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12 causes of low back pain
Low back pain is not a diagnosis, but a symptom. It can be caused by dozens of different pathologies. Accurate identification of the cause is the key to effective treatment.
1. Herniated Disc
The most common cause of acute low back pain with radiation into the leg. The disc nucleus protrudes beyond the fibrous ring and compresses the nerve root. Pain worsens with bending, coughing, and sneezing. Statistically, L4-L5 and L5-S1 herniations account for 95% of all lumbar herniations.
2. Disc Protrusion
The preceding stage of herniation — the disc bulges, but the fibrous ring is still intact. It manifests as dull, aching low back pain that worsens after prolonged sitting. Treatment is most effective at this stage and can prevent full herniation.
3. Spinal Stenosis
Narrowing of the spinal canal due to degenerative changes. Characteristic symptom is neurogenic claudication: pain and weakness in the legs when walking, relieved by leaning forward. Most common in people over 50 years old.
4. Facet Joint Syndrome
Osteoarthritis of the zygapophyseal (facet) joints of the spine. Cause of up to 40% of chronic low back pain cases. Pain is localized in the lumbar area, worsens with extension and rotation. Does not radiate below the knee (unlike herniation).
5. Osteochondrosis
Degenerative-dystrophic changes in intervertebral discs and vertebral bodies. Develops gradually, manifests as morning stiffness and dull pain with loading. MRI shows disc dehydration, osteophytes, and reduced intervertebral space height.
6. Spondylolisthesis
Displacement of a vertebra relative to the one below. Can be degenerative (in the elderly) or isthmic (in young athletes). Manifests as low back pain, a "step" on palpation, and sometimes compression of neural structures.
7. Sciatica (Radiculopathy)
Inflammation or compression of the sciatic nerve. Manifests as shooting pain from the low back along the posterior thigh to the foot. Pain may be accompanied by numbness, tingling, and weakness in the leg.
8. Sacroiliitis
Inflammation of the sacroiliac joint. Often masquerades as "low back pain," but is actually located lower — in the buttock and sacral area. This may be a sign of ankylosing spondylitis or reactive arthritis.
9. Myofascial Pain Syndrome
Chronic tension and spasm of lumbar muscles (quadratus lumborum, spinal extensors). Often develops with a sedentary lifestyle. Pain is dull, diffuse, with characteristic trigger points.
10. Failed Back Surgery Syndrome (FBSS)
Persistence or worsening of pain after spine surgery (microdiscectomy, stabilization). Causes: recurrent herniation, scar-adhesion process, instability of adjacent segment. Regenerative treatment is particularly effective in these cases.
11. Vertebral Compression Fracture
More common in elderly people with osteoporosis — can occur with minimal stress. Acute pain at the fracture site, worsening with movement. Diagnosed by X-ray or CT.
12. Tumors and Metastases
Rare but dangerous cause. Characteristic are nighttime pains that do not subside at rest, weight loss, and worsening general condition. Requires immediate contrast-enhanced MRI.
Red Flags — when a doctor is needed urgently
Cauda Equina Syndrome
Numbness in the perineum, impaired urination and defecation, bilateral weakness in the legs. This is an emergency condition — urgent evaluation within 24-48 hours is required.
Progressive Neurological Deficit
Increasing weakness or paralysis of the foot (foot drop), loss of sensation over a large area of the leg.
Pain After Trauma
Acute low back pain after a fall, accident, or sports injury — vertebral fracture must be ruled out.
Systemic Signs
Unexplained weight loss, fever, night sweats combined with back pain — oncology and infection must be ruled out.
Diagnostics: which examinations to undergo
Lumbar Spine MRI
Gold standard of diagnostics. Shows the condition of discs, neural structures, ligaments, and muscles. No radiation exposure. Mandatory for pain lasting more than 4-6 weeks or with neurological symptoms. We provide free evaluation of MRI scans.
Radiography
With functional tests (flexion/extension) — to detect instability. Shows bone structures, osteophytes, spondylolisthesis. Does not visualize soft tissues or herniations.
EMG (Electroneuromyography)
Suspected radiculopathy — determines the level and degree of nerve damage. Helps differentiate the cause of numbness and weakness in the leg.
Laboratory Tests
ESR, C-reactive protein, complete blood count — to rule out inflammatory diseases (Behçet's disease, infectious spondylodiscitis). HLA-B27 for suspected ankylosing spondylitis.
How it is treated: the cause comes first
Treatment depends on the cause of the pain, so it starts with an examination and, if needed, imaging — X-ray, ultrasound or MRI. The same pain can be caused by osteoarthritis or by a tendon, nerve or disc problem.
Most patients are helped by conservative treatment: exercise therapy, load management, short courses of painkillers and sometimes injections. Regenerative methods (PRP, cell preparations) are discussed once the diagnosis is known and there is at least limited evidence for it; no method guarantees a result.
We send a description of your case and your images to several partner clinics. The clinic doctors give a preliminary opinion, suggest a plan and quote a price, and we help you compare the options.
Diseases Causing Low Back Pain
Herniated Disc
Prolapse of the disc nucleus with nerve compression. Acute pain radiating to the leg.
Spinal Stenosis
Narrowing of the spinal canal. Neurogenic claudication, pain while walking.
Facet Joint Syndrome
Osteoarthritis of the facet joints. Pain on extension, up to 40% of chronic pain cases.
Osteochondrosis
Disc degeneration. Morning stiffness, dull pain with loading.
Spondylolisthesis
Vertebral slippage. Instability, pain when transitioning from sitting to standing.
Sciatica
Compression of the sciatic nerve. Shooting pain down the leg to the foot.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
- Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 2015.
- Lurie JD et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised · Lower back pain on one side
Questions about Low Back Pain
Seek urgent medical attention for: numbness in the perineum or both legs, urinary dysfunction, progressive leg weakness, pain after trauma, unexplained weight loss, fever. These symptoms may indicate cauda equina syndrome or other emergencies.
In most cases, yes. Pain from a herniation resolves in many people within 6–12 weeks, and the herniation itself often shrinks over time. The basis of treatment is activity, exercise therapy and painkillers; for severe radicular pain a periradicular or epidural injection helps. Intradiscal methods (PRP, cell products) are still being studied, and evidence for their effectiveness is limited. Surgery is discussed for neurological deficit or persistent severe pain.
Primary test — MRI of the lumbar spine (without contrast). Additional: X-ray with functional tests, EMG for suspected radiculopathy, blood tests (ESR, CRP) to rule out inflammatory diseases.
A block with local anaesthetic and corticosteroid quickly reduces inflammation and radicular pain, with an effect that usually lasts weeks or months; frequent repeated corticosteroid injections are undesirable. PRP for back pain has been studied less, and reliable evidence of its effectiveness is still limited. No injection replaces exercise. The clinic physician decides which method is appropriate based on the MRI and clinical picture.
The cost depends on the diagnosis, the number of procedures and the extent of diagnostics, as well as on the clinic: each clinic has its own conditions and prices. We send your request to several partner clinics and forward their offers for comparison. Send your MRI via the form on the website — the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion is usually ready within 1–3 working days.