Lower back pain – causes, symptoms and treatments

Want to know the reasons why you have pain in your lower back? Want to feel better? Read on
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  • Find out about the most common lower back pain causes and what can be done to help

    Are you one of the 10 million people in Scotland and England suffering from persistent back pain? Because backache is a big problem, and if you’re female the causes of lower back pain can be manifold.

    About 8 in 10 of us have at least one attack of lower back pain in our lives, and a survey conducted by Deep Heat found that for 16% of us back pain is a daily occurrence. “According to The Lancet’s research papers, disability due to back pain has risen by more than 50% since 1990,” explains Anisha Joshi an osteopath known for her ‘little black book’ of celebrity patients. It’s little surprise, then, that Public Health England reported ‘musculoskeletal conditions are the leading cause of pain and disability in England and account for one of the highest causes of sickness absence and productivity loss.’ In 2017 alone, the cost to the economy was approximately £11.6 billion.

    Around 14% of musculoskeletal consultations are related to lower back pain but for some practitioners this figure is even higher. “The most common reason for a patient to visit me is lower back pain. It accounts for about 40% of my practice workload,” says Joshi. Yet, although it’s the third most commonly reported symptom of any kind, a reason isn’t always found. If it goes away within six weeks you’ve probably experienced ‘non-specific back pain’. But when lower backache persists, the discomfort is specifically in the lower right back or lower left side, or if you’re suffering from severe pain you’ll need medical attention.

    Though there are other reasons for backache more often than not you’ll discover that the issue is mechanical, such as sore muscles, torn ligaments and sciatica. Treatment includes pain relief, and equipment or exercises to strengthen the lower back. Read on to learn about the causes, when to seek help, and what you and medical professionals can do to ease your symptoms.

    What is causing my lower back pain?

    “Generally, back pain is caused by a compressive injury, either a one-off or a repetitive strain often accompanied by a trigger event, such as putting on your socks,” explains Michael Fatica, osteopath and co-founder The Mayfair Clinic in London. “The human body is remarkably strong and putting on socks is not something that would injure a healthy back. One that has born the brunt of poor practices for long periods, however, will become vulnerable.

    “Activities like sitting badly for long periods, the wrong form during exercise, taking up a high impact sport (think about those home exercise HIIT workouts). These can cause real trouble for people’s backs but, if they’re lucky, they heal well. If they’re unlucky they can be misdiagnosed with muscle issues and may proceed to exercise to help muscle spasms which worsen the underlying issue.”

    Specifically, ”women complain of lower back pain due to restrictions in their spinal vertebrae, postural issues or even hormonal changes,” adds Joshi. “Other causes of lower back pain can be a restricted lumbar vertebrae, a prolapsed [slipped] disc, osteoarthritis, kidney issues and period pain.”

    Other possible causes include hernia, sciatica (trapped nerve), ankylosing spondylitis (swelling of the joints in the spine), gynaecological issues such as ovarian cysts and endometriosis, sacroiliitis (inflammation of the sacroiliac joint), spinal stenosis (an abnormal narrowing of the spinal canal), spondylolisthesis (when a spinal bone slips out of position), and, rarely, cancer.

    Lower back pain in women

    Lower back pain on the right side

    While lower back pain on the right side is usually a result of mechanical issues such as tight, sore or sprained muscles, sciatica, sacroiliitis, torn ligaments or simply wear and tear, pain sometimes radiates from one of our internal organs, which indicates another problem.

    Possible causes

    Possible causes of lower back pain on the right side are appendicitis – this is because the appendix rests on the lower right side – or a problem with the right kidney, which hangs slightly lower than the left, such as an infection or kidney stones. Gallstone pain is also felt on the right side, though this is usually felt higher up. For women, gynaecological issues including ovarian cysts, fibroids, endometriosis and an ectopic pregnancy can cause referred pain.

    Treatment for back pain on the right side

    First, try treating it at home (see our tips, below). However, if you have a fever, are sick, have an area on the right side that’s tender to touch, or you feel very unwell or are in intense pain, get medical help quickly.

    Lower back pain on the left side

    Just like the right side, lower back pain on the left side is usually a result of mechanical issues such as tight, sore or sprained muscles, sciatica, sacroiliitis, torn ligaments or simply wear and tear. However, as before, pain radiating from our internal organs can sometimes be the cause.

