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Pain in the lower back

Our spine is anatomically divided into three sections: Cervical spine, thoracic spine and lumbar spine. As the name suggests, the lumbar spine is located in the lumbar region and consists of 5 lumbar vertebrae and their joints. The intervertebral discs, which ensure the mobility of the spine, lie between the individual vertebral bodies. Intervertebral discs have a high water content and act like a buffer to cushion the pressure between the vertebral bodies. Low back pain is primarily about pain in the lumbar spine, although other areas of the spine are often involved in the pain.

Causes of low back pain

More than 90% of those affected by back pain suffer from so-called unspecific pain, i.e. pain for which no clear cause can be found. This may be due, among other things, to the fact that the lower back is heavily stressed by walking upright, but also by our modern lifestyle, in which a lot of time is spent sitting. Most of the pain in the lower back, for example in the lumbar vertebrae, is caused by shortened muscles and fasciae, for example in the large muscles of the hip flexor. Hip flexors (Iliopsoas muscles) are responsible for the mobility of the hip and therefore for walking movement. If the person sits a lot and otherwise does not move very much, these muscles get stiff. The consequences are poor blood circulation and then painful tension in the muscles. This is what we call unspecifc low back pain

How does pain develop and what can be done about it?

Treat pain

Triggers of low back pain

If you have low back pain, medical professionals often diagnose lumbar spine syndrome. Lumbar spine syndrome can have many causes and triggers. The most common triggers for low back pain include:

- Overload
- Lack of movement
- Excess weight

Physical causes of low back pain

In addition to the above-mentioned triggers for lumbar spine pain, the following diseases can be added as a long-term consequence or primary cause of low back pain:

- Lumbago
- Sacroiliac joint blockage (blockage in the sacroiliac joint)
- Disc herniation (prolapse) or bulging (protrusion)
- Fibromyalgia (pain syndrome)
- Rheumatic diseases (e.g. Bechterew’s disease)
- Inflammation of the vertebrae (spondylitis), also in combination with inflammation of the intervertebral disc (spondylodiscitis)
- Vertebral body fractures (e.g. due to osteoporosis)
- Formation of gaps between vertebrae (spondylolysis) up to sliding vertebrae (spondylolisthesis)
- Joint wear (osteoarthritis of the lumbar spine or spondyloarthropathy)
- Facet syndrome
- Narrowing of the spinal canal (spinal canal stenosis)
- Misalignments of the spine (e.g. scoliosis)

Psychological triggers and intensifiers for low back pain

Psychological factors can also trigger or intensify low back pain. Constant stress, excessive demands, sleep problems, anxiety disorders and depression are often responsible for poor posture and the associated strong muscle tension. The perception of pain can also be more intense in certain situations in which people are psychologically challenged. This creates an interplay in which psychological factors and pain reinforce each other. In the case of unspecific back pain that cannot be improved by conventional therapies, the possibility of psychosomatic diseases (complaints that are triggered, intensified or sustained by psychological factors) should also be taken into account.

Symptoms of low back pain

Symptoms of low back pain can be limited to the lumbar spine area or extended to the pelvis, abdomen, and legs. In addition to the lumbar spine pain, sensory disturbances can occur in the further course. Decreased flexibility of the lumbar spine can often be seen before the pain in the lower back appears.

- Pulling, pressing, or stabbing pain in the lower back
- Pain that radiates to the hips, pelvis, buttocks and legs
- Increased pain in the lumbar spine when sneezing or coughing
- Sensory disturbances (tingling and stinging, numbness, paralysis in the leg)
- Pain during heavy exertion or sporting activities
- Feeling of permanent tension in the back muscles (even when lying on your back)
- Feeling of constant blockage in the lower lumbar vertebrae area (sacroiliac joint)
- Limited mobility (leaning forward is painful, the back can no longer be rounded)

Painful areas in the lower back

Low back pain can appear in different areas, centrally, to the right, or to the left. Mostly it indicates muscle tension in this region, but in a few cases can also arise from one-sided or centrally positioned blockages, nerve irritation, inflammation, organic diseases or other problems in the lumbar spine.

Causes of lateral pain in the lower back

As we previously said, more than 90% of low back pain cases are unspecific, there’s no a clear cause. However, in this section we analyze some rare possible factors which can cause low back pain:

- One-sided muscle tension due to one-sided strain
- Lateral herniated disc (possibly radiating to the right or left leg)
- Lateral joint wear
- Nerve root or nerve irritation on the right or left
- Unilateral joint blockage (e.g. of the sacroiliac joint)
- Impaired sciatic nerve (possibly radiating to the right or left leg)
- Inflammation of the renal pelvis (often accompanied by fever, painful urination and unilateral flank pain)
- Kidney stones/renal colic

Renal pelvic inflammation and renal colic can affect both the right and left kidneys. In case of suspicion, please have a doctor determine the causes of the pain in the lower right or left back.

