Some Causes and Features of Low Back Pain

Cause	Common Features*	Tests†
Common causes
Sprains and strains	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)
Vertebral compression fractures	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 disc, 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
Lumbar spinal stenosis	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	X-rays MRI or sometimes CT
Fibromyalgia	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
Cauda equina syndrome	Numbness in the groin and around the anus Loss of bladder control and/or loss of bowel control (incontinence)	MRI
Shingles	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 In the vertebrae (osteomyelitis) In the disc (diskitis) Around the spinal cord (spinal epidural abscess)	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 medications that suppress the immune system, or who use injection illicit drug use	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.

Cause

Common Features*

Tests†

Common causes

Sprains and strains

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)

Vertebral compression fractures

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 disc, 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

Lumbar spinal stenosis

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

X-rays

MRI or sometimes CT

Fibromyalgia

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

Cauda equina syndrome

Numbness in the groin and around the anus

Loss of bladder control and/or loss of bowel control (incontinence)

MRI

Shingles

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

In the vertebrae (osteomyelitis)
In the disc (diskitis)
Around the spinal cord (spinal epidural abscess)

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 medications that suppress the immune system, or who use injection illicit drug use

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.

In these topics

Low Back Pain