Low Back Pain: Could It Be Something More?

Hobbled by low back pain? Just about everyone has back pain now and then. The most common causes are sprains (torn ligaments) and strains (torn tendons or muscles). These can happen when you lift something heavy, twist the wrong way, or sit too much.

They usually heal on their own in a few days or weeks. If your back pain drags on, is severe, or makes it hard to keep up with your daily routine, see your doctor. Although most back pain isn’t harmful, it can sometimes signal a more serious problem.

Your doctor can figure out what’s wrong and make sure you get the right treatment.

Mechanical Low Back Pain

Most low back pain is mechanical. That means it’s caused by an injury or by wear and tear on your back. Mechanical back pain usually feels better after rest and some self-care.

There are different causes of mechanical low back pain.

Disk disease. Your spinal disks are rubbery cushions that act like shock absorbers between the bones in your spine (called vertebrae). As you get older, the disks dry out. Then they don’t provide as much of a cushion. They can also crack. That causes some of a disk’s soft inner core to slip out. Your doctor may call this a ruptured or slipped disk. You can feel a lot pain if that slipped core presses on nearby nerves.

Spinal osteoarthritis (OA). When people talk about “bone-on-bone” arthritis, they usually mean OA. It happens when cartilage that cushions the ends of your bones wears down. Cartilage is a firm, rubbery tissue that keeps bones in your joints from rubbing together. When the cartilage between the facet joints on each side of your spinal bones wears away, you can have low back pain. Spinal OA is more common as you get older. But it can happen sooner if you’ve ever injured your back.

Osteoporosis. This causes bones to become thin, weak, and more likely to break (known as a fracture). The first sign that something’s wrong may be back pain from a spinal fracture. A series of small fractures can make you shrink or have a stooped posture. A healthy diet with lots of calcium and vitamin D helps keep your bones strong and make weak bones stronger. So can daily weight-bearing exercises like walking, hiking, or jogging.

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Sciatica. The sciatic nerve is the longest one in your body. It runs from your lower back down each leg. Sciatica starts in your low back, often when a slipped disk presses on the nerve or when the nerve is inflamed. You can also have pain in your hips and rear. Burning and tingling could be felt all the way to your toes. For some people, sciatica comes and goes. For others, the pain is constant.

Spinal stenosis. This happens when the space in your spinal column gets narrower. That puts pressure on your spinal cord and nerves.  The most common type, lumbar spinal stenosis, causes pain in your lower back. Your legs might also feel numb or weak when you walk.

Inflammatory Arthritis

Sometimes back pain can be a symptom of an inflammatory form of arthritis. This kind of back pain doesn’t go away on its own. But you’ll feel much better when you move and stretch.

There are different forms of inflammatory arthritis.

Psoriatic arthritis (PsA). This can affect many parts of the body. About half of people with PsA also have back pain. You may hear it called spondylitis or axial arthritis. It often shows up after you’ve had PsA for a while. Some people can have back pain for years before they find out they have PsA.

Ankylosing spondylitis (AS). Severe low back pain is the main symptom of AS. It often starts in the sacroiliac joints where your spine connects to your pelvis. At first, you might have mild aches in your lower back that come and go. In time, the pain might get worse and last longer. You usually feel it most in the morning or after you sit for a long time. Treatment can prevent the pain from getting worse.

Non-radiographic axial spondyloarthritis (nr-AxSpA). This is an early form of AS. You have the same painful symptoms, but damage to your SI joints doesn’t show up on X-rays. That’s what non-radiographic means. Not everyone with nr-AxSpA goes on to have full AS. There’s no way to know who will get it and who won’t.

Fibromyalgia (fibro). Fibro can make you ache all over. But unlike arthritis, you feel the pain deep in your muscles, not your joints. Back pain is a common problem because your lower spine has so many muscles that support your posture. You could also have spinal OA or inflammatory arthritis at the same time that you have fibro.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on November 25, 2019

Sources

SOURCES:

National Institute of Neurological Disorders and Stroke: “Low Back Pain Fact Sheet.”

Medscape: “Mechanical Low Back Pain.”

DukeHealth.org: “When Can a Doctor Help Your Back Pain?”

ClevelandClinic.org: “Acute Mechanical Back Pain,” “Degenerative Back Conditions.”

National Osteoporosis Foundation: “What Is Osteoporosis and What Causes It?" “Prevention and Healthy Living.”

Arthritis.org: “Sources of Arthritis Pain,” “Psoriatic Arthritis and Back Pain.”

University of Maryland Medical Center: “A Patient’s Guide to Ankylosing Spondylitis.”

Genetic and Rare Diseases Information Center: “Ankylosing Spondylitis.”

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