MSD Manual

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Some Causes and Features of Low Back Pain

Some Causes and Features of Low Back Pain

Cause

Common Features*

Tests†

Common causes

Pain that

  • Often occurs on one or both sides of the spine

  • Worsens with movement and lessens with rest

  • Typically develops while lifting, bending, or twisting

A doctor's examination

Osteoarthritis, sometimes with compression of a spinal nerve root

Pain over a specific part of the spine, which sometimes

  • Is worsened by standing

  • Is relieved by sitting

  • Travels down a leg

  • Is accompanied by numbness and/or weakness

Usually in older people with pain and/or deformities in other joints

X-rays

Sometimes MRI or CT (for osteoarthritis that is severe enough to cause nerve root pain)

Pain over a specific part of the spine, sometimes starting suddenly

Usually in people who are older or who have osteoporosis

X-rays

Sometimes CT or MRI

A herniated disk, usually with compression of a spinal nerve root

Pain over a specific part of the spine that usually

  • Travels down a leg

  • Is accompanied by numbness and/or weakness

  • Is worsened by coughing, sneezing, straining, or leaning forward

A doctor's examination

Sometimes MRI

Rarely CT

Pain over a specific part of the spine in the lower back that

  • Is worsened by straightening the back (as when walking or leaning back)

  • Is relieved by leaning forward or sitting

  • May travel down one leg or both legs

Usually in older adults

A doctor's examination

Sometimes MRI

Spondylolisthesis, sometimes with compression of a spinal nerve root

Back pain that sometimes

  • In adolescents, is on one side of the spine, may travel down a leg, and may accompany a fracture

  • In adults, is over a specific part of the spine, travels down both legs, and involves tissue degeneration

  • Is accompanied by numbness and/or weakness

  • Is worsened by standing or leaning back

Often in adolescents associated with a fracture and in adults associated with degeneration (two different processes)

X-rays

MRI or sometimes CT

Aching and stiffness in many areas of the body (not just the lower back)

Sore areas that are tender to the touch

Often poor sleep

Most common among young or middle-aged women

A doctor's examination

Less common causes

Ankylosing spondylitis (inflammation of the spine and large joints)

Stiffness, often worse immediately after awakening

Progressive loss of back flexibility, often causing the back to hunch forward

Sometimes a painful red eye and/or pain in other joints

Often in young men

X-rays or occasionally MRI

Blood tests

Numbness in the groin and around the anus

MRI

Pain in a strip of skin on either the right or left side of the body, but not both

Usually blisters develop on the painful strip of skin often after the pain starts

A doctor's examination

Cancer

Progressively worsening pain, regardless of position or activity

Sometimes loss of appetite and/or weight

Usually x-rays

MRI or CT

Infection

Progressively worsening, constant pain, regardless of position or activity

Sometimes fever and/or night sweats

Often in people who have had back surgery, who have an immune disorder, who take drugs that suppress the immune system, or who use IV drugs

Usually x-rays

MRI or CT

Blood tests

* Features include symptoms and results of the doctor's examination. Features mentioned, including pain, are typical but not always present.

† If pain resolves without treatment and no warning signs are present, testing may not be necessary.

CT = computed tomography; IV = intravenous; MRI = magnetic resonance imaging.