Rheumatology’s role: Inflammatory back pain from axial spondyloarthritis is one cause a rheumatologist can evaluate, especially in younger adults with morning stiffness that eases with movement.
For full details on this condition, see our main page: Low Back Pain.
Overview
Low back pain is pain between the bottom of the ribs and the top of the legs. It can be short-lived (acute) or last more than three months (chronic). Sources include muscles, discs, facet joints, the sacroiliac joints and the vertebral endplates.
For chronic low back pain, identifying the most likely pain source helps match you with the right treatment. Options at GSMC range from therapy and injections to minimally invasive procedures.
Watch and learn
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Common symptoms
- Aching or stiffness in the lower back
- Pain worse with sitting, standing or bending
- Pain that spreads to the buttocks
- Muscle spasm
- Difficulty with daily activities or sleep
Causes and risk factors
- Muscle strain
- Facet joint arthritis
- Disc degeneration
- Vertebrogenic (endplate) pain
- Sacroiliac joint dysfunction
- Spinal stenosis
How it is diagnosed
Diagnosis usually starts with a conversation about your symptoms and a physical exam. Depending on what we find, your clinician may order X-rays, an MRI or CT scan, or nerve tests. Imaging findings are interpreted together with your exam, because many people have changes on an MRI that do not cause pain.
Treatment options
Self-care and lifestyle
Most low back pain improves with time and activity. Staying active, short walks, heat, and gentle stretching and core work may help. Avoid long bed rest.
Physical therapy and medications
A physical therapy program focused on exercise and movement is often the next step. Short-term anti-inflammatory medicine or other medicines may be used if they are safe for you.
Injections and nerve blocks
When pain comes from a specific source, image-guided injections may help confirm the source and ease pain: facet joint injections or medial branch blocks for facet pain, SI joint injections for SI pain, and epidural injections when a nerve is irritated.
Minimally invasive procedures
For pain that keeps returning from a confirmed source, options may include radiofrequency ablation (facet or SI joints), Intracept for vertebrogenic pain, VIA Disc NP for selected disc pain, MILD for stenosis, or spinal cord stimulation for persistent pain.
Surgical evaluation
Surgery is considered for nerve compression with weakness, instability, or when other care has not helped and imaging matches your symptoms.
Frequently asked questions
What is chronic low back pain?
Low back pain lasting longer than about three months is usually considered chronic.
Which treatment is right for me?
It depends on the likely source of pain, your exam and your imaging. Your physician will explain the options and the evidence for each.
Should I stay in bed?
Bed rest is generally not recommended. Gentle activity is usually better for recovery.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.