Explore the different types, possible causes and treatment options for lower back pain
This article was written, reviewed and contributed to by some of Australia’s leading experts in the field of pain and lower back pain. We aim to empower you to better understand what’s causing your pain and alleviate any concerns or anxiety you may have.
Our goal is to enlighten you with new information if lower back pain is a chronic condition and something you’ve been dealing with for a period of time.
This page includes a practical and actionable plan, backed by the latest medical research to treat your lower back pain (including things you can do from home) and to help you get back feeling your best.
Read on as we guide you to understand the different types of lower back pain and discover what type you may have.
What is Lower Back Pain?
Lower back pain (lumbago) describes pain and stiffness around the lumbar spine (lower part of the spine). This term describes many lower back conditions, such as sciatica, muscle spasms and strains, sprains (ligament injuries) and disc injuries (e.g., bulging disc).
According to the Australian Institute of Health and Welfare, back conditions are the second most common disease in Australia.[1] These problems affect approximately 4 million Australians in any given year. Additionally, it is estimated that 70-90% of the population will suffer from lower back pain at any given time.
Despite being one of the most common health problems globally, lower back pain is also misunderstood. Many people who experience back pain often assume that their symptoms originate from spinal damage and abnormalities. However, research has suggested that the vast majority of cases are related to other issues, such as muscle spasms and sprains (ligament injuries).[2]
Pain is categorised as either acute, subacute or chronic back pain
Acute lower back pain: (0 days - 6 weeks)
Acute lower back pain is a type of pain that comes on quickly, usually due to an injury or fall. The pain is a normal response to the injury and usually subsides once it has calmed down. This can be in a matter of days, or sometimes several weeks, depending on the type of injury.
Subacute lower back pain: (6 weeks - 3 months)
Sub-acute lower back injuries occur when slightly more tissue damage is involved, like a muscle strain. People tend to move from acute to subacute pain if their injury doesn’t heal quickly, and they continue to aggravate it with too much exercise or painful movements.
Chronic lower back pain: (3 months +)
Chronic lower back pain is any pain that lasts over three months. Chronic pain is tricky, as it usually hasn't responded to initial treatments or rest successfully. This can sometimes result from severe injury, but in other cases can be a sign of some other underlying issues that are causing the prolonged pain (i.e., stress, anxiety or poor recovery).
What are the symptoms of lower back pain?
Pain in the lower back is the primary symptom resulting from several potential types of medical problems. Symptoms may vary from a dull ache to a shooting or stabbing sensation. Pain that comes on suddenly is "acute", while pain that lasts more than three months is considered "chronic".
Common complaints of pain in the lower back
People may experience
Pain areas: in the back, hip or leg, in the muscles and bones
Sensory: leg numbness or pins and needles
Also common: back joint dysfunction or muscle spasms
What causes lower back pain?
An injury to the muscles or tendons in the lower back can cause lower back pain, usually resulting in mild lower back pain. In more severe cases, causes can include arthritis, structural issues or even disc injuries.
Lower back pain is defined as “pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain.”[3]
Lower back pain can result from a problem in one or several parts of the lower back, including:
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Muscles (strain)
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Ligaments (sprain)
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Nerves
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Bone injuries - in the lower back, the bones are referred to as vertebrae
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Discs - the shock absorbers between each vertebra
Common reasons why people experience pain in the lower back
The list above is only a fraction of the reasons why people may experience lower back pain, and quite often it is a combination of factors. These factors may result in a more serious injury, some of which are listed below:
Common injuries that cause low back pain
Bulging disc
A bulging disc is a condition where the disc between the spinal bones is protruding and causing pain. Patients find any bending type of movement painful.
Herniated Disc
A herniated disc is more severe than a bulging disc. It occurs when the disc has broken and fluid from within the disc has leaked out. This will make bending movements even more painful than a bulging disc.
Sciatica
This is a common pain that starts in the lower back, with pain radiating down the “sciatic” nerve. Prolonged sitting particularly causes pain for patients with sciatica.
Degenerative Disc Disease
Degenerative disc disease is a long-term problem that occurs mainly in older age, where the discs of the spine are more brittle and are worn out.