Causes of central low back pain

In most cases, unspecific low back pain is due to muscle tension.

If low back pain occurs during pregnancy, it is usually a result of the natural release of the hormone progesterone. This hormone prepares the body for childbirth by loosening ligaments and tendons. As a result of this loosening and because the weight on the lumbar spine increases over the course of pregnancy, pregnant women often develop low back pain.

Causes of low back pain radiating to one leg

Low back pain can radiate to one leg with the following triggers and causes:

- Disc herniation or bulging
- Lumbago/lumbar sciatica)
- Radiculopathy/radiculitis (irritation or damage to nerve roots)

Low back pain which occurs both on the right and left and radiates to the buttocks, hips, or one leg, can be triggered by a herniated disc (prolapse). This arises when the intervertebral disc is no longer adequately supplied with nutrients due to prolonged incorrect loading or too little movement and becomes brittle or injured by a sudden severe overload. In the case of a prolapse, the shell of the gelatinous nucleus breaks, it slips out of its original position and can press on the surrounding nerves.

A so-called lumbago can also cause pain in the lower right or left of the back with radiation to the buttocks, hips or legs. This is due to irritation, entrapment, or inflammation of the sciatic nerve.

Radiculopathy/radiculitis can cause acute or chronic pain, sensory disturbances and paralysis in the lower back due to irritation or damage to nerve roots. Radiculopathy can develop when the lumbar spine shows degenerative changes in the bones, herniated discs, and signs of infections or autoimmune diseases.

You should also keep this in mind for low back pain

Low back pain when coughing

Coughing not only stresses the front chest muscles. When you cough, the broad back muscle contracts at the same time, which is why it is also called the cough muscle. A persistent cough leads to overuse of these cough muscles, which can lead to sore muscles and painful tension in the lower back.

Caution: If you have lower or upper back pain accompanied by fever, fatigue, and a protracted cough, you should definitely seek medical advice. It could be a case of pneumonia! By the way: In the case of atypical pneumonia, these symptoms are sometimes less pronounced. Please always have a long-lasting cough clarified by a doctor.

Low back pain when breathing in

Low back pain when breathing in can originate from muscle stiffness. People who usually breathe too superficially, can experience tension in the thoracic vertebrae and diaphragm, which can also affect the lower back. Especially when the diaphragm is very tense and not very mobile, shortness of breath can occur.

Low back pain when breathing in can also be the side effect of a flu-like infection. Please consult medical professionals if symptoms persist. In that case it could be related to pneumonia, lung disease or pleurisy.

After a fall that bruises or breaks ribs, difficulty breathing can occur along with lower or upper back pain. This diagnosis can be confirmed by an X-ray.

Low back pain when lying down

Back pain in the supine or lateral position can arise if low back pain muscles aren’t relaxed when lying down. If you have low back pain while lying on the bed, our best advice for you is to lie on your preferred side, with your legs flexed and a pillow between them.

Treatment of low back pain

Acute, subacute and chronic pain not only restricts general well-being, It also instinctively makes us adopt a protective posture, which in turn increases muscle tension and therefore causes even greater pain in the lower back. In order to escape this vicious cycle of pain and to reduce consequential damage such as signs of wear or nerve damage to the spine, you should have severe pain in the lumbar spine, sensory disturbances such as tingling and numbness in the legs and restricted mobility clarified by a doctor and be treated accordingly. You can relieve tension-related low back pain yourself with household remedies, exercise and other measures.

Heat therapy for lower back pain

The first choice to relieve tension-related pain in the lower back is heat therapy. In addition to classic home remedies such as hot water bottles, heating pads, saunas, hot baths or infrared light, ThermaCare® HeatWraps are particularly suitable, as these can be attached directly to the lumbar region with a Velcro fastener and therefore provide constant heat deep into the painful muscle for 8 hours at a temperature of approx 40 °C. ThermaCare® for back pain can be worn discreetly under clothing and can therefore also be used at work, on the go and while doing sports.

The effect of heat therapy with a continuous, moderate supply of heat in the treatment of acute, unspecific lower back pain has been clinically proven*

More tips on how to relieve tension-induced low back pain naturally with heat can be found here.

Heat therapy for back pain

Massages to relieve low back pain

If muscle tension and tightness are the cause of low back pain, massage can also have a soothing effect. During a massage, pulling and pushing stimuli are given to the muscles, which can help to loosen hardening and promote blood circulation. This can have a particularly relaxing effect in the lumbar spine area. The intensity of the massage should be based on the needs of the patient. Massage can be well combined with heat therapy.

