Lower back pain is a common complaint. Clients regularly mischaracterize their pain and misdiagnose themselves due to not being properly educated about anatomical landmarks and different types of pain. I will discuss some basic anatomical landmarks that will help a layperson more precisely understand the actual body parts being discussed. I will also describe some different commonly-used descriptive words for pain that can allow you to properly differentiate your pain sensation.
I may not have worded it very simply, but it is a simple process I will walk you through. First I am talking about your lower back body parts, then about pain itself, and then we will put it together and maybe end this article with you able to figure out which part of your lower back is actually bothering you and why. Once you know that you will be better equipped to develop a plan to get out of pain.
The Anatomy
Before we talk about specific spots, let's describe the normal lower back anatomy. There are five lumbar vertebrae. The twelve above the lumbar (low back) are the thoracic. All thoracic vertebrae have ribs attached to them. So, between the tailbone and your lowest rib is five lumbar vertebrae. They are numbered 1-5, with 1 being the top and 5 being the bottom. Your lowest disc, the L5 disc, is between your lowest vertebra and your tailbone. Your tailbone is shaped like an upside-down triangle. Your SI joints (sacro-iliac joints) are the two knobs of bone on either side of the bottom of your lower back.
I would like you to stand up. Place your hands on your hips on your side so that your index fingers rest on the hips. The hip bone there is roughly level with your 4th lumbar vertebra. You can use your fingertips to rub your SI joints while keeping your thumbs on your hips. Your lowest lumbar bone and the disc below is are midline roughly parallel to the top of your SI joints. If you are a health body weight and not too injured to reach, you can rub your thumbs around where your lowest disc is by bringing your thumbs inwards from the SI joints.
Characterizing Pain
There are many commonly-used descriptive words to describe pain. Since pain is a subjective, rather than objective, sensation that means even using accepted and agreed-upon terminology doesn't guarantee anyone the ability to perfectly describe the pain. To illustrate subjectivity, two people may similarly describe the sound that a chirping bird makes but they will experience and react to similar pain differently.
With that concern in mind, let's outline the descriptive words.
Burning pain is likely nerve pain. If there is a burning type sensation in your lower back this may be due to a disc injury irritating a nerve root. Still, nerve pain of lower back origin is typically felt in the legs and feet, not in the back where the pain is being caused. Burning pain is more common in the buttocks, legs and feet.
Shooting pain is felt very briefly, but it's very intense. The shooting aspect of the pain may be a sudden irritation to a nerve sending a large degree pain sensation down the course of the sciatic nerve. This happens quickly - nerves can transmit impulses 50 miles per hour and your legs is just a few feet long.
Sharp pain often describes high intensity pain that is localized and does not shoot anywhere. Sharp pain and stabbing pain are often used synonymously.
Dull pain is poorly localized. Dull pain, often a dull ache, is of a lower intensity and is difficult to pinpoint. Many people wave their hand over an area, as opposed to pointing, when asked to point to their pain.
Pain may be positional. This may be due to certain body positions irritating different body parts, or it may be the use of the injured body part that causes the pain. Some times the pain is reproducible only with a certain position, other times it is due to a particular activity.
Another factor is at what time and for how much of your day do you experience the pain. Some types of pain are more common in the morning, other types are more common with increased activity, some are typically intermittent in nature, and some types of pain tend to be constantly painful.
Putting this Information Together
It is important that I point out at this time that you should not rely on any diagnosis you give yourself based solely on reading this article. You could very will be misunderstanding something I am saying or you may be experiencing a serious type of pain I am not describing. Frankly, relying on advice you find on the Internet is rarely intelligent when any serious health issue is concerned.
Is it muscle pain? If the pain is reproduced by performing a particular motion or posture, then it may be muscular in origin. Muscle pain is commonly described as soreness. Muscle pain is either felt in the bulging, central part of a muscle or at the part where the muscle attaches to bone. Sometimes lower back pain felt mostly at the back crest of your hip bone, below your ribs where some back muscles attach. Sometimes the easiest thing to do it take your hand and knead into your back muscles to see if they cause your pain to be reproduced. Muscle pain is often lateral in nature. By that I mean that either the right low back, or the left low back, may be in pain due to an injury to a muscle on one side while the other side isn't injured.
Is it disc or nerve pain? If the pain is burning or shooting, or if you have numbness or tingling in your butt or legs, then a disc and/or nerve is probably involved. Discs have minimal pain sensing ability, but when injured may cause localized burning slightly off midline in the lower back. This may be accompanied by the leg pain or numbness.
Did I tear or break anything? That localized disc pain indicates a possibly torn outer disc layer. There are not many easy-to-break bones in the lower back. Hip bones are hard to break and you would have experienced a fall or collision with something and have had x-rays in all likelihood, so you wouldn't be reading this article trying to find out what went wrong. Lumbar vertebrae can fracture, so