    Possible causes

    A possible cause of lower back pain on the left side is pancreatitis. While the pain tends to be on the middle left side it can radiate towards the lower back. For women, gynaecological issues including ovarian cysts, fibroids, endometriosis and an ectopic pregnancy can cause referred pain in the lower left back.

    Treatment for back pain on the left side

    First, try treating it at home (see our tips, below). However, if you have a fever, are sick, have a tender spot on your left side, or you feel very unwell or are in intense pain, seek prompt medical care.

    Lower back pain in women

    As well as aches and pulls and sprains, women have female hormones to thank for lower backaches. Aside from gynaecological issues such as pregnancy, ovarian cysts, fibroids and endometriosis, we “experience more pain around the time of the menstrual cycle, due to prostaglandins getting secreted by the uterus, which can get into the blood stream and cause lower back and leg pain,” explains Joshi.

    Another, less discussed, possibility of back pain in women is having had a C-section. “The big area that concerns me is for those women who’ve had a C-section (elective or emergency),” says Fatica. “A C-section disrupts the core muscles of the back and the impact of this is that, later on, when that woman injures her back, she has a harder time recovering as there is an inherent lack in core competence. This is often because there’s very little focus on C-section rehabilitation.”

    Treatment for lower back pain in women

    First, try treating it at home (see our tips, below). However, if you have a fever, are sick, feel very unwell or are in intense pain, get medical attention.

    When to see a doctor about back pain

    When to see a medical professional

    It’s always worth having severe or chronic back pain checked out by a professional. If you’re over 55, there’s a 5% chance your lower back pain is caused by a fracture. There’s only a 1% chance it’s down to something more sinister, such as a tumour, aneurysm or infection.

    Contact your GP if your lower back pain hasn’t begun to ease and is preventing you doing everyday tasks after more than three days, or if you’re still in severe pain or it’s worsened after six weeks. Seek urgent medical help if back pain is accompanied by:

    • Fever
    • Recent serious trauma, i.e. a car accident
    • Numbness or tingling in groin or legs
    • Loss of bladder/bowel control or an inability of pass urine
    • Medical history of osteoporosis or cancer, or recent unexplained weight loss
    • Night discomfort
    • Leg weakness that comes on suddenly or gets progressively worse, or more pain in the leg than the back
    • Inability of get comfortable sitting or sleeping when you feel back pain

    How do medical professionals treat lower back pain?

    A GP will usually suggest pain medication, exercises or physiotherapy. An osteopath, chiropractor or acupuncturist may also be able to help.

    While “lifestyle and exercises are relevant to all patients,” says Fatica, medical professionals may approach your pain differently. For example, “at the Mayfair Clinic, we use vibration to reduce muscle dysfunction, a spine adjusting machine to improve spine mobility, laser therapy to improve healing and circulation, and IDD therapy to decompress the spine.”

    How to treat lower back pain at home

    Ice it

    If pain starts after an injury such as a fall, knock, sprain or strain, apply an ice pack for 10 minutes several times a day. Alternate with a (covered) hot-water bottle to encourage blood flow, but start and finish with ice to ease inflammation.

    Keep moving

    Stay active and carry on as normal, as much as possible. Start slowly, with a gentle activity like walking, and increase gradually.

    Don’t take to your bed

    Extended bed rest causes muscles to seize up and weaken. If you must life down, restrict yourself to one to two hours over the first couple of days. Place a pillow under your knees to ease strain, or between your knees if you’re lying on your side.

    Get medicinal help

    Take ibuprofen or aspirin every four to six hours. For more severe pain, take codeine. Paracetamol can be added for greater relief but always stick within the maximum recommended daily dose. You can also combine medication with a drug-free Deep Heat Pain Relief Patch that offers up to 16 hours relief. If that doesn’t help, your GP can prescribe a stronger painkiller or muscle relaxant.

    The right mattress for lower back pain

    Lifestyle changes to treat lower back pain

    Replace your mattress

    The softer your mattress, the less evenly your weight will be distributed, and the more likely you are to experience discomfort. A medium to firm mattress is your best option. Before you commit to a new mattress make sure you’ve diagnosed exactly what your back issues are. Do some research to figure out what kind of mattress will suit your needs. The Emma mattress is an excellent option or browse more mattress reviews.

