Lumbar Spine Pain: Lower Back Pain, Lumbar Spine Pain (Lumbar Spine Pain, Lumbar Spine Syndrome), Its Symptoms and Treatments

Back pain in the lower lumbar spine is very common. Approximately 80 percent of the population experiences it once or several times in their lifetime.

This back pain is often caused by a herniated disc. Other degenerative conditions of the lumbar spine can also cause pain in the LWS. These include, for example, degeneration of the small vertebral joints (known as facet joint osteoarthritis).

The lumbar spine is the lower part of the spine © Peter Hermes Furian / Fotolia

Far more commonly, however, muscular imbalance—that is, uneven muscle strength—leads to pain in the lower lumbar spine. An example of this is weak abdominal muscles combined with normally strong back muscles. The pain is usually preceded by 1 to 2 days of unusual lifting or carrying (e.g., unfamiliar gardening tasks, etc.).

Unfortunately, muscle tension cannot be seen on either an X-ray or an MRI. As a result, doctors often mistakenly focus their search for the cause on the intervertebral discs and the small vertebral joints. Functional muscular imbalances are frequently overlooked as a cause of pain.

Pain in the lower lumbar spine often manifests as an unstable “feeling of giving way.” Movement-related stabbing pains also occur. In some cases, the pain radiates to the flank. Some patients are no longer able to quickly move from a bent-over position to an upright posture.

Many people suffer from lower lumbar back pain at some point in their lives © artstudio_pro / Fotolia

Patients with symptoms in the lumbar spine often adopt a compensatory posture to alleviate the pain. As a result, they stand in a slanted or misaligned posture.

Over time, this compensatory posture leads to further symptoms. Therefore, an important treatment goal for the patient is to correct this compensatory posture.

Pain in the lumbar spine can lead to various symptoms depending on the cause. The specific pain patterns provide insight into the possible clinical picture:

• Pain when bending forward: Mainly associated with a herniated disc, inflammation or irritation of the sacroiliac joint, or facet joint syndrome
• Pain when leaning back: The sacroiliac joint or nerve compression may be responsible (foraminal stenosis)
• Pain when sitting: Common in cases of a herniated disc, facet joint syndrome, and vertebral joint blockages, or in cases of disc degeneration (osteochondrosis)
• Relief when lying down: In cases of spinal canal stenosis, herniated discs, and spondylolisthesis. Other lumbar spine conditions can cause pain even at rest.
• Weakness: Especially in cases of spinal canal stenosis

Conventional X-ray imaging is often performed during the acute phase. In these cases, doctors often document only the misalignment of the lumbar spine. If pain radiates into the legs, an MRI (magnetic resonance imaging) is frequently used as an additional diagnostic tool. This allows for the detection or exclusion of severe herniated discs.

Far more helpful than X-ray imaging is

• a thorough medical history (patient interview and medical history) as well as
• a detailed clinical examination, including testing of shortened muscle groups (e.g., abdominal, gluteal, or hip flexor muscles).

Almost all patients report unusual muscular strain shortly before the onset of pain. The diagnosis is then often acute lumbago (= acute lower back pain, also known as “lumbago”) due to muscular imbalance.

As a first-line measure for lower back pain, a stepped-bed position is often used. To do this, the patient lies on their back and bends their legs at the hips and knees to a 90° angle. A foam cube, a beverage crate covered with a blanket, or a chair can be helpful for this.

This elevated lying position relieves pressure on

• intervertebral discs,
• small facet joints, and
• the often-shortened abdominal muscles.

A hot water bottle placed on the abdomen and gluteal muscles can also be helpful.

As treatment progresses, intensive heat therapy for the muscle groups surrounding the hips is also recommended, e.g., through a hot shower.

Physical therapy measures, including massage and fango, are also beneficial for the affected, overworked muscle groups. This stretches and relaxes the muscles, and if successful, helps them return to a state with minimal pain.

Conventional pain relievers are rarely effective for muscle-related back pain. Muscle relaxants often have a better effect in this case.

If a herniated disc or facet joint syndrome is the cause of the pain, this underlying condition should be treated. Correcting muscle imbalances then serves only as a complementary measure.

The duration of treatment, including physical therapy, depends on the patient’s overall condition and the severity of the pain. A general guideline is approximately 3 to 6 weeks. If there is no significant improvement after that, the diagnosis should be reviewed and further tests conducted.

In the case of a herniated disc, surgery can provide relief. A neurosurgeon will weigh the benefits and risks with the patient. For facet joint syndrome, injections have proven to be an effective treatment. The video demonstrates the exact procedure for facet joint infiltration as a pain management therapy:

Pain in the lower lumbar spine can recur repeatedly.

Preventive measures include

• regular stretching of the muscle groups prone to shortening (i.e., gluteal, abdominal, and hip flexor muscles) as well as
• strengthening the muscles that stabilize the trunk (e.g., back extensors).

Often, one-sided exercise routines tend to exacerbate rather than correct muscular imbalances. It is therefore advisable to perform these exercises under the guidance of a physical therapist.

Improved joint mobility also has a positive effect on lower back pain. Walking and cycling are gentle forms of exercise that are recommended for back pain. 

Excessive rest and breaks from exercise are only useful as an initial measure against pain. Exercise should be reintroduced into your daily routine as soon as possible to prevent muscle atrophy. Start slowly with a light workload; consistency and a gradual increase in intensity are key. 

Being overweight puts strain on the back and its structures. Lose any excess weight to relieve pressure on the spine. A balanced diet and more exercise, following the principle of “burning more calories than you consume,” will help you achieve this goal. A nutritionist can provide you with personalized advice. 

Before exercising, you should stretch and loosen up your muscles sufficiently © Nastassia Yakushevic / Fotolia

Once the pain has subsided, you can generally resume any physical activity. This is provided that no actual structural damage to the intervertebral discs has been detected.

As you get older, however, you need to place increasing emphasis on what’s known as “muscle hygiene.” This means that when exercising, you must warm up, loosen, and stretch the muscle groups being used. This ensures optimal muscle function and helps prevent injuries. Otherwise, the risk of a muscle tear or strain increases.

Lower back pain is very rarely caused by intervertebral disc damage or a herniated disc. Muscular strain is the far more common cause. Accordingly, treatment must focus on the cause (i.e., the muscles).

If the pain persists and conservative therapies are ineffective, further diagnostic testing is necessary.

If neurological deficits are present, the diagnosis should focus on intervertebral disc damage or damage to the spinal nerves. Examples of neurological deficits include

• tingling,
• a sensation of heat or cold without any external cause, or
• numbness.

Why does back pain often occur in the lower back?

The lower back bears a large portion of the body’s weight, which is why the lumbar spine is subjected to particular strain. Common causes include wear and tear, herniated discs, or prolonged sitting.

What is lumbar spine syndrome?

Lumbar spine syndrome describes discomfort and pain in the lumbar spine region. Symptoms range from acute pain to chronic lower back pain.

Can pain in the lumbar spine radiate down into the leg?

Yes, in the case of a herniated disc or nerve irritation, pain can radiate from the lower back into the leg.

When is back pain considered acute, and when is it chronic?

Acute back pain usually lasts only a few days or weeks, while chronic pain persists for more than three months and recurs more frequently.

How can lower back pain be treated?

Treatment depends on the cause and ranges from exercise, physical therapy, and pain management to targeted interventions for lumbar spine syndrome.