Lower Back Pain: Causes and Treatment

Frequent sitting, lack of exercise, uneven strain, and strenuous physical activity are the usual suspects when it comes to lower back pain. They are among the most common causes. However, organic or psychological conditions can also affect the back. Possible causes include:

• Muscle Tension: Muscle tension is widespread among the general population and is often the cause of aching and stabbing pain in the lower back. The causes include one-sided and repetitive movement patterns, as well as habitual postures such as sitting at a desk all day.
• Poor Posture: People with a swayback often suffer from lower back pain. The muscle tension and shortening caused by this poor posture are what trigger the pain.

• Excess weight: Being severely overweight places an enormous strain on the spine. Combined with a chronic lack of exercise, posture suffers under the pressure of the weight.
• Stress: Sometimes lower back pain is a sign of emotional strain. Stress at work or in your personal life, in particular, often manifests as nonspecific back pain.
• Sleeping Conditions: In many cases, the wrong mattress leads to lower back pain in the morning. Instead of waking up feeling refreshed, you struggle out of bed with a pulling and stabbing sensation in your lower back.
• Pinched nerve: One sudden, jerky movement—lifting a water jug from left to right—and suddenly a nerve in your lower back is pinched. This also often happens from lying in an awkward position for too long. However, an imbalance in muscle tension is usually already present beforehand. A trained, well-balanced back can compensate for such strains.

• Sciatica: A classic cause of lower back pain is sciatica. In this condition, the sciatic nerve is compressed by abnormal muscle tension in the gluteal-lumbar region (piriformis syndrome). This causes severe pain that radiates from the lumbar region through the buttocks and down into the leg.
• Injuries: Accidents or falls can cause injuries to the lumbar vertebrae, such as avulsions or fractures. The ligaments can also be affected.
• Lumbago: Lumbago—also known as acute lumbalgia or acute lumbar spine syndrome—is a well-known and dreaded condition. The pain suddenly shoots through the back like a stab and restricts mobility. It is caused by muscle stiffness resulting from a sudden, jerky movement when standing up or lifting something.
• Vertebral Blockages: The lumbar spine is in constant motion throughout the day. It bends forward and straightens up, rotates from right to left, and bends from side to side. A careless, jerky movement can lead to a painful blockage if a myofascial imbalance is already present.
• Osteoporosis: Osteoporosis causes bone tissue to become brittle. The strain on the spine can therefore lead to spondylolysis and vertebral fractures.
• Other Conditions: Back pain is not necessarily caused by a problem in the spine. Often, other conditions such as heart failure, heart attack, stroke, depression, shingles, pyelonephritis, pneumonia, or inflammatory joint diseases lead to back pain. It is always considered a medical emergency if shortness of breath, signs of paralysis, or a feeling of tightness in the chest are present.
• Pregnancy: The natural weight gain and physical changes during pregnancy also affect the spine. As pregnancy progresses, the pelvic region changes, and many women develop a swayback due to the weight of their abdomen.

Older adults often complain of lower back pain. In these individuals, the muscle-fascia tissue is less flexible—for example, due to a lack of water and nutrients. They have also spent many more years in poor posture and move even less, which leads to significantly more muscle tension. However, due to a predominantly sedentary lifestyle and increasing comfort, many younger people are now also affected by back pain.

Sometimes the problem isn’t with the lumbar spine at all; rather, the pain originates in the surrounding organs. In such cases, the pain can radiate to the back and cannot be relieved by back therapy alone. These organs are located in the lower abdomen:

• Intestines
• Bladder
• Reproductive organs

However, other organs can also cause referred pain and lead to lower back pain:

• Stomach
• Pancreas
• Kidney
• Gallbladder
• Lungs
• Spleen

In some cases, digestion alone can cause a temporary stabbing, pulling, or dull pain in the lower back.

For many women, menstrual cramps radiate to the lower back. In women with endometriosis, the symptoms may become more severe or less severe over the course of the cycle, or they may persist continuously.

The symptoms are usually not limited to the lower back. Often, the pain radiates into the legs or the upper back. The pain also manifests itself in very different ways. The most common symptoms are

• a stabbing, burning, dull, pressing, or throbbing pain in the lower back
• limited range of motion
• pain radiating into the buttocks or legs
• numbness and tingling in the legs
• weakness in the legs

Back pain can be acute and very severe, but it often becomes chronic or comes and goes.

If the symptoms last up to three months, they are considered subacute. Sometimes the back only acts up during certain movements, such as bending over, lifting heavy objects, or twisting the upper body.

If acute back pain restricts your breathing or movement, you should definitely see a doctor. The same applies if the pain is persistent and cannot be relieved by conservative treatments such as heat, exercise, and massage.

If lower back pain occurs primarily while lying down—whether at night in bed or during the day while resting on the sofa—various factors may be at play. The following causes are particularly common for lower back pain while lying down:

1. Irritation of the sciatic nerve or a pinched nerve
   
   When lying down, the body relaxes, and irritated nerves are often felt more distinctly. The sciatic nerve, in particular, can come under pressure due to unfavorable lying positions—such as twisting or bending the lumbar spine to the side. This results in pulling, burning, or stabbing pain in the lower back, often radiating into the buttocks, leg, or even down to the foot.

