What is lower back pain?
Low back pain is a common but painful condition that affects the lumbar region of the spine (the lower part of the back). Most people experience some form of lower back pain at some point in their lives, however it tends to be more common in the older population.[1]
The spine is a complex structure, made up of many bones, ligaments, joints, cartilage, and nerves. However, due to this complexity and the role in the body, the lower back is susceptible to pain and injury.[2]
Lower back pain can be caused by a sprain or strain. Common causes include poor posture, sitting for long periods, lack of exercise, herniated disc, and disc degeneration. In most cases, low back pain can resolve on its own, or with physiotherapy and pain relief. However, low back pain can sometimes indicate a serious underlying medical condition and surgery may be required.
Symptoms of low back pain range from a dull ache to a burning or shooting pain. Low back pain may make it difficult to stand and it can become painful to sit.
What are the symptoms of lower back pain?
The symptoms of low back pain vary, but some common symptoms include:
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Pain in the back and surrounding areas (such as dull, aching, shooting, tingling, burning pain)
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Radiating sensation to the thigh, legs, or feet
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Difficulty walking or moving
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Pain when sitting, or when moving from sitting to standing
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Struggling with everyday tasks, such as getting dressing
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Muscle spasms
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Sharp pain in the lower back
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Lower back tightness
The causes of lower back pain in sitting
There are many different causes of low back pain. Low back pain that develops suddenly, such as from a muscle strain or injury, is called acute pain. Pain that develops over a period of time is called chronic pain, and includes osteoarthritis and stenosis. A large proportion of individuals can move from acute to chronic low back pain.[3] Prolonged sitting can increase the stress on the affected structures in the spine, which may worsen the pain and symptoms.
Some of the causes of low back pain include:
1. Muscle strain
A muscle strain occurs when a muscle in the lumbar region is overstretched or overloaded. This can occur during heavy lifting, twisting, or vigorous exercise.
Symptoms can include pain in the lumbar region, shooting pain, stiffness, muscle tension, and difficulty moving from sitting to standing. Contributing factors to a muscle strain include low physical fitness, sitting all day, a sedentary lifestyle, and poor lifting techniques. Most muscle strains recover within a month, however it can become an ongoing issue if the original trigger is not addressed.
2. Sciatica
Sciatica is a term that describes pain originating from the sciatic nerve, which runs from the spine down the back of the leg to the foot. Sciatica can develop gradually, and is often worsened by sitting for prolonged periods of time.
The symptoms often include a sharp, shooting pain in the leg, which can radiate to the thigh, lower leg, and even the foot. The pain is sometimes described as an ‘electric shock’. There are occasionally sensory and motor changes that coincide with the pain. It usually only occurs on one side of the body, however this may not always be the case.
3. Herniated disc
A herniated disc occurs when fibrocartilaginous tissue extrudes from a spinal joint and compresses the nerves travelling in that area. This constricts the nerve, causing pain that can radiate down the leg. In more severe cases, it can also cause numbness and/or weakness.
The risk factors of a herniated disc include heavy lifting, especially in a bent or twisted position, ageing, trauma or injury, or repetitive movements or sports. A herniation may occur suddenly, but also may develop gradually over time.
In some cases, there may be no symptoms of pain. However, in symptomatic cases, disc herniation can cause severe, sharp, shooting pain that can make it painful to sit or difficult to walk. In some severe cases, a herniated disc may require surgery.
4. Degenerative joint disease
Degenerative joint disease, also known as osteoarthritis, is a progressive condition that occurs with age or injury. It occurs when the cartilage and discs in the lumbar spine stiffen and degrade over time. These vertebral joints and discs are important for absorbing load and allowing movement.
A significant number of people with degenerative joint disease may not have any symptoms at all. However, for those with symptoms, the pain can be severe. These vertebral joints and discs are important for absorbing load and allowing movement. Therefore, people with degenerative joint disease may experience stiffness, reduced range of motion, and pain when sitting, bending, or moving.
