Persistent Lower Back Pain: Causes, Relief, and When to See a Doctor

At-a-Glance

• Lower back pain affects 80% of Americans at some point in their lives
• Most cases are mechanical (muscle, ligament, or joint-related) and improve with conservative treatment
• Prolonged sitting, poor posture, and weak core muscles are major contributors
• Red flags include loss of bowel/bladder control, severe leg weakness, or pain after trauma
• Exercise and movement are usually better than bed rest for recovery

What It Feels Like

Persistent lower back pain can manifest in various ways, from a dull, constant ache to sharp, shooting pains. The discomfort is typically located in the lumbar region—the area between your ribcage and hips.

Common descriptions include:

• A dull, constant ache across the lower back
• Sharp, stabbing pain with certain movements (bending, twisting, lifting)
• Stiffness, especially in the morning or after sitting
• Pain that radiates down one or both legs (sciatica)
• Muscle spasms or tightness in the lower back
• Pain that worsens with prolonged standing or sitting
• Difficulty standing up straight after sitting

The pain may be localized to one spot or spread across the entire lower back. It might improve with rest or worsen depending on the underlying cause.

Common Causes

Muscle or Ligament Strain

Muscle and ligament strains are the most common causes of lower back pain. They result from overuse, improper lifting, sudden movements, or maintaining awkward positions.

Signs it might be a strain:

• Pain started after physical activity, lifting, or sudden movement
• Localized tenderness and muscle tightness
• Pain worsens with movement but improves with rest
• No numbness, tingling, or weakness in legs
• Gradual improvement over days to weeks

What helps:

• Continue gentle movement—avoid prolonged bed rest
• Ice for first 48 hours, then heat therapy
• Over-the-counter anti-inflammatory medications
• Gentle stretching and gradual return to activity
• Physical therapy if pain persists
• Most strains heal within 2-6 weeks

Poor Posture and Ergonomics

In our desk-bound society, poor posture is a leading contributor to chronic lower back pain. Slouching, hunching over screens, and inadequate lumbar support strain back muscles and ligaments.

Signs posture is the culprit:

• Pain develops gradually over time
• Worsens during or after prolonged sitting
• Improves with position changes or walking
• Accompanied by neck or shoulder tension
• No specific injury or triggering event

What helps:

• Ergonomic workspace setup (chair with lumbar support, monitor at eye level)
• Take standing/walking breaks every 30-60 minutes
• Strengthen core muscles to support spine
• Practice good posture awareness
• Consider a standing desk or ergonomic chair
• Physical therapy for posture correction

Herniated or Bulging Disc

The discs between your vertebrae act as cushions. When a disc herniates (ruptures) or bulges, it can press on nearby nerves, causing pain that may radiate down the leg.

Signs it might be a disc issue:

• Pain radiates down one leg (sciatica)
• Numbness, tingling, or weakness in leg or foot
• Pain worsens with sitting, bending forward, or coughing
• May improve when standing or walking
• Often affects one side more than the other

What helps:

• Physical therapy focusing on core strengthening and flexibility
• Anti-inflammatory medications
• Epidural steroid injections in some cases
• Most herniated discs improve without surgery within 6-12 weeks
• Surgery considered only if conservative treatment fails or neurological symptoms worsen

Degenerative Disc Disease

As we age, spinal discs naturally lose hydration and height, leading to degenerative changes. This is a normal part of aging but can cause pain in some people.

Signs it might be degenerative disc disease:

• Gradual onset, typically in people over 40
• Pain worsens with sitting, bending, or twisting
• May improve with walking or changing positions
• Stiffness in the morning
• Pain fluctuates—good days and bad days

What helps:

• Regular low-impact exercise (swimming, walking, cycling)
• Core strengthening exercises
• Maintain healthy weight
• Anti-inflammatory medications
• Physical therapy
• Heat therapy
• Rarely requires surgery

Spinal Stenosis

Spinal stenosis is narrowing of the spinal canal, which can compress nerves. It's most common in people over 50 and often results from arthritis.

Signs it might be spinal stenosis:

• Pain, numbness, or weakness in both legs
• Symptoms worsen with walking or standing (neurogenic claudication)
• Relief when sitting or leaning forward (like pushing a shopping cart)
• Gradual onset and progression
• May have difficulty walking long distances

What helps:

• Physical therapy emphasizing flexion exercises
• Anti-inflammatory medications
• Epidural steroid injections
• Walking aids or assistive devices
• Surgery if conservative treatment fails and quality of life is significantly affected

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints connect your spine to your pelvis. Inflammation or dysfunction of these joints can cause lower back and buttock pain.

