Lower back pain overview

Why lower back pain is so common

In Australia the vast majority of people, around 80%, will have lower back pain at some point in their lives.

In most cases lower back pain, sometimes referred to as ‘lumbago’, gets better without any medical treatment. However, some cases may require treatment ranging from over-the-counter medication for pain and inflammation to physical therapy or spinal injections.

Opioid medications should not be used for most forms of back pain, and surgery should only be reserved for significant structural or medical problems causing back pain.

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Common symptoms of lower back pain

How lower back pain can feel

Lower back pain can range from mild discomfort to severely disabling pain and may also affect movement, strength and sensation.

Aching or stabbing pain

Pain may range from a dull ache to sharp or stabbing sensations.

Reduced movement

Bending, twisting or moving the lower back may become difficult.

Weakness

The affected area or limbs may feel weaker than normal.

Numbness or tingling

Pins and needles or reduced sensation may occur.

Radiating pain

Pain may extend through the buttocks and into one or both legs.

Lower back anatomy and pain sources

Structures that can contribute to lower back pain

The lower back, also referred to as the lumbar section of the spine, is made up of several structures that work together to provide movement, stability and protection.

Lower back pain is often caused by strains of the muscles and ligaments, called myofascial pain. Other causes may include a herniated disc or osteophytes (‘bone spurs’) placing pressure on nerve roots. Facet joints can also become significant sources of pain with increasing age.

Vertebrae

Five spinal bones form the lumbar section of the lower back.

Intervertebral discs

Discs between the vertebrae provide cushioning and allow bending and twisting.

Spinal cord and nerves

The spinal canal protects the spinal cord, with major nerves exiting between the vertebrae.

Facet joints

These joints connect neighbouring vertebrae and help provide stability to the spine.

Muscles and ligaments

Soft tissues attached to the spine control movement and support the lower back.

Types and diagnosis of lower back pain

Identifying what is causing lower back pain

Lower back pain is classified into two types according to what is causing the pain.

  • Mechanical lower back pain – Refers to pain resulting from inflammation caused by injury or irritation to structures such as the facet joints, discs, ligaments or muscles, or where one vertebra slips out of place, called spondylolisthesis. Mechanical lower back pain may also be caused by infections or tumours in or near the spine.
  • Neuropathic lower back pain – Describes where a nerve root is compressed or irritated, sometimes referred to as a ‘pinched nerve’, by a herniated disc or an osteophyte. Pain will often radiate from the lower back down the leg or legs, which is known as sciatica.

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Lower back pain diagnosis and assessment

Finding the cause before treatment begins

Because the spine is such a complex composite structure, correct diagnosis needs to be made by a doctor before any treatment is offered.

Most of the time, expensive imaging is not needed to make the diagnosis, but should be reserved for cases where the doctor suspects fracture, infection, tumour or significant structural abnormality.

Appropriate treatment will depend on the cause and severity of the pain.

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  • Comprehensive pain assessments
  • Individual treatment planning
  • Medication review and optimisation

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