My lower back hurts. Why?

Lower back pain and you

Has this ever been you? You are not alone.

At any one time, up to 540 million people around the world are experiencing lower back pain. Because of its prevalence, lower back pain has been researched extensively and our understanding of this complex area has evolved.

In part one of this series we will try to explain what may be the cause of the pain in your lower back.

What can cause the pain?

In the vast majority of cases there will be no identifiable cause for the pain in your lower back on an X-ray, CT scan or MRI. And most times, your GP or physiotherapist will not be able to provide a specific area causing your pain.

Possible sources of pain include the vertebral disc, facet joints, spinal and gluteal muscles and pelvis.   These areas can result in local pain in the lower back; referred pain into the buttocks or gluteals; or pain into the legs.

Do I have sciatica?

Leg pain does not immediately suggest the presence of a prolapsed disc or sciatica.  Clinical testing and identifying what aggravates the pain is necessary to correctly determine the presence of a significant lumbar spine disc prolapse.  Research suggests that a significant prolapsed disc only occurs in 1-3% of the population.

Leg pain can sometimes be associated with neurological deficits such as pins and needles; numbness; muscle weakness; and bowel and bladder disturbance.  These neurological symptoms are significant and if you are experiencing any of these you should see your GP or physiotherapist immediately.

The most common cause of neurological symptoms and leg pain is the presence of a significant disc prolapse and localised inflammation.  Fortunately, symptom improvement is usual with only 10% of people still having significant pain 6 weeks after the symptoms begin.

So why do I have pain?

Recent developments in the understanding of pain suggest that pain can exist to protect us.  Recurrent pain may occur because the brain has become more sensitive and over-protective.

Pain is there as a warning system.  Not to stop us doing activities but more to tell us if that activity is aggravating.

In conclusion, what we have understood to cause pain in our lumbar spine is now proving to be inaccurate.  Pain in the lower back is very rarely caused by any damage and is more there to warn us of a aggravating movement.

In the next part of the series we will discuss what activites can cause lower back pain.