Specifically identifying and describing symptoms plays a key role in obtaining a diagnosis of the underlying cause of low back pain.

Knowing how to track and describe one’s lower back pain symptoms is often the first step in obtaining effective pain relief.

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The lumbar region of the spine, commonly known as the lower back, consists of five vertebrae labeled L1 through L5 and is situated between the thoracic, or chest, region of the spine and the sacrum.

The two lowest segments in the lumbar spine, L4-L5 and L5-S1, carry the most weight and experience maximum movement, making these segments prone to injury and pain.

The most common cause of lower back pain is a torn or pulled muscle. Pain from a pulled back muscle, also called a muscle strain, is acute and often remains localized to the lower back area. A muscle strain can be accompanied by muscle spasms, as the body tries to stabilize the injury.

Lower back pain can also occur due to problems affecting the lumbar spinal discs. The discs can herniate or degenerate, and if the disc material irritates a nearby spinal nerve root, it can cause lower back pain or radiating pain in the legs and feet. This type of pain is called radicular pain or sciatica and travels down the leg through the large sciatic nerve. If the disc material compresses a nerve root, symptoms of radiculopathy, such as numbness, tingling, and weakness may occur in the affected leg.

Another type of lower back pain is called vertebrogenic pain, which occurs when the vertebral endplate, situated between the vertebral body and the intervertebral disc, becomes damaged. This pain is felt as a persistent dull ache or burning pain deep in the lower back area. Vertebrogenic pain usually flares up while sitting, standing, and bending the spine forward. In some cases, the pain may spread into the tissues surrounding the spine and the buttocks.

Dysfunction of the sacroiliac joints is another cause of lower back pain. These joints connect the triangular-shaped sacrum to the hip on each side of the spine. The SI joints can become painful due to chronic trauma or an acute injury. SI joint pain is similar to sciatica and is typically felt in the lower back, buttock, and thigh, along with a feeling of weakness and instability during certain movements or activities.

Other causes of lower back pain are degenerative spinal conditions, which occur due to wear and tear or natural aging of the spine. A few of these conditions include lumbar spinal stenosis, lumbar osteoarthritis, and degenerative spondylolisthesis.

Rarely, certain low back conditions, such as a severely herniated disc, can compress the spinal cord or cauda equina, which is a medical emergency. Symptoms include numbness, loss of balance, lower extremity weakness, and loss of bowel and bladder control.

It is important to understand the underlying cause of lower back pain in order to effectively treat the symptoms.

Common Symptoms of Lower Back Problems

The specific symptoms vary considerably, and how the symptoms develop, what they feel like, and what makes the pain better or worse are all important to understanding the underlying diagnosis.

Typical signs and symptoms include some combination of:

Dull, aching pain

Pain that remains within the low back (axial pain) is usually described as dull and aching. The aching back may be accompanied by muscle spasms, stiffness, and aches in the hips and pelvis.

Pain that travels to the buttocks, legs, and feet

Sciatica pain extending from low back down to the leg and feet.

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Sciatica symptoms travel down into the leg and/or foot.

Sometimes low back pain includes a sharp, stinging, tingling or numb sensation that moves down the thighs and into the leg and/or foot, commonly called sciatica. The medical term is radicular pain.

Sciatica is caused by irritation of the sciatic nerve that starts in the lower back, and is usually only felt on one side of the body.

Watch Sciatica Causes and Symptoms Video

Pain that is worse after prolonged sitting

Sitting puts pressure on the lumbar discs, causing low back pain to worsen after sitting for long periods of time. Walking and stretching can alleviate low back pain quickly, but returning to a sitting position may cause symptoms to return.

Pain that feels better when changing positions

Depending on the underlying cause of pain, some positions will be more comfortable than others. For example, with lumbar spinal stenosis walking normally may be difficult and painful, but leaning forward onto something, such as a shopping cart, may reduce pain. How symptoms change with shifting positions can help identify the source of pain.

Pain that is worse after waking up and better after moving around

Many who experience low back pain report symptoms that are worse first thing in the morning. After getting up and moving around, however, symptoms are relieved. Pain in the morning is due to stiffness caused by long periods of rest, decreased blood flow with sleep, and possibly the quality of mattress and pillows used.

Of course, there are other ways people experience low back pain. Low back pain varies on an individual level, and many factors influence the pain experience, including mental and emotional health, financial stress, or exercise and activity level.

How Low Back Pain Develops Over Time

An illustration showing degeneration of the lumbar disc.

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Degenerative disc disease-related low back pain fluctuates but worsens gradually over time.

Depending on the cause of low back pain, the onset of symptoms can vary widely. Back pain may include:

Pain that develops slowly

Symptoms caused by repetitive motions or stress-inducing positions tend to come on slowly and progressively worsen. Pain may develop after certain activities or at the end of a long day, and may feel like a constant ache.

Pain that comes and goes, but gets worse over time

Low back pain caused by degenerative disc disease can be felt off and on, but pain flare-ups get progressively more severe over a long period of time.

Immediate pain after an injury

Sudden or jarring movements can damage the spine and its supportive muscles, causing immediate, acute pain.

Delayed symptoms after injury

Sometimes symptoms develop or get worse a few hours or days after an accident or injury. Delayed pain is generally thought of as a side effect of natural healing processes of muscles.

Dr. Peloza is a board-certified, fellowship-trained minimally invasive orthopedic spine surgeon at Midwest Orthopedic and Spine Specialists, MO. Dr. Peloza has given several presentations at medical conferences and scientific meetings on topics that include minimally invasive surgery, scoliosis correction, and lumbar fusion.