Many people think that “low back pain” is a diagnosis. In reality, low back pain is a symptom. A symptom is something a person feels, while a diagnosis identifies the underlying cause of that symptom. The important question is not simply “Why does my back hurt?” but rather “What diagnosis is causing my low back pain?”

Successful treatment depends on making the correct diagnosis and then treating that diagnosis appropriately. Different conditions can produce similar symptoms, but they may require very different treatments. Some causes of low back pain are relatively minor and improve with conservative care. Others can significantly affect quality of life. A few may even be life-threatening and require immediate medical attention.

Understanding the many possible causes of low back pain helps explain why a careful evaluation by a qualified spine specialist is so important.

The human musculoskeletal system is comprised of muscles, fascia, tendons, ligaments, cartilage, bones, and joints. This system is the source for most causes of low back pain. 

Muscles

The most common cause of low back pain involves the muscles that support the spine. Muscle strains can occur from lifting, twisting, sports activities, falls, prolonged sitting, poor posture, or overuse.

When muscle fibers are stretched beyond their normal limits, microscopic tears develop. This leads to inflammation, stiffness, tenderness, and pain. Muscle related pain is often worse with movement and may improve with rest.

Fascia

Fascia is a thin but strong layer of connective tissue that surrounds muscles and other structures throughout the body. The thoracolumbar fascia in the lower back plays an important role in spinal stability and movement.

Fascial irritation or injury can produce significant pain and tightness. Because fascia contains many nerve endings, even small injuries can create noticeable discomfort.

Tendons

Tendons connect muscles to bones. Repetitive movements, overuse, and injuries can lead to tendon inflammation or degeneration. Tendon related pain often develops gradually and becomes worse with certain activities.

Ligaments

Ligaments connect bones to other bones and help stabilize joints. Excessive bending, twisting, falls, or lifting injuries can stretch or tear spinal ligaments.

Ligament injuries may cause pain, instability, muscle spasms, and difficulty performing normal activities.

Facet Joints

Facet joints are small joints located on the back side of the spine. They guide movement and provide stability between vertebrae.

Like other joints in the body, facet joints can develop arthritis and cartilage wear over time. Inflamed facet joints commonly cause localized low back pain that is often worse with standing, walking, twisting, or arching backward.

Sacroiliac Joints

The sacroiliac joints connect the spine to the pelvis. These joints transfer forces between the upper body and the legs.

Sacroiliac joint dysfunction can develop from trauma, arthritis, pregnancy, altered walking patterns, or degeneration. Pain may occur in the low back, buttocks, groin, or upper legs and can sometimes mimic sciatica.

Vertebral Compression Fractures

The vertebrae are the bones that make up the spinal column. In people with osteoporosis, even minor injuries can cause compression fractures.

These fractures often produce sudden severe back pain. The pain typically worsens with sitting and bending the spine and improves when lying down. Early diagnosis is important because untreated fractures can lead to spinal deformity and chronic pain.

Disc Related Pain

Among all causes of chronic low back pain, disc related pain deserves special attention because it is extremely common.

The spinal discs function as shock absorbers between adjacent vertebrae. Each disc contains two main parts:

• The nucleus pulposus, a soft gel like center. 
• The annulus fibrosus, a tough outer ring made of multiple layers of strong fibers. 

Healthy discs distribute forces during standing, walking, bending, and lifting. Unfortunately, aging, repetitive stress, injuries, and genetics can cause tears or fissures to develop within the annulus fibrosus.

These annular fissures are often the true source of discogenic low back pain.

Unlike muscles, skin, and many other tissues, spinal discs have a very limited blood supply. The outer portion of the disc receives only minimal nutrients, while the inner portions receive almost none. Because healing depends on blood flow, disc fissures generally cannot heal spontaneously.

As a result, painful annular fissures may persist for years. Continued stress on the damaged disc often leads to progressive degeneration, loss of disc height, bulging, protrusions, herniations, and chronic pain. Historically, there was no direct way to repair these fissures. Treatments focused on managing pain symptoms through medications, physical therapy, injections, activity modification, or surgery.

This explains why degenerative disc disease frequently worsens over time. The underlying annular injury remains present while the disc continues to deteriorate.

Many people are unaware that Discseel was developed specifically to address painful annular fissures. Discseel is a minimally invasive, nonsurgical injection procedure that uses fibrin, an FDA approved biologic, to seal disc fissures and stimulate healing. The procedure is performed using fluoroscopic imaging to precisely target damaged discs.

For patients searching for a nonsurgical alternative to living with chronic disc related low back pain, learning more about Discseel may be worthwhile.

Spinal Stenosis

Spinal stenosis occurs when the openings surrounding nerves become narrowed. This narrowing may result from arthritis, ligament thickening, disc bulges, or bone spurs.

Patients often experience back pain, leg pain, numbness, tingling, or weakness. Symptoms frequently worsen with standing and walking.

Nerve Compression

Nerves exiting the spine can become compressed by herniated discs, bone spurs, cysts, or spinal narrowing.

Compressed nerves may cause pain that travels into the buttocks, legs, or feet. Numbness, tingling, burning sensations, and weakness may also occur.

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward relative to another. This condition can create instability, nerve compression, and chronic low back pain.

Beyond the musculoskeletal system, there are other important diagnoses to consider for the cause of low back pain symptoms.

Kidney Conditions

Not all low back pain originates from the spine.

Kidney stones commonly cause severe flank and low back pain. Kidney infections may also produce back pain along with fever, chills, and urinary symptoms.

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm occurs when a portion of the body’s largest artery becomes enlarged.

Although uncommon, this condition can cause back pain and may become life threatening if rupture occurs. Sudden severe back or abdominal pain requires immediate medical evaluation.

Tumors and Cancer

Both benign and malignant tumors can cause low back pain. Cancer that spreads to the spine may produce persistent pain that often worsens at night and may not improve with rest.

Infections

Spinal infections involving discs, bones, or surrounding tissues are uncommon but serious. Symptoms may include severe pain, fever, chills, weakness, and unexplained fatigue.

Inflammatory Conditions

Diseases such as ankylosing spondylitis and other inflammatory arthritic disorders can cause chronic back pain and stiffness. These conditions often require specialized medical treatment.

Solving the Mystery of Low Back Pain

Low back pain has several possible causes. The source may involve muscles, fascia, tendons, ligaments, joints, vertebral bones, discs, nerves, internal organs, infections, tumors, or vascular conditions.

Some diagnoses primarily affect comfort and quality of life. Others can lead to disability if left untreated. A small number are potentially life threatening and may represent medical emergencies that require immediate attention.

The key to successful treatment is identifying the correct diagnosis rather than simply treating the symptom of pain in the low back. A thorough evaluation by a properly trained spine specialist can help determine the true source of pain and guide the most appropriate treatment plan.

If you are struggling with the symptom of low back pain, contact Regenerative Spine & Joint Center today at (614) 389-3089 to schedule a consultation and begin the process of finding the cause of your pain and the most appropriate treatment options.