Severe pain in your lower back typically occurs due to a problem in your spine or hip but may also originate from your internal organs. This blog provides a guide to the accompanying symptoms and potential causes of acute, severe lower back pain.

Range of symptoms that may accompany sharp pain the lower back

Acute pain in your lower back may be limited to one or both sides. You may also feel that the pain originates from a particular spot on the left or right side of your lower back. Sharp lower back pain typically includes one or more of the following symptoms and characteristics:

  • Decrease in motion. Severe lower back pain is typically associated with increased tension and spasm in the surrounding muscles, causing stiffness and a decreased range of motion.
  • Radiate through nerves. If your lower back problem originates from your spinal nerve roots, a shooting pain may radiate into your leg through the affected nerve.
  • Cause neurologic deficits. Lower back pain that is caused by irritation or compression of nerves may be associated with neurologic symptoms, such as numbness, tingling, a pins-and-needles sensation, and a general feeling of weakness in the leg(s).

These symptoms may be aggravated or relieved by specific postures or activities, such as sitting, standing, walking, and lying down. While spinal pain typically resolves in a few days to weeks, the symptoms can become debilitating, significantly affecting your daily activities.


Common musculoskeletal causes of severe lower back pain

The most common causes of acute lower back pain include a sudden or repetitive injury to one or more structures that support your back, such as muscles, ligaments, joints, and intervertebral discs.

Muscle strain

A pulled muscle (muscle strain injury) can send intense flareups of pain, spasm, and stiffness across your lower back. This injury may also be localized and cause sharp pain in the left or right side of your lower back. Common symptoms of a muscle strain injury in your lower back include:

  • Acute, shooting pain that intensifies with movement
  • Difficulty in standing or walking
  • Sharp pain while going from a sitting-to-standing or standing-to-sitting position

The pain is typically relieved when you recline with support and elevate your legs or lie down and elevate your knees. Following the PRICE protocol may also help relieve pain and heal the injured muscle.

See Pulled Back Muscle Treatment

Lumbar herniated disc

Your spinal discs serve as shock absorbers between your vertebrae, support your upper body, and allow a wide range of lower back movements. If your lower spinal disc(s) herniates, it may leak its inner contents, irritating or compressing a nearby spinal nerve root. 1 Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2020 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: The resulting cascade of inflammatory events causes a variety of symptoms, such as:

  • Acute lower back pain and stiffness
  • Increased pain during certain activities, such as lifting heavy objects or strenuous exercise
  • Burning feeling in the buttock, thigh, and/or calf
  • Sharp pain or a dull ache along the outer side or under the foot
  • Weakness, numbness, and tingling in the leg

When these symptoms originate from your sciatic nerve roots (L4 to S3), it’s called sciatica. 2 Giuffre BA, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2018 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:

Herniated disc symptoms may be relieved by taking anti-inflammatory medications and performing specific types of lumbar extension exercises, which may also help heal the disc. More intense medical treatment(s) may be required when significant neural compression occurs with severe symptoms.

Read more: Lumbar Herniated Disc: What You Should Know

Piriformis syndrome

This pain syndrome affects the piriformis muscle, located deep in your buttock. If you have piriformis syndrome, your buttock and hip become painful, and this pain may be referred to your lower back. 3 Hicks BL, Varacallo M. Piriformis Syndrome. [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: Common symptoms include:

  • Sharp, searing pain in the buttock that increases while sitting for a long time
  • Acute lower back pain and stiffness
  • Warm sensation or a burning feeling along the back of your thigh

Piriformis syndrome pain may be relieved by taking pain-relieving medication. In severe cases, muscle relaxants (obtained through a prescription) may help relieve muscle stiffness and pain. Long term management usually includes piriformis muscle stretch and physical therapy.

Read more about Piriformis Syndrome Treatment

Sacroiliac joint dysfunction

Sacroiliitis, a condition that causes inflammation and dysfunction of your sacroiliac (SI) joint, which connects the bottom of your spine to your pelvis on each side may cause 4 Raj MA, Varacallo M. Sacroiliac (SI) Joint Pain. [Updated 2019 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: :

  • Sharp, stabbing, or shooting pain felt directly over your affected joint – on the right or left side of your lower back and buttock
  • Burning sensation along the back of your thigh
  • Positional flare-ups that may occur when you move from standing to sitting, climb stairs, or lie on the affected side

Pain-relieving medications in combination with postural correction and sacroiliac joint exercises may help reduce the acute symptoms. Medical treatments, such as radiofrequency ablation may be required if the joints are severely inflamed and irritate nearby nerve tissues.

See Treatment Options for Sacroiliac Joint Dysfunction

While these are relatively common patterns, the actual presentation of these conditions can vary significantly, making it difficult to self-diagnose the root cause of pain. It is also possible for severe lower back pain to occur with no identifiable cause. This condition is called nonspecific lower back pain. 5 Casser HR, Seddigh S, Rauschmann M. Acute Lumbar Back Pain. Dtsch Arztebl Int. 2016;113(13):223‐234. Available from:


Acute back pain due to inflammation of internal organs

Pain in your lower back may occur due to the inflammation or irritation of an internal organ or may be a sign of infection. Organs of the mid-back, abdominal, or pelvic regions can cause pain specifically in the right or left side of your lower back or be generalized throughout the area.

Common examples of lower back pain stemming from internal organs include:

  • Kidney stones. Acute lower back pain may be felt when a kidney stone moves inside the kidney or the ureter, a thin tube connecting the kidney to the bladder. The pain is typically localized to the left or right side depending on the kidney that’s affected.
  • Kidney infection. Kidney infections usually start as urinary tract infections (UTI), causing inflammation and pain on the left or right lower back area, depending on the kidney affected.
  • Ulcerative colitis. Persistent inflammation of the large intestine (colon) can cause abdominal cramping and sharp back pain on one or both sides of the lower back and abdomen.
  • Pancreatitis. A lower left back pain may be due to inflammation of the pancreas, which also causes upper abdominal pain at the same time.
  • Appendicitis. An inflamed appendix can cause a sharp pain in the lower right abdomen and back.

Women may develop lower back pain from specific conditions, such as uterine fibroids and endometriosis, and pregnancy.

View Slideshow: 7 Ways Internal Organs Can Cause Lower Back Pain

Caring for your lower back pain can help reduce the symptoms and improve function in your back and legs. While lower back pain typically subsides in a few weeks, some underlying problems may cause your pain to become chronic, lasting for months.

See Back Care for Lower Back Pain

Consult your doctor for an accurate diagnosis of your lower back problem to help understand if your pain originates from your lower spine and/or hip or form an internal organ. A doctor can conduct relevant medical tests to diagnose your pain and formulate an effective treatment plan.

Learn more:

Causes of Lower Back Pain

Non-Surgical Treatments for Lower Back Pain

Dr. Benjamin Bjerke is an orthopedic surgeon. He specializes in minimally invasive and motion-preserving spine surgery.