Low Back Pain

The lower back is supported by the lumbar spine, which consists of five vertebrae (L1 to L5) located between the ribs and the pelvis. Between each vertebra are intervertebral discs, fibrocartilaginous cushions that absorb shock and allow for spinal mobility.

The entire structure is held together by ligaments and muscles that provide stability and movement.

The lumbar spine supports most of the body’s weight. It is precisely this significant mechanical load that makes it particularly vulnerable to injury and wear and tear. Five pairs of lumbar nerves (L1 to L5) and five pairs of sacral nerves (S1 to S5) originate in this region. Any compression or irritation of these nerve roots can cause pain radiating into the buttock, thigh, or foot—a condition known as cruralgia or sciatica.

Low back pain manifests in a wide variety of ways depending on the individual and the underlying causes. It can be dull or sharp, burning or throbbing, constant or intermittent. It may remain localized in the back or radiate to the buttocks, hips, or legs.

Among the most common symptoms: Lower back pain is considered acute if it lasts less than four weeks, subacute between four and twelve weeks, and chronic beyond three months.

• Pain worsened by certain movements (bending, lifting, standing up) or prolonged positions (sitting or standing)
• Morning stiffness, gradually relieved by activity
• Muscle spasms, sometimes very painful
• Pain radiating down one leg, with tingling or numbness (a sign of nerve damage), but which is treated differently from pure low back pain

Low back pain is generally classified into two main categories based on its cause.

Common low back pain (or nonspecific low back pain), by far the most common type, results from a gradual mechanical deterioration of the intervertebral discs and facet joints. These structures, which are slightly worn, struggle to ensure optimal functioning of the spine, forcing the muscles to compensate. It is this muscular overload that is often the source of pain, sometimes manifesting as muscle spasms and stiffness. Spinal osteoarthritis (spondylosis) is part of this same degenerative process.

Specific low back pain encompasses identifiable and distinct causes that require targeted management:

• Herniated disc: the gelatinous nucleus of a disc protrudes and compresses a nerve root
• Narrow lumbar canal (spinal stenosis): narrowing of the spinal canal exerting pressure on the nerves
• Vertebral compression: fracture of a weakened vertebra, often linked to osteoporosis
• Ankylosing spondylitis: an inflammatory rheumatic condition affecting the joints of the spine

Several factors increase the likelihood of developing low back pain or of it becoming chronic:

• Age: incidence peaks between the ages of 35 and 55; spinal structures gradually deteriorate with age
• Sedentary lifestyle: weak back and abdominal muscles provide poor support for the spine
• Overweight: excess weight increases mechanical stress on the lumbar spine
• Smoking: associated with an increase in the frequency and intensity of low back pain
• Psychological factors: stress, anxiety, depression, and job dissatisfaction contribute to the onset and, above all, the persistence of pain
• History: a first episode of low back pain predicts a 20–45% risk of recurrence within the following year

The diagnosis of low back pain relies primarily on a thorough physical examination. The doctor asks the patient about the location, nature, and progression of the pain, as well as any triggers and medical history. They systematically look for warning signs that could indicate a serious cause: fever, unexplained weight loss, history of cancer, recent trauma, urinary problems, or progressive neurological deficits.

A neurological examination of the lower extremities (sensation, muscle strength, reflexes) helps assess for possible nerve root involvement.

In the vast majority of cases, no additional tests are necessary during the acute phase. Studies show that early imaging does not alter the course of non-specific low back pain and exposes patients to incidental findings (such as asymptomatic disc herniations, present in one in four adults under 60) that may lead to unnecessary treatments.

However, tests are indicated if warning signs are present, or if pain persists despite four to six weeks of conservative treatment:

• X-ray: useful for detecting fractures, bone compression, or misalignment
• MRI: the gold standard for visualizing discs, nerves, and soft tissues
• CT scan: an alternative to MRI, particularly in cases of contraindications
• Blood tests: to rule out infectious, inflammatory, or neoplastic causes

Acute and subacute low back pain

Contrary to intuition, bed rest makes things worse. Early mobilization, tailored to the intensity of the pain, promotes faster healing. The goal is not the total absence of pain, but maintaining as normal an activity level as possible.

In terms of medication, acetaminophen is the first-line analgesic. If this is insufficiently effective, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be added for a short period (one to two weeks maximum). Muscle relaxants are sometimes helpful in cases of significant muscle spasms. Opioids are reserved for severe, refractory pain, under strict medical supervision.

