Low Back Pain in Older Adults

Adults aged 50 years and older are especially vulnerable to lower back pain caused by age-related wear and tear of the spinal discs, joints, and other spinal structures, in addition to nonspecific causes of pain, such as muscle strain.

Some of the most common conditions related to lower back pain in older adults are listed below.

 Facet Joint Osteoarthritis

Arthritis of the spine, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops over time. Pain can be caused by the breakdown of cartilage between the facet joints in the spine.

Percentage of older adults affected by facet joint arthritis

The gradual breakdown of cartilage in the facet joints of the lumbar spine can begin as early as 15 years of age and becomes increasingly predominant with advanced age. Research has shown that this condition occurs in an estimated ¹ Suri P, Miyakoshi A, Hunter DJ, et al. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population. BMC Musculoskelet Disord. 2011;12:202. Published 2011 Sep 13. doi:10.1186/1471-2474-12-202 :

• 36% of adults aged 44 years or younger
• 48% of adults aged 45 to 54 years
• 84% of adults aged 55 to 64 years
• 89% of adults aged 65 years or older

Facet joint osteoarthritis does not necessarily cause lower back pain. Older adults are prone to this condition, making it a more likely source of back pain in old age.

What facet joint arthritis feels like

Facet joint osteoarthritis in the lower back may include some combination of the following characteristics:

• Pain that is most intense first thing in the morning, and again toward the end of the day
• Pain that interrupts sleep
• Localized tenderness when the affected area of the spine is pressed
• Pain that is described as aching, steady, or intermittent pain
• Lower back pain that is aggravated by prolonged activity
• Stiffness or loss of flexibility in the lower back

At first, the symptoms may be intermittent, but can develop into steadier pain over time, and may eventually cause sciatica.

Read more about Facet Joint Osteoarthritis

As the facet joints degenerate, the intervertebral disc may also degenerate. Both facet joint osteoarthritis and degenerative disc disease are most common in the L4-L5 and L5-S1 spinal segments, ² Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216-224. doi:10.1038/nrrheum.2012.199 the lowest sections of the lower back. While the symptoms of degenerative disc disease may coincide with the symptoms of facet joint osteoarthritis, given enough time—sometimes decades—degenerative disc disease tends to be less painful.

See Degenerative Disc Disease Progression over Time

Sacroiliac Joint Dysfunction

Older age is a risk factor for sacroiliac (SI) joint pain, and a specific causative event, such as a fall, precedes nearly half of all cases of sacroiliac joint pain. ³ Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116. doi:10.1586/ern.12.148

The SI joints lie on each side of the lower spine, connecting the spine to the hips. Restricted movement or excess movement of these joints leads to pain in the lower back and hip/buttocks, and the pain may radiate into the groin or the back of the leg.

Common symptoms of SI joint dysfunction

The symptoms of dysfunction or inflammation in one or both SI joints usually includes any combination of the following characteristics:

• Pain in the buttocks and/or lower back that is most intense when sitting or lying on one side
• Burning, sharp pain or numbness that radiates into the groin, the back of the thigh, or the outer side of the thigh
• Pain typically on one side of the body but may also occur on both sides of the body
• Stiffness or loss of flexibility in the lower back and hips

See Sacroiliac Joint Dysfunction Symptoms and Causes

Regular activities that use the sacroiliac joint, such as bending at the waist or stair-climbing, tend to increase the pain. Activities that are not symmetrical, such as lifting weight with one arm, can also provoke an increase in pain. Sacroiliac joint dysfunction may also mimic the symptoms of sciatica.

Read more about Sacroiliac Joint Dysfunction (SI Joint Pain)

Lumbar Spinal Stenosis and Degenerative Spondylolisthesis

Narrowing of the openings in the spine (spinal stenosis) may place pressure at the point where the nerves travel down the spine (central stenosis) and/or exit the spine (foraminal stenosis). The resulting pain tends to be more pronounced when walking or standing upright and is relieved when sitting down.

When a vertebral body slips forward over the one below it (spondylolisthesis), the misalignment may lead to pressure on the nerves running down the spinal canal and/or the nerves that exit the lumbar spine. Spondylolisthesis causes low back pain that worsens with walking or standing upright and may be accompanied by radiating leg pain.

Common symptoms of spinal stenosis and degenerative spondylolisthesis

Spinal stenosis is sometimes associated with spondylolisthesis. The symptoms of lumbar spinal stenosis and degenerative spondylolisthesis tend to overlap. Both conditions include any combination of the following signs and symptoms:

• Leg pain and lower back pain that develop or worsen when walking short distances or standing upright for prolonged periods of time
• Quick relief of pain when sitting down or bending forward, such as over a grocery cart at the supermarket
• Symptoms that develop over time
• Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs (sciatica)

These conditions typically place pressure on the nerves at the point where they exit the spine. Such pressure increases with extension (bending backward) of the hips and lower back. When constant or recurring pressure causes nerve inflammation, leg pain may occur.

Read more about Lumbar Spinal Stenosis and Degenerative Spondylolisthesis

Spinal Compression Fracture

The risk of a spinal compression fracture, also called a vertebral fracture or an osteoporotic fracture, increases as the bones become weaker and more brittle with age. The majority of vertebral compression fractures do not cause pain, ⁴ McCarthy J, Davis A. Diagnosis and Management of Vertebral Compression Fractures. Am Fam Physician. 2016;94(1):44-50. but when symptoms do occur, they most commonly arise suddenly as soon as the vertebra fractures.

Signs and symptoms of spinal compression fracture

A spinal compression fracture can include any combination of the following characteristics:

• Sudden onset of back pain
• Pain that worsens with standing or walking
• Partial relief of pain when lying on the back
• Height loss
• Limited spinal flexibility
• Deformity and change in function

The main risk factors for a vertebral fracture include age (older than 50 years), menopause with osteoporosis, and long-term use of corticosteroids. ⁵ Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J. 2006;6(5):479-487. doi:10.1016/j.spinee.2006.04.013 In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Read more about Vertebral Fracture Symptoms

Less Common Causes of Low Back Pain in Older Adults

Low back pain may be caused by conditions that occur less often in older adults. Examples of less common causes include:

• Piriformis syndrome
• Infection
• Spinal tumor
• Fibromyalgia
• Ankylosing spondylitis
• Coccydynia
• Hip osteoarthritis

The age group at risk for degeneration in the spine is also at risk for degeneration in the hip joints. It is important to examine the hips, which may contribute to or cause low back pain, before selecting a treatment plan. One study showed that hip replacement surgery may effectively decrease back pain in patients with both hip osteoarthritis and lumbar degenerative disc disease. ⁶ Ran TF, Ke S, Li J, et al. Relieved Low Back Pain after Total Hip Arthroplasty in Patients with Both Hip Osteoarthritis and Lumbar Degenerative Disease. Orthop Surg. 2021;13(6):1882-1889. doi:10.1111/os.13135

Finally, it is important to note that one’s attitude and situation also have an effect on pain levels and duration. For example, people who are depressed, under stress, or have a compensable back injury are more likely to develop chronic pain. Patients who are stress-free and have few complicating psychological factors are more likely to improve with appropriate treatment for their conditions.