Michael S. Vrana, M.D.
Orthopedic Surgeon
Where does the pain travel?
the pattern points to the sourceThe lower back is five stacked vertebrae, cushioned by a disc between each pair and joined at the back by two small facet joints, with the spinal nerves passing down through them to the legs. Most low back pain is mechanical, from the muscles, discs, and facet joints, and settles within a few weeks. Where the pain travels tells you more than how much it hurts.
Stays in the back or buttock
The muscles, discs, or facet joints. This mechanical pain is the most common pattern, and usually eases with time.
Travels down the leg
A nerve root pinched in the lower spine, often by a disc herniation. This leg pain, sometimes with numbness or tingling, is what most people call sciatica.
Comes on with standing and walking
If it eases when you sit or lean forward, the pattern suggests a narrowed spinal canal crowding the nerves to the legs.
A few signs call for prompt attention rather than waiting: weakness in a leg, loss of bladder or bowel control, or back pain with fever, chills, or unexplained weight loss.
What causes low back pain?
common causesMuscle or ligament strain
Support muscles and ligaments overstretched or overworked, often by lifting or twisting. The most common source, and it usually settles.
Herniated disc
The soft center pushes through the disc's tough outer ring onto a nerve root, sending pain down the leg.
Degenerative disc and facet changes
The discs lose height and facet joints develop arthritis with age, which can ache and stiffen the back.
Spinal stenosis
Bone spurs and thickened ligaments narrow the canal, tiring or cramping the legs with standing and walking.
Spondylolisthesis
One vertebra slips forward on the one below, aching with activity and, in larger slips, pinching a nerve root.
Compression fracture
A vertebra weakened by osteoporosis collapses under minor stress, causing sudden back pain, mostly in older adults.
How is low back pain diagnosed and treated?
exam first, surgery rarelyEvaluation begins with an examination, including a check of leg strength, sensation, and reflexes. Imaging is not routine early, since scans often show harmless age-related changes; an MRI is used when pain persists, a nerve is involved, or the warning signs above are present. Nearly all low back pain improves without surgery, through staying active, physical therapy, and anti-inflammatory medication. OSI provides this nonsurgical care and refers to a pain specialist or spine surgeon when needed. The practice treats neck pain along the same lines.