    Change how you sleep

    Pain can cause difficulty sleeping and lack of sleep can make the pain even worse – it’s a vicious cycle that’s hard to break. Small changes like rearranging your sleeping position, reducing or increasing the number of pillows, or relaxing with a hot shower before bed can make a difference.

    Change your clothes

    Constrictive clothing like skinny jeans and Spanx can restrict the spine’s normal range of motion and inhibit normal conditioning of muscles. This causes the lower back to become more susceptible to strain and injury, say experts. So let it all hang out, ladies – doctor’s orders.

    MORE: is your handbag causing back issues?

    Get online

    The Mayfair Clinic offers the Back in Shape Programme – free to join, or £15 per month for Premium membership, it’s ideal if you’re housebound and need expert advice. Or take a look at the clinic’s YouTube channel.

    Exercise your core

    Exercising the muscles in your abs and back can have a positive impact on lower back pain. Even doing something as simple as correcting your posture while you’re sitting at your desk has a lasting effect. If you feel like taking it a step further, practise sitting upright on an exercise ball for 30 minutes a day, or take up Pilates.

    Have a foot check-up

    According to a study in the journal Rheumatology, women whose feet roll inwards when they walk may be especially prone to lower back pain. If you suspect that your feet might not be helping, it’s worth speaking to a specialist about your concerns. You can then look into taking extra measures, such as wearing orthotics to correct the arch of your feet.

    Keep moving

    You may think the best way to deal with pain is to lie still, but there’s nothing worse for lower back pain. Stretch your body out, go for a walk and enjoy the fresh air. Even better, take part in a yoga class.

    Get a massage

    Research found that those who received weekly massages experienced less pain after 10 weeks compared to those who didn’t. General relaxation rubdowns also worked as well as structural massages that target specific body parts. Another study revealed that 63% of people experienced moderate improvement in lower back pain when they underwent six osteopathic manual treatments over 8 weeks, with 50% reporting substantial improvement.

    Try acupuncture

    A 2013 study reported that acupuncture might actually provide more relief than painkillers. Acupuncture works by changing the way your nerves react and can help with inflammation around the joints.

    Stop smoking

    Smoking compromises blood supply to the spine, which can cause the intervertebral discs to age more quickly. This increases susceptibility to injury and herniation.

    Sit less

    In recent years, sitting has been coined the new smoking and for good reason – sitting in a chair puts 30% more pressure on the spine than standing or walking. If you sit at a desk all day (or on the sofa all evening), get up and walk around at least once an hour. Avoid slouching and, if you can, adjust your seat so it tilts slightly back. 

    MORE: why sitting is bad for you

    Stretches for the lower back

    Why exercise strengthens the lower back

    Firstly, “you wouldn’t give exercises to someone with severe back pain. Only once the area has calmed down would you consider giving an exercise plan to strengthen the surrounding muscles,” says Joshi. Once your pain is manageable level stretches and exercises can help without the need to rely on painkillers. These exercises include spinal stretches, extensions, rotations, bridges and planks – check out these stretches for back pain for instructions.

    MORE: how to use a foam rollers on your back

    Can lower back problems cause waist pain in women?

    “Due to the anatomy of the lower back and pelvis you can experience referral pain into your waist or groin as a woman,” says Joshi. “I can relieve these symptoms by treating the lower back and the relaxing of surrounding muscles.”

    Fatica agrees: “As an osteopath, this would be no different to normal lower back pain so I would [amongst other things] work to reduce muscle dysfunction and improve spine mobility,” he says.

    What can be done about severe lower back pain?

    Nagging or intermittent back pain is one thing, but what if it becomes acute? “The first priority would be to get someone out of pain as quickly as possible,” says Joshi. “Treatment would involve gentle soft tissue techniques and mobilisation of the spine and pelvis. Then hydrotherapy advice like hot and cold treatment to reduce any inflammation in the area,” If it persists after treatment, contact GP as you may require tests.

    Could my lower back pain be cancer?  

    For most of us, the thought that we may have cancer is a terrifying one but don’t panic. “Certain kinds of cancer could metastasise to bone, and this could be in the lower back, but it’s decidedly rare,” says Fatica. Joshi agrees: “Lower back pain is rarely a sign of cancer. Some cancers can manifest as such but these symptoms are typically unremitting and have other ‘red flag’ symptoms.”

    Exercise equipment to strengthen your lower back

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