Is your back pain related to ankylosing spondylitis, a type of arthritis that tends to affect younger adults? Ankylosing spondylitis causes the cartilage that cushions the ends of joints to wear away, so that the bones rub together.

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Lower back pain is more common than upper back pain and middle back pain. It can develop because you’ve overstretched the muscles and ligaments of your lower back, or overtaxed them while lifting a heavy object. Its origins also can lie in simple wear-and-tear over time, but in some circumstances, lower back pain can signal a serious underlying condition, particularly if it’s accompanied by kidney pain or pancreas pain.

You should see your doctor if:

• You’re 70 years or older and have the onset of new lower back pain.
• You have the bone-thinning disease osteoporosis.
• Your lower back pain follows a fall.
• Your immune system is weak, you’ve had cancer, or you’ve taken corticosteroids for a long time.
• The pain persists even when lying down, or it awakens you from sleep.
• You have leg weakness or develop new sexual, bowel, or bladder dysfunction.
• You have an unexplained fever or weight loss.
• The lower back pain spreads into the lower leg, especially if the leg feels weak.
• The pain does not improve within four weeks.

Lower Back Pain Causes

Common causes of lower back pain include:

• Degenerative disk disease, which occurs naturally as we age, causes the spinal disks (the soft, elastic material that forms a shock-absorbing cushion between the spinal vertebrae) to break down. The disks become thinner and less flexible, and also may develop tiny cracks that can bulge, rupture, or break (a condition called herniated disk). The subsequent lack of cushioning between the vertebrae can put you at higher risk for lower back pain.
• Degenerative spondylolisthesis also is related to wear and tear on the muscles and ligaments of the lower back, which gradually become less able to keep the spinal vertebrae aligned. This makes it possible for the vertebrae to press on the spinal nerves, causing lower back pain that radiates down the legs. Other symptoms include a feeling of weakness in the legs. Many sufferers find that leaning forward while sitting relieves the pain because it increases the space available for the spinal nerves. (See also our post “Is a Pinched Nerve Causing Your Pain?“)
• Ankylosing spondylitis is a type of arthritis that tends to affect younger adults. It causes the cartilage that cushions the ends of joints to wear away, so that the bones rub together. In severe cases, the disease stimulates new bone growth that fuses together the vertebrae in the spine.
• Spinal stenosis develops when the space around the spinal cord narrows, putting pressure on the spinal cord. The most common underlying cause for spinal stenosis symptoms is osteoarthritis, to which your body may respond by forming bony outgrowths called bone spurs. These narrow the space the spinal nerves pass through, eventually pinching the nerves that travel down to the legs. This results in lower back pain, along with numbness, weakness, and/or pain in the legs, groin, hips, and buttocks. These symptoms are usually worse when you’re walking or standing; as with degenerative spondylolisthesis, the discomfort tends to decrease when you sit and lean forward, since this increases the space available for the nerves.

Treating and Preventing Lower Back Pain

Most instances of lower back pain can be relieved by over-the-counter painkillers, among them acetaminophen and ibuprofen. Some anti-seizure drugs, such as gabapentin (Neurontin), and pregabalin (Lyrica), can be taken to reduce pain caused by damaged nerves, and corticosteroid injections into the space around the nerves also can help relieve pressure on the nerves by reducing inflammation. However, the latter can only be given a few times a year, because repeated steroid injections can weaken nearby bones and connective tissue.

Alternative methods of pain relief, such as acupuncture and yoga, also can be effective at easing lower back pain, as can weight loss (excess weight increases the burden on your lower back).

For long-term relief, you also should aim to modify the way you use your body, and work to strengthen the muscles in your back. Try these steps:

• Modifying your body mechanics. Use the correct lifting technique (bend at the knees when lifting things, and carry heavy objects close to your body) to lessen the strain on your lumbar region. It’s also important to avoid spending long periods of time sitting in slumped positions that place stress on your back.
• Boosting muscle strength. The abdominal and lower back muscles support the spine, but in older adults especially, these often are weak. Active rehabilitation can rebuild strength, and physical therapy that focuses on strengthening core muscle groups in the abdominal area and the lower back has demonstrated positive effects in patients with lower back pain. A physical therapist can show you the most effective exercises for lower back pain, and make sure you’re doing them correctly.

Is Surgery a Good Idea?

Often, lower back pain clears up within two months, so surgery isn’t usually necessary unless conservative approaches haven’t helped ease your discomfort, and your lower back pain is affecting your mobility. Disk replacement surgery (in which a damaged disk is removed and replaced with an artificial disk) and spinal fusion (in which the damaged disk is removed and the vertebrae are fused together with bone grafts and screws, to immobilize the painful area) are the main surgical options for treating degenerative disk disease.

For spinal stenosis symptoms, a procedure called laminectomy has about an 80 percent success rate at improving walking abilities. Laminectomy enlarges the spinal canal by removing bone spurs, bone, and ligaments that may be pressing on the spinal nerves.

Keep in mind that surgical procedures for back pain mean a long recovery time afterwards, and many people gain little relief. For these reasons, surgery to alleviate lower back pain should be seen as a last resort.

See also our post “UHN Blog: How to Relieve Lower Back Pain.”

Originally published in 2016, this post is regularly updated.