Physical therapy is not recommended as a first-line treatment for isolated acute low back pain, but becomes particularly valuable during the subacute phase, especially through active exercises for muscle strengthening and proprioception. Manual therapies (spinal manipulation, osteopathy) may be beneficial when symptoms persist beyond one to two weeks.

Other complementary approaches show varying degrees of effectiveness depending on the patient: acupuncture, yoga, massage, and transcutaneous electrical nerve stimulation (TENS).

Chronic Low Back Pain

When pain persists for more than three months, multidisciplinary care becomes necessary. This combines active physical therapy, psychological support if needed, and social or occupational support. Certain situations may warrant corticosteroid or local anesthetic injections around the spinal nerves, or neuromodulation techniques.

Surgery remains an option reserved for specific indications: herniated disc with progressive neurological deficit, severe spinal stenosis, or documented spinal instability. It is considered only after all properly conducted conservative therapies have failed.

Most cases of low back pain have a favorable outcome. A few specific situations require special attention:

Cauda equina syndrome is a rare surgical emergency: compression of the sacral nerve roots can lead to urinary problems (retention or incontinence), bowel dysfunction, saddle anesthesia, and weakness in the lower limbs. It requires immediate imaging and surgical intervention.

The transition to chronicity, affecting approximately 10% of patients, is a major concern. These cases account for the majority of healthcare costs and prolonged work absences, and require intensive multidisciplinary care.

No intervention has been shown to prevent a first episode of low back pain. However, several measures reduce the risk of recurrence and chronic progression:

Regular physical activity is the most well-documented protective factor. Core muscle strengthening exercises (core training) complement this approach. Quitting smoking, maintaining a healthy weight, and adopting proper work postures (ergonomic desk, correct lifting techniques) also help protect the spine.

See your doctor promptly if:

• The pain persists for more than a week without improvement, or worsens
• It radiates down a leg beyond the knee, accompanied by numbness or weakness
• It occurs after a trauma (fall, accident)
• It is associated with a fever, unexplained weight loss, or a history of cancer

Hôpital de La Tour offers comprehensive and coordinated care for low back pain, from diagnosis through follow-up. All relevant specialists (spine surgeons, rheumatologists, sports medicine physicians, radiologists, pain management specialists, and physical therapists) practice on the same campus, which facilitates communication between teams and minimizes delays between stages of care.

La Tour’s spinal surgeons are specialists trained in orthopedic surgery or neurosurgery, with in-depth additional training in the surgical treatment of spinal conditions.

For people suffering from chronic low back pain, La Tour has developed MyBack, a multi-therapy group program focused on physical activity and therapeutic education. This interdisciplinary approach aims to help patients better manage pain in their daily lives, regain confidence in their bodies, and restore a lasting quality of life—without necessarily considering surgery.

How do I know if my back pain is serious?

The vast majority of lower back pain cases are mild and temporary. However, certain symptoms warrant prompt medical attention: pain that persists for more than a week without improvement, pain radiating down one leg below the knee, the onset of muscle weakness, fever, or unexplained weight loss.

Should I rest or stay active when I have back pain?

Staying as active as the pain allows is the current recommendation, well-established by research. Strict bed rest slows healing and weakens the muscles. Gentle movements, tailored to your tolerance, promote faster recovery.

Is an MRI necessary to diagnose low back pain?

No, in most cases. A clinical examination is sufficient to diagnose common low back pain and rule out serious causes. An MRI is useful if warning signs are present or if the pain does not respond to several weeks of conservative treatment.

Can lower back pain go away without treatment?

Yes, frequently. Many acute episodes resolve spontaneously within a few days to a few weeks, sometimes without any medical intervention being necessary. Pain relief and clear information on what to do, however, speed up recovery.

Is exercise discouraged when you have back pain?

Not generally. Certain physical activities, particularly low-impact ones such as swimming, walking, or cycling, are recommended even during the moderate acute phase. During the recovery phase, regular muscle strengthening is one of the best ways to prevent recurrence.

When is lower back pain considered chronic?

Lower back pain is considered chronic when it persists for more than three months. This situation affects about 10% of patients but accounts for the majority of prolonged work absences and healthcare costs related to lower back pain. Early multidisciplinary care helps limit this risk.

What is sciatica, and how does it differ from ordinary low back pain?

Sciatica refers to pain that radiates from the lower back down the leg, following the path of the sciatic nerve, often all the way to the foot. It indicates irritation or compression of a nerve root, most commonly due to a herniated disc. It may accompany low back pain but constitutes a distinct clinical condition requiring specific evaluation.