Table: Some Causes and Features of Low Back Pain - Merck Manuals Consumer Version

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