Spinal Compression Fractures
These can happen more during an impact, like car accidents or falls, and they are more likely to occur in women and people over 50.
Spinal Stenosis
Spinal stenosis is a narrowing of the spinal canal that can lead to nerve-related pain. Patients find extension movements uncomfortable.
Spondylolysis
Spondylolysis is a small crack or stress fracture in one of the vertebrae (usually in the lower back). This is quite common in teenagers and adolescents participating in high-level sports, like gymnastics.
Spondylolisthesis
Spondylolisthesis occurs when a vertebrae slips out of place onto the vertebra below it, which causes severe lower back pain.
Common conditions that cause lower back pain
Several conditions may present with lower back pain. If you have any of these conditions, lower back pain could be one of the symptoms:
Sports that increase the risk of lower back pain
Previously listed are some of the more common causes of lower back pain, like heavy lifting or prolonged computer work. However, lower back pain may also occur when playing sports. Here is a list of the most common sports that result in lower back pain:
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Cricket
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Weightlifting
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Netball
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Gymnastics
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Tennis
Other risk factors include
Lower back pain can happen to anyone, even young people. However, there are certain factors that might increase your likelihood:
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Age - The chances of lower back pain increase as you age, with anyone 30+ much more likely.
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Lack of exercise - Motion is lotion; not using your back muscles can lead to weakness and, in turn, increased chances of pain.
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Poor lifting techniques - Putting extra stress on your back instead of using your legs to lift can lead to back pain.
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Obesity / overweight - Extra body weight increases the mechanical load on the back and increases chronic inflammation.
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Diseases - Rarer conditions like arthritis and even cancer can contribute to the chances of getting back pain.
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Psychological conditions - Even though it may not seem like a direct link, people prone to depression or anxiety appear to have an increased risk of lower back pain.
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Smoking - At this point, the evidence clearly shows that smoking is not great for anything, but it can also increase back pain. The cause may be increased coughing and pressure on the back and the toxic inflammation caused by the cigarettes.[1]
How is lower back pain diagnosed?
There are several options available when it comes to diagnosing the underlying cause of lower back pain. One of the most common, and one that is most recommended by Australian GP’s, is an assessment from a physiotherapist.
Lower back pain is extremely common and something that physiotherapists see regularly. The process of diagnosing it is straightforward.
Like any other pain or injury, a physiotherapist will start with a detailed history of your activities and previous injuries - this is an interview-like process that is usually referred to as a consultation. A typical session will last between 30-60 minutes, and in this time, you will discuss the specific issues you are having related to your lower back pain.
After establishing the history of your lower back pain, they will conduct a hands-on assessment, performing a series of physical tests to determine the cause of your problem and rule out other conditions.
Following your initial assessment, a treatment plan will be created that will be tailored to you, according to the severity of your injury. After this, your physiotherapist will establish how many sessions are required, what home exercises you need to do, and provide you with a timeline for how long a full recovery should take.
How is lower back pain treated?
Having lower back pain can be irritating and limit your function, and can worsen if left untreated. Therefore, it is essential to have your condition assessed by highly qualified experts such as a qualified physiotherapist to provide you with the appropriate treatment solutions.
There are several options when it comes to treating lower back pain. Australian GPs' most common treatment option is physiotherapy.
Lower back pain is an injury that physiotherapists come across regularly and again, the process of treating it is straightforward. Following the initial consultation, the physiotherapist will be in the best position to determine your treatment plan.
Depending on the severity of your lower back pain, a physiotherapist may provide you with a combination of the following types of treatments:
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Education and professional advice - Speaking to a physiotherapist is vital in gaining the correct information regarding lower back pain
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Manual therapy - Hand-on physiotherapy, used to help reduce pain and increase range of motion
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Therapeutic massage - Another hands-on-technique, primarily used to reduce muscle tension
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Soft tissue and joint mobilisation - Specific joint mobilisations are used to reduce stiffness in particular areas
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Therapeutic exercises - Specific exercises tailored to improve your lower back pain
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Core stabilisation exercises - Exercises targeted to improve your core strength
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Stretching - Stretching will help lengthen muscles and increase range of motion
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Dry needling - A technique used to help alleviate pain and reduce muscle tension
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Heat and electrotherapy - Used to reduce tension and pain in acute situations.