5. Spinal stenosis
In the spine, there are many different passageways in the vertebral bones through which important nerves travel. ‘Stenosis’ means abnormal narrowing, therefore spinal stenosis refers to narrowing of the passageways in the spinal column.
When these passages become narrower, it reduces the space for these nerves to travel. Eventually, the nerves may become compressed, causing pain, weakness, and numbness or tingling.
Spinal stenosis can occur over time with age, from an injury or arthritis, or in rare cases due to a tumour or infection. As it affects the nerves in the lower back, symptoms can worsen with sitting or bending.
6. Poor posture
Poor posture, while sitting, working, or exercising, can increase the risk of developing low back pain. Sitting or moving with the spine in an unsupported position can put undue stress on the muscles, ligaments, and joints in the back.
This includes work tasks, such as lifting items or sitting at a computer. Carrying a heavy backpack or handbag and loading one side of the body more than the other can trigger low back pain. Moreover, being inactive all week then doing large amounts of activity on the weekend can also overload the spine and cause pain.
Other causes of lower back pain
When to see a doctor
Some causes of lower back pain may require immediate medical attention. This may be required for some symptoms, including:
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Severe, persistent, unrelenting pain
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Loss of bladder or bowel control
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Tingling, weakness, or numbness in the legs
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Loss of strength
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Significant pain with coughing or sneezing
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Unexplained weight loss
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Loss of consciousness
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Other unexplained symptoms.
These signs and symptoms can indicate a serious underlying issue that may require urgent surgical input.
How is lower back pain diagnosed?
A health practitioner, such as a doctor or physiotherapist, can take a detailed history and perform a physical examination to determine the cause of the low back pain. They will also check reflexes, sensation, and strength to determine if any of the nerves are affected.
It is not always necessary, but in some instances your doctor may request imaging, such as an X-ray or MRI, or blood tests to further assess the cause of the pain.
As there are many different causes of low back pain, it is important to get the correct diagnosis before a treatment plan is introduced.
Treatment for pain in the lower back when sitting
Postural correction
Correcting poor posture can significantly reduce symptoms of low back pain. Some key postural changes include adding support for the lower back, ensuring the shoulders are not hunched, and resting the feet firmly on the floor when sitting.
It is also helpful to consider posture when lifting items, exercising, and carrying items. This may involve evenly distributing weight through both feet or using a machine rather than manually lifting items.
Medical treatments
There are several treatment options that a doctor may recommend, including:
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Oral pain relief, such as opioid medications
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Steroid injections or nerve blocking injections for pain relief
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Acupuncture or dry needling
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Laser therapy acupuncture and laser therapy
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Medications such as antidepressants
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Other analgesics.
In some situations, a doctor may recommend a review with a neurosurgeon. This is usually in situations where there is severe and persistent pain, there is an underlying medical condition, or when conversative treatment has not been successful.
Physiotherapy
A physiotherapist can help alleviate symptoms and restore movement through various treatment methods. This may involve:
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Exercise - A physiotherapist may prescribe exercise to improve the strength of the back and surrounding muscles.
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Stretches - A stretching regime may be incorporated to improve the mobility and function of the muscles in the target area.
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Massage - Specific massage techniques can be used to relieve tight muscles.
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Cold or heat therapy - Ice or heat packs may be used for short-term pain relief.
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Other passive modalities, such as taping.
Self-care
Self-care and lifestyle strategies can help alleviate symptoms of low back pain when sitting. This may include:
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An ergonomic desk and chair set-up for working
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Avoiding prolonged periods of sitting
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Frequently changing positions, such as from sitting to standing
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Going for short walks throughout the day
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Using a chair roll or lumbar pillow to support the lumbar spine when sitting
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Mindfulness or relaxation
Things to consider about lower back pain
Low back pain is a common issue. There are many causes of low back pain, and they can cause sitting to become painful. There are steps to take to reduce the risk of developing low back pain, including correcting poor posture, strengthening the body, and setting up an ergonomic workspace. It is important to consult a doctor if you have unexplained or unusual symptoms.