Physiotherapy to relieve lower back pain

Physiotherapy such as manual therapy, chiropractic or osteopathy can help to loosen blockages in the spine and to loosen and stretch the muscles. Before you start physiotherapy, you should have a doctor clarify which treatment is appropriate to your case.

Pharmacological therapy for low back pain

Non-steroidal pain relievers and anti-inflammatory medication such as Ibuprofen and Diclofenac or analgesics such as Paracetamol can provide quick relief from lower back pain. Muscle relaxants can also be used for very severe pain in the lumbar region. However, since these drugs can have severe side effects (and in the case of some muscle relaxants, even addictive potential), they should only be used for a short time and under medical supervision. When taking analgesics, it should always be remembered that tension-related pain in the lower back is a warning signal that painkillers can hide, but not cure. In order to alleviate or prevent pain in the lower back in the long term, you should also take other measures such as regular back-friendly exercise and avoidance of poor posture and strain.

Exercise to relieve low back pain

Exercises from back school, physiotherapy, sensorimotor therapy, yoga, stretching and relaxation exercises, fascia training … there are numerous methods with which you can loosen and strengthen your lower back. Exercise is one of the best methods to treat low back pain. Muscle shortening and tension around the lumbar spine caused by a sedentary lifestyle can be relieved by stretching. In order to provide better blood flow and increase articular mobility. Also sporting activities that correspond to your fitness level are recommended.

Stepped position to relieve lower back pain

As a relaxing and pain relieving measure for low back pain, the stepped position is recommended. To do this, those affected should lie flat on their backs on the floor and place their legs at right angles on a stool, chair or sofa. Relaxation in the lower back muscles can be felt after just a few minutes.

Electrotherapy to treat low back pain

To treat low back pain, so-called TENS devices can be prescribed by a doctor. TENS stands for Transcutaneous Electrical Nerve Stimulation. This device attached to the lower back ensures low-threshold electrical stimulation treatment in the affected areas, which should help to inhibit the transmission of pain. TENS devices are suitable for self-treatment, which is particularly advantageous for pain in the lower back, as it is difficult to massage yourself in this area.

Ultrasound to relieve low back pain

With ultrasound therapy, high-frequency vibrations massage the painful areas in the lower back. Heat is generated in the tissue, blood circulation and metabolism are stimulated. The muscles can relax. This can help to relieve low back pain.

Acupuncture and acupressure for low back pain

If needles are set or pressure is applied to certain trigger points, tension in the back muscles can be released (according to the theory behind acupuncture and acupressure). Points outside the lower back that are reflexively related to the lumbar spine can also be treated. In acupuncture, for example, needles in the ear are used to treat low back pain. Traditional Chinese Medicine (TCM), to which acupuncture belongs, offers further treatment options (e.g. using herbs, diet or exercise) for low back pain.

Cold therapy for low back pain

If the lower back pain is not primarily due to tension, but rather is triggered by acute inflammatory reactions, cold applications such as cold compresses, cool packs, cooling gel compresses or pain gels may be appropriate. In the event of inflammation and injuries in the lower back, please clarify the treatment options with a doctor in advance.

Exercise caution for low back pain

Caution: In the case of nerve stretching pain, urinary or faecal incontinence, symptoms of paralysis or numbness in the legs as well as injuries to the spine, vertebral bodies or the spinal cord, medical treatment is essential!

Medical professionals may use imaging techniques such as x-rays, magnetic resonance imaging (MRI), computed tomography (CT), or neurological tests to determine the conductivity of nerves to determine the cause of pain in the lumbar spine. Possible nerve damage must be treated quickly.

FREQUENTLY ASKED QUESTIONS

What can be done about pain in the lower back area?

There are a number of measures that can be used to alleviate pain in the lumbar region. For tension-related pain in the lower back, heat therapy, exercise, massage, physiotherapy, analgesics, ultrasound and acupuncture can help. Cold therapy may also be indicated for lower back pain that is due to acute inflammation or injury. Please have a doctor determine the cause of the pain in the lumbar spine before starting therapy.

What helps to relieve pain in the lower back?

Rapid relief from pain caused by muscle tension in the lumbar vertebrae is provided by heat applications such as ThermaCare® HeatWraps, sauna or red light, stretching exercises for shortened muscles, certain massage techniques as well as ultrasound and analgesics. In severe cases, you can also resort to prescription muscle relaxants for pain in the lower back after consulting a doctor.

Where does back pain in the lumbar region come from?

More than 90% of those affected by back pain suffer from so-called aspecific pain, i.e. pain for which no clear cause can be found. The most common cause is the lack of movement.
Other causes of lumbar vertebrae pain include:
- Lumbago
- Disc prolapse
- Fibromyalgia
- Rheumatic diseases
- Inflammation
- Vertebral fractures
- Formation of gaps between vertebrae
- Joint wear
- Narrowing of the spinal canal