2. An unsuitable mattress or lack of pressure relief
   
   A mattress that is too hard, too soft, or sagging cannot provide adequate support for the spine while you sleep. If the shoulders and pelvis do not sink in ergonomically correctly, this often leads to spinal misalignment—such as an exaggerated swayback (hyperlordosis) or a lateral curvature (tendency toward scoliosis). This promotes muscle tension, myofascial trigger points, and strain on the intervertebral discs and joints.

3. Excessive Lordosis (Hyperlordosis)

   People with increased lumbar lordosis often find lying down uncomfortable because the lumbar spine cannot fully relax. A flat pillow or a small roll under the knees while lying on your back, or a slightly angled side-lying position, can help relieve pressure on the lower back and better support the natural lordosis.

4. Unhealthy sleeping habits

   In addition to the mattress, the box spring, pillows, and preferred sleeping position also affect back health. An ergonomic side-sleeping position with a pillow between the knees or a supine position with the legs slightly elevated can support the natural alignment of the spine and relieve pressure on the lumbar spine.

Many people notice that the longer they sit, the worse their back pain becomes—especially in the lumbar region. This is no coincidence: the sitting position places particularly heavy strain on certain structures of the spine. Here are the most common reasons why back pain worsens when sitting:

1. Poor sitting posture and lack of movement

   When sitting, the body often tends to slump. This causes either the lower back to become overextended (hyperlordosis) or the pelvis to tilt backward (posterior tilt). Both lead to uneven stress on the intervertebral discs and facet joints. In addition, a lack of physical activity reduces blood flow and metabolic activity in the tissues, which contributes to tension and pain in the lumbar spine.

2. Herniated Disc

   When sitting, pressure on the intervertebral discs increases—significantly more than when standing or lying down. If the intervertebral discs are already damaged (e.g., due to degeneration or protrusions), this can lead to nerve irritation. This often results in pain radiating into the buttocks, leg, or even down to the foot (sciatic pain symptoms).

3. Sacroiliac Joint (SIJ) Syndrome or SIJ Blockage

   The sacroiliac joint (SI joint) connects the sacrum to the pelvis. Prolonged sitting, one-sided strain, or poor movement patterns can lead to dysfunction. Typical symptoms include one-sided, deep-seated pain in the sacrum area that may radiate into the buttocks or thigh.

4. Lack of Active Stability

   Weak core muscles (deep abdominal and back muscles) prevent the spine from being optimally stabilized while sitting. As a result, passive structures such as ligaments, intervertebral discs, and joint capsules take on more of the load—which, over time, causes pain and strain-related problems.

5. Limited hip flexor mobility and its effects

   Frequent sitting causes the hip flexor muscles—especially the iliopsoas—to remain in a shortened position for long periods of time. This often leads to increased muscle tension and functional limitations in hip extension. Limited hip flexor mobility affects pelvic alignment and can contribute to strain on the lumbar spine. As a result, the back is more likely to develop an exaggerated swayback (hyperlordosis) or compensate through unfavorable movement patterns.
   

Tip: Regularly changing positions, taking breaks to do mobility and strengthening exercises, and building stable core muscles can help prevent back pain while sitting in the long term. An ergonomically adapted seating environment also supports back health.
If symptoms are persistent or severe, it is essential to seek an evaluation from a doctor or physical therapist.

There are various treatment options for lower back pain, each of which depends on the cause of the symptoms.

Acute pain is treated differently than chronic pain. In most cases, however, conservative therapy provides relief:

• Exercise
• Fascia exercises
• Heat
• Massage
• Physical therapy
• Back Exercises
• Acupuncture
• Acupressure
• Medications
• Back Pain Therapy
• Surgery

In most cases, treatment involves relaxing the back muscles, releasing tension, and correcting muscular imbalances. Back pain often improves with the application of heat, massage, training with a foam roller, and increased physical activity in daily life. This stimulates blood circulation and loosens tight tissue.

Surgery for back pain is now rarely necessary, except in cases such as a fracture or a herniated disc, or when cauda equina syndrome is present—a condition associated with numbness on the inner thighs and incontinence.

Targeted exercises are an effective way to treat back pain. Regular training of the back and abdominal muscles is actually the best preventive measure for staying symptom-free in the long term. It is particularly important to stretch the deep anterior myofascial chain.

The following exercises can provide short-term relief for acute lower back pain:

Step Position: Lie on your back with your lower legs resting on a chair so that your knees and hips form a 90-degree angle. In this position, your lower back can relax and the pain subsides.

Knee Pulls: Lie on your back and pull both knees toward your chest. Wrap your hands around your knees and actively pull them even closer as you exhale; as you inhale, release them gently. Repeat the exercise several times until the pain subsides.

Cat-Cow Pose: Get on all fours and keep your back straight. Then, as you exhale, round your back like a cat. As you inhale, move your spine in the opposite direction and repeat the sequence several times. This mobilizes the spine and releases tension.