A typical physiotherapy session with a physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for your lower back pain to improve in just one session.
Next step: Creating a treatment plan made for you
Following your initial appointment, the physiotherapist will craft a tailored treatment plan that will highlight what course of action is required, including what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.
Self-care strategies
If you’re feeling pain in your lower back there are a number of things you can do from home.
Things to do:
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Take a break. Listen to your body and have a rest.
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Drink plenty of water; hydration is always good for recovery.
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Use hot packs for pain relief - they can be extremely useful
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Exercises
Things to avoid:
- If you’re experiencing pain while at work, playing sports, or even cleaning the house, don’t push through, there’s no benefit! This will only increase your pain and delay your recovery.
Do I need a specialist or surgery?
In rare cases, physiotherapy and other conservative management don’t always solve the problem.
It is best to talk to your physiotherapist if your condition persists to reevaluate your options.
In most cases, starting with an MRI and/or X-ray will be the most sensible suggestion; that way, the surgeon can better understand what they are dealing with.
Good surgeons will always consult with your physiotherapist to develop the best solution for you.
What is the recovery time / prognosis for lower back pain?
Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of the lower back pain.
In some cases, patients begin to feel the benefits of manual therapy in just one session. Typically, full recovery for mild back pain can take three weeks, while more severe cases can take six to eight months.
Important factors in your recovery post-treatment:
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Sticking to your rehabilitation program and regularly exercising
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Resuming your sports activity gradually
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Paying attention to pain and resting as necessary.
Other factors that may influence your recovery time:
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The severity of injury - Probably the most obvious factor. Minor muscle issues can come and go in several days, but if you've really hurt yourself, don't be too alarmed if it takes several weeks to settle down.
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Age - Unfortunately, the reality is that we do “bounce back” quicker when we are younger.
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General health - If your body is in good shape, then you’ve got the best chance of a quick recovery. A healthy body is a quick-to-heal body.
Can pain in the lower back be prevented?
Guaranteeing prevention can be impossible; however, you can decrease the risk of lower back pain through some of these techniques.
These tips can double as things to prevent lower back pain from occurring as well as helping reduce symptoms if you already have back pain.
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Exercise: Maintaining good flexibility and strength is essential in minimising the risk of lower back pain.
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Look after yourself: At the risk of repeating, overall health and wellbeing cannot be understated as a preventative strategy. Less weight and stronger muscles!
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Avoid obvious things that hurt your back: This one is a bit more individualised. If bending over a lower bench for hours really hurts you, then you should probably stop doing it. If back pain occurs with tasks you can't avoid, like computer work, then try and build in strategies to reduce that, like regular breaks or a sit to stand desk.
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Be resilient: Whilst avoiding obvious things that flare up your back is sensible, it is healthy to participate in activities you enjoy. Don't sideline yourself in fear of back pain. At the end of the day, you are robust, strong and can withstand plenty!
Outlook and the main takeaways
If there is one main takeaway from this article, it’s that there are many types, causes and severities of lower back pain, and the most important thing you can do is act on these pain signals (you’re getting them for a reason). Book a time, and have your lower back pain diagnosed by a physiotherapist today.
Anatomy of the lower back
The lower back generally comprises three main components. Firstly, there are five vertebral bodies, L1-L5.
Secondly, there are intervertebral discs between each vertebra, and finally, spinal nerves exiting the lumbar spine at each level.
The vertebral bodies of the lower back are larger than any other of the spine, as their main function is dealing with force and load on the body. The discs are also subsequently larger to allow for as much shock absorption as possible. The nerves that exit the lumbar spine all innervate the muscles and tissues of the pelvis and lower limbs.
The last vertebrae of the lower back is L5, and it sits upon the sacrum - which is connected to the tailbone. In some cases, the L5 and the top of the sacrum are fused, whilst in most cases, they are separated by a disc.
