What’s causing your lower back pain?

The top three causes are sprains and strains, herniated discs, and stenosis.

Lower back pain is among the most common complaints of older age. The lumbar or lower area of the spine can suffer from many different ailments. “You do most of your bending in the lower back, and that’s probably why the lower back tends to be affected more,” explains Dr. Jeffrey Katz, a Harvard Medical School professor and editor of the Harvard Special Health Report Low Back Pain: Healing Your Aching Back.

      The key to finding relief starts with understanding the cause of your pain. See if any of these symptoms sound familiar, and address pain as soon as possible to keep it from getting worse.

Sprains and strains

Together, sprains and strains are the most common cause of lower back pain. A sprain is an injury to a back ligament, which helps hold the bones in your spine together. A strain is an injury to a muscle or a tendon, which connects muscle to back bones.

► Symptoms: Forward or sideways bent-trunk posture, limited motion, and spasms in your back muscles.

► What you should do: “Try to maintain everyday activities and stay physically active while avoiding activities and postures that make it worse, such as lifting and twisting,” says Dr. Katz. “That alone should do the trick.” Healing can last days to weeks, Icing the injured area right after the injury, and applying wet heat thereafter, can help. So can stretching exercises and over-the-counter painkillers such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin). However, long-term NSAID use can cause stomach ulcers and bleeding, liver and kidney damage, and increased risk for heart attacks, so be sure to get your doctor’s approval before using them. If your pain gets worse, not better, you may have a more serious condition that warrants a doctor visit.

Disc problems

The bones in your spine are separated by cushions called discs. Aging dries out the gelatinous inside of a disc and thins the outer layer, which may cause the entire cushion to deflate and bulge out of place. That rarely causes pain. However, if the soft inside protrudes through a crack in the outer layer, it can inflame the spinal nerves and cause pain. That’s called a herniated disc, sometimes referred to as a “slipped” disc.

► Symptoms: Sudden lower back pain or numbness that often travels into the buttock and down the leg, sometimes all the way to the foot (a condition known as sciatica).

►What you should do: “Don’t panic; this condition usually gets better on its own, but it may take a few months,” says Dr. Katz. He advises that you stay as active as you comfortably can. Over-the-counter painkillers can help relieve backache and leg pain. If pain persists for weeks, see your doctor for imaging tests. You may need a prescription painkiller and a course of physical therapy. An epidural steroid injection has been shown to relieve leg pain from sciatica.

Spinal stenosis

Sometimes the spinal canal, the channel down the spine that holds the spinal cord and nerve roots, can be squeezed or narrowed by bulging discs, thickened ligaments, or small growths called bone spurs. The narrowing is called stenosis. Stenosis puts pressure on the nerves and spinal cord.

►Symptoms: The pressure causes lower backache that’s especially painful when standing up straight, bending backward, or walking. The pain often goes away when you lean forward or sit. Stenosis may also cause pain in the buttocks and legs.

►What you should do: Over-the-counter painkillers and physical therapy can help back pain, and an epidural steroid injection can relieve leg pain. “However, this pain is not likely to go away on its own,” says Dr. Katz. “You may need prescription medication for pain and surgery to decompress the nerve roots.”♣

Harvard Health Letter