Low back pain: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 29, 2023

Everyone has had back pain at least once in their life. It is the so-called “low back pain”, so called because it concerns the lumbar region

Given the vastness of the territory potentially affected by the pathology, depending on the area in which it is located, back pain takes on different and specific names.

Neck pain affects the neck, shoulders and trapezius muscles while, if it occurs in the upper part of the trunk, it is called back pain.

Low back pain is, to date, the problem that affects the most people and, second only to the flu and its symptoms, is the main cause for going to the doctor.

What is low back pain and which anatomical areas it affects

Back pain, which can affect men and women alike at any stage of life, is more common in adulthood and advanced age, when bones and muscles are victims of physiological deterioration and become stiffer day after day.

The typical pain of low back pain (which can be perceived as sharp, or as an intense burning with tingling) is caused by problems with the musculoskeletal system, in particular, with the bones of the column (vertebrae), muscles, ligaments and intervertebral discs.

The lumbar area is, in fact, the most subject to traumatisms because the body loads weigh the most on it.

Normally, the structures of the vertebral column are connected to each other in such a way as to remain mobile and elastic, thanks to the presence of intervertebral discs and intervertebral joints.

These cartilaginous structures make it possible to avoid direct friction between the bone heads.

Following overloads or continuous microtraumas, it is easier for the cartilage to get damaged and lose its flexibility: this is how the mechanisms that lead to low back pain are established, a pain that arises acutely and can then become chronic.

In some cases the pain and discomfort can be so intense as to become disabling, preventing even the simplest activities from being carried out.

It is frequent, when suffering from back pain, to find it difficult to perform even the simplest movements and daily activities.

From an epidemiological point of view, it is estimated that, to date, about 40% of individuals in the world and about 15 million Italians suffer from low back pain.

Although sporadic episodes are increasingly frequent even among young people, the pathology remains more common with ageing: about 50% of individuals over 60 have experienced at least one episode of low back pain in their life.

Types of low back pain

Low back pain can be classified according to the trigger, the severity of the symptoms and the region in which they are located.

Back pain according to the underlying cause

Low back pain is defined as mechanical when it appears due to causes concerning the musculoskeletal system such as the presence of a herniated disc, compression of the nerves, degeneration of the vertebral discs or fracture of a vertebra.

On the other hand, low back pain is non-mechanical when it is a consequence of inflammation, infection and, in rarer cases but still to be considered, tumors.

Low back pain for internal organs occurs when there are kidney disorders such as kidney stones.

Back pain according to the severity of symptoms

Acute low back pain occurs suddenly, triggering even very strong pains.

Its duration is short (maximum 5/6 weeks) and is known to most as “witch’s blow”.

We realize that low back pain has evolved towards a chronic state when the pain appears gradually, but lasts for more than a year.

In this case, the alternation of phases of exacerbation with others of remission is frequent.

In an intermediate stage we find sub-chronic low back pain, with symptoms that last between 6 weeks and a year.

Back pain according to its location

When the pain is local, it means that it develops in a specific part of the lower back, usually due to other conditions such as kidney stones or disc lesions.

In a low back pain where the pain is instead radiated, the discomfort is not only felt in the lumbar region, but the lower limbs are also affected.

It usually happens because a peripheral nerve is compressed due to conditions such as a herniated disc, sciatica, osteoarthritis or spinal stenosis.

You may feel weakness and tingling in the limbs.

Low back pain, the causes

The most common cause of low back pain is an injury to the musculoskeletal structures of the back, after they have been subjected to sudden movements or too high loads.

Contractures, strains and tears are part of this category of injuries.

Poor posture is the second most frequent cause of back pain, as are all spinal asymmetries (scoliosis, lordosis, kyphosis).

Low back pain is often related to pregnancy and can occur both during and after this period.

This happens because the woman’s body suddenly finds itself having to change its center of gravity and to support an “abnormal” weight.

All the traumas to which the back can be subjected are causes of low back pain: vertebral fractures, falls on the back, road accidents.

Back pain can also be caused by diseases and infections such as kidney stones, slipped discs, spinal stenosis or spondylolisthesis.

If there is osteoporosis, the bones are weaker than normal and the lumbar vertebrae can also be affected.

Among the rarest causes we find the presence of vertebral tumors.

They increase the risk of contracting back pain:

a sedentary lifestyle, especially if associated with overweight or obesity;
aging (like all muscles and bones, even those of the back gradually weaken with age);
incorrect and frequent lifting of weights;
excess of sport (or sport not practiced correctly);
back pain can be a somatization of anxiety and stress;
sleeping on a too soft mattress;
in children and adolescents, carrying excessively large and heavy backpacks.

Low back pain, associated symptoms

Back pain is usually due to sudden and forced movements, traumas and injuries.

Although the main symptom is sharp and stinging or dull pain with tingling, low back pain, when it is associated with other pathologies, can manifest itself with a series of other disorders affecting the muscles, ligaments and vertebral bones:

stiff back and difficulty in movement: there is pain and it is more difficult to move so much that, in the most serious cases, the muscles of the back and lower limbs can atrophy;
if connected to a herniated disc or sciatica, pain, tingling and weakness are felt in all the lower limbs, from the thighs to the feet, with possible effects on walking (lameness);
if it is accompanied by vertebral tumor, one notices an unjustified weight loss and sudden urinary and faecal incontinence;
there may be constant pain and discomfort with lifting, twisting and flexing the lower trunk (and there may also be involuntary spasms of the muscles involved).

How is a diagnosis of low back pain made?

After experiencing the first symptoms, it is advisable to contact the family doctor when these do not resolve with a little rest.

If the problem is not resolved in a short time, it is advisable for the subject to undergo a medical examination to rule out the presence of other pathologies in progress that have caused the low back pain.

The diagnosis generally takes place with a simple medical examination, which involves the execution of various investigations: the doctor subjects the back, in particular the lumbar area, to a check, carrying out some tests to identify which movements bring pain and which instead they relieve it.

For nonspecific low back pain, rest from all painful activities is usually prescribed.

If the physical examination is not sufficient to establish the cause of the pathology with certainty, the doctor can prescribe some diagnostic imaging tests (X-rays, magnetic resonance, CAT scans) which allow to show any problems that have triggered the symptoms, to evaluate the extent of the damage present and, if any, which nerves are compromised.

The first doctor you go to is your general practitioner who prescribes pain-relieving and anti-inflammatory therapy.

If further diagnostic investigations are required, it is possible to contact a physiatrist or an orthopedic surgeon who, once the cause has been identified, takes care to start the rehabilitation program or plan any surgery.

Low back pain, the treatments

The final aim of each treatment is to eliminate the painful symptomatology and, in the first instance, we try to obtain this result in a conservative way.

If your back pain is caused by muscle injury or ligament trauma:

active rest can be very helpful. It is necessary to avoid all activities that bring pain, however keeping in movement in order not to atrophy the whole muscular system;
maintain correct posture and, if necessary, undergo postural gymnastics sessions;
exploit the properties of thermal therapy. Applying ice or hot packs on the painful area (4/5 times a day for about 20 minutes) relieves inflammation and relaxes the muscles;
follow pain-relieving and anti-inflammatory therapy that help control pain (muscle relaxant drugs can also be useful).

All these precautions must be followed under strict medical supervision, due to their possible side effects.

If the pain persists, you can try alternative ways such as laser therapy sessions and ultrasounds directed at the painful area or physiotherapy.

It is important that, after recovery, the return to normal activities (work, sport) takes place gradually and not abruptly, otherwise a relapse will often be more difficult to treat.

In chronic and severe cases, it may be necessary to take cortisone-based or opioid-based drugs such as morphine to relieve pain for a short time or even resort to surgery.

This road is taken when the pain has reached a chronic state and the first problems appear when walking.

The surgical techniques used today are all minimally invasive.

Low back pain has a positive prognosis in most cases.

The pain and the ability to move improve a lot already in the first weeks of treatment, with a complete recovery almost always.

For some patients recovery may be slower with recurring episodes of low back pain throughout the year.

How to prevent low back pain?

Prevention of low back pain is not always possible because, sometimes, it can arise without a specific cause.

However, it is possible to adopt a series of virtuous behaviors in everyday life, useful both for the good health of the back and of the whole organism:

avoid overweight and obesity by following a healthy lifestyle. As we have seen, too high loads can damage the spine and should be avoided by following a correct diet combined with regular physical exercise;
get regular exercise. It’s important to move, but not overdo it. The main exercises to combat back pain are aimed at stretching and strengthening the abdominal, back and iliopsoas muscles. If you are prone to frequent back pain, prefer full-bodied but low-impact sports such as swimming and cycling;
lift weights properly. Avoid too heavy loads that can damage the vertebrae and vertebral discs;
maintain correct posture, both sitting and standing. This reduces the strain and load on the back. For the same reason, it is recommended not to stand or sit for too long.

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