Signs it might be SI joint dysfunction:

• Pain in lower back, buttocks, or back of thigh
• Pain on one side more than the other
• Worsens with stairs, standing from sitting, or running
• Tenderness over SI joint (dimples in lower back)
• May follow pregnancy, injury, or arthritis

What helps:

• Physical therapy focusing on SI joint stabilization
• Anti-inflammatory medications
• SI joint injections
• Pelvic belt or support
• Exercises to strengthen surrounding muscles

Less Common but Serious Causes

Cauda Equina Syndrome

This is a rare but serious condition where nerve roots at the base of the spinal cord are compressed. This is a medical emergency.

Warning signs:

• Severe lower back pain
• Loss of bowel or bladder control
• Numbness in the "saddle area" (inner thighs, buttocks, genitals)
• Severe weakness in both legs
• Sexual dysfunction

Action: Seek emergency care immediately. Delayed treatment can result in permanent nerve damage.

Spinal Infection or Tumor

Though rare, infections (osteomyelitis, discitis) or tumors can cause persistent back pain.

Warning signs:

• Unexplained fever with back pain
• Night sweats
• Unintentional weight loss
• History of cancer
• Pain that worsens at night
• Pain unrelieved by rest

Action: See a doctor promptly for evaluation.

Compression Fracture

Vertebral compression fractures can occur from osteoporosis, trauma, or cancer.

Warning signs:

• Sudden onset of severe back pain
• Recent fall or trauma
• History of osteoporosis
• Pain worsens with standing or walking
• Loss of height

Action: Seek medical evaluation, especially if you have osteoporosis risk factors.

When to See a Doctor

Schedule a doctor's appointment if:

• Pain persists beyond 4-6 weeks despite self-care
• Pain is severe and not improving
• Pain radiates down one or both legs below the knee
• Numbness, tingling, or weakness in legs
• Pain interferes significantly with daily activities
• You're over 50 and experiencing new back pain
• You have a history of osteoporosis

Self-Care and Relief Strategies

Immediate Relief (First 48 Hours)

• Ice therapy: Apply ice packs for 15-20 minutes every 2-3 hours
• Gentle movement: Avoid bed rest; light walking is beneficial
• Over-the-counter pain relievers: Ibuprofen or naproxen for inflammation
• Avoid aggravating activities: No heavy lifting or twisting

Ongoing Management

• Heat therapy: After 48 hours, use heating pads or warm baths
• Gentle stretching: Focus on hamstrings, hip flexors, and lower back
• Core strengthening: Planks, bridges, and pelvic tilts
• Low-impact aerobic exercise: Walking, swimming, or cycling
• Maintain healthy weight: Reduces stress on spine
• Proper lifting technique: Bend knees, keep back straight, lift with legs

Exercises That Help

Knee-to-Chest Stretch:

• Lie on back, pull one knee toward chest
• Hold 15-30 seconds, repeat with other leg

Cat-Cow Stretch:

• On hands and knees, alternate arching and rounding back
• Improves flexibility and relieves tension

Pelvic Tilts:

• Lie on back with knees bent
• Flatten lower back against floor, hold 5 seconds
• Strengthens core and improves posture

Bird Dog:

• On hands and knees, extend opposite arm and leg
• Builds core stability

What to Avoid

• Prolonged bed rest (worsens stiffness and weakness)
• Heavy lifting or twisting motions
• High-impact activities during acute pain
• Sitting for extended periods without breaks
• Ignoring pain signals—don't push through severe pain

Prevention Strategies

• Exercise regularly: Aim for 150 minutes of moderate activity weekly
• Strengthen your core: Strong abdominal and back muscles support the spine
• Maintain good posture: Especially when sitting and standing
• Lift properly: Bend at knees, keep load close to body
• Maintain healthy weight: Excess weight stresses the lower back
• Quit smoking: Smoking reduces blood flow to spinal discs
• Ergonomic workspace: Proper chair, desk height, and monitor position
• Stretch regularly: Especially if you sit for long periods

Frequently Asked Questions

The Bottom Line

Lower back pain is extremely common and usually improves with conservative treatment. Most cases result from muscle strain, poor posture, or mechanical issues rather than serious underlying conditions.

The key to recovery is staying active with gentle movement, strengthening your core, and addressing contributing factors like poor ergonomics or weak muscles. While it's tempting to rest completely, gentle activity promotes healing and prevents the deconditioning that can lead to chronic pain.

However, certain red flag symptoms—such as loss of bowel or bladder control, progressive leg weakness, or fever—require immediate medical attention. For persistent pain beyond 4-6 weeks, professional evaluation can identify the cause and guide appropriate treatment.

Remember: This information is educational and doesn't replace professional medical advice. If you're experiencing persistent or severe lower back pain, consult a healthcare provider for proper diagnosis and treatment.