worsens with bending, lifting, twisting, standing, or walking
• Pain that improves with rest, position change, or sitting in some cases
• Pain that travels into the buttock, hip, thigh, calf, or foot
• Sciatica, meaning nerve pain that travels down the leg
• Numbness, tingling, or pins-and-needles sensation in the leg or foot
• Weakness in the leg, ankle, or foot
• Foot drop or difficulty lifting the front of the foot in selected cases
• Muscle spasms in the lower back
• Difficulty standing upright or walking normally
• Pain that worsens with extension or arching of the back in some facet or stenosis-related conditions
• Symptoms that worsen with walking and improve with sitting or bending forward, which may occur with lumbar spinal stenosis

Seek urgent medical evaluation for low back pain with progressive weakness, numbness in the groin or saddle area, new bowel or bladder problems, fever, unexplained weight loss, history of cancer, severe pain after trauma, or pain with worsening neurological symptoms. Seek emergency medical care or call 911 for sudden leg weakness, loss of bowel or bladder control, or symptoms concerning for cauda equina syndrome.

What Causes This Condition?

Low back pain can have many causes. Some are related to muscles and soft tissues, while others involve the discs, joints, nerves, bones, or stability of the lumbar spine.

Possible causes and related conditions may include:

• Lumbar muscle strain or ligament sprain
• Myofascial pain involving irritated muscles and soft tissues
• Herniated disc, when disc material irritates or compresses a nerve root
• Bulging disc
• Degenerative disc disease, involving wear or breakdown of spinal discs
• Discogenic pain, meaning pain thought to arise from the intervertebral disc
• Lumbar radiculopathy, or nerve root irritation in the lower back
• Sciatica, a common term for nerve pain traveling down the leg
• Lumbar spinal stenosis, which is narrowing around the spinal canal or nerve roots
• Neurogenic claudication, leg pain, heaviness, or weakness with walking caused by lumbar spinal stenosis
• Facet joint disease, involving the small joints in the back of the spine
• Spondylolisthesis, when one vertebra slips forward relative to another
• Spondylosis, or arthritis-related degenerative change in the spine
• Spinal instability
• Sacroiliac joint dysfunction or SI joint pain
• Vertebral compression fracture
• Osteoporotic spinal fracture
• Traumatic spinal fracture
• Scoliosis, kyphosis, infection, inflammatory disease, or spinal tumor in selected cases

These causes and risk factors do not mean every patient with low back pain has a serious spine condition. Treatment planning depends on symptoms, examination findings, imaging results when needed, neurological function, injury history, and overall health.

How It Is Diagnosed?

Low back pain is diagnosed through medical history, physical examination, neurological examination, and imaging or additional testing when appropriate. The goal is to determine whether the pain is muscular, joint-related, disc-related, nerve-related, fracture-related, instability-related, or caused by another condition.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain location, duration, triggers, injury history, leg symptoms, weakness, numbness, prior treatment, and red-flag symptoms
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, walking pattern, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root involvement
• Straight leg raise or other nerve tension testing when lumbar radiculopathy or sciatica is suspected
• X-rays of the lumbar spine to evaluate alignment, arthritis, disc space narrowing, fracture, deformity, or degenerative change
• Flexion-extension X-rays in selected cases to assess abnormal motion or spinal instability
• MRI of the lumbar spine when nerve compression, herniated disc, spinal stenosis, infection, tumor, fracture, or significant neurological symptoms are suspected
• CT scan of the lumbar spine when bone detail, fracture, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may involve lumbar radiculopathy, peripheral neuropathy, peroneal neuropathy, or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, cancer-related concern, or another medical condition is suspected
• Diagnostic injections in selected cases when the pain source may involve the facet joints, sacroiliac joint, or nerve root

The goal of diagnosis is to identify the likely pain generator, determine whether nerve compression or spinal instability is present, and decide whether conservative care, pain management, injections, or surgical evaluation may be appropriate.

Treatment Options

Low back pain treatment depends on the cause, severity, duration, neurological examination, imaging findings, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, fracture, infection, tumor, cauda equina syndrome, or other urgent concern.

Treatment options may include:

• Activity modification to reduce movements, positions, or lifting that worsen symptoms
• Physical therapy to improve core strength, flexibility, posture, walking mechanics, and lumbar spine stability
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Weight management and conditioning when these factors are relevant to spine stress and overall health
• Treatment of posture, ergonomic, or activity-related contributors
• Lumbar epidural steroid injection in selected cases involving lumbar radiculopathy, sciatica, or nerve irritation
• Facet joint injection, medial branch block, or radiofrequency ablation in selected cases when facet-mediated low back pain is suspected
• Sacroiliac joint injection or SI joint treatment in selected cases when the sacroiliac joint is thought to be a pain source
• Basivertebral nerve ablation in selected patients with vertebrogenic low back pain and appropriate MRI findings
• Spinal cord stimulation in selected patients with chronic neuropathic pain or failed back surgery syndrome after specialist evaluation
• Microdiscectomy in selected cases involving lumbar disc herniation with nerve compression and persistent or progressive leg symptoms
• Lumbar laminectomy or decompression in selected cases involving spinal stenosis or nerve compression
• Lumbar fusion, such as transforaminal lumbar interbody fusion, lateral interbody fusion, or anterior lumbar interbody fusion, in selected cases involving instability, deformity, spondylolisthesis, or certain recurrent spine conditions
• Vertebral fracture treatment in selected compression fractures or traumatic fractures
• Rehabilitation and follow-up care to support strength, mobility, function, and symptom monitoring

Surgery is not appropriate for every patient with low back pain. Neurosurgical treatment may be considered when low back pain is associated with lumbar radiculopathy, spinal stenosis, spondylolisthesis, spinal instability, fracture, tumor, progressive neurological symptoms, or structural compression that has not improved with appropriate non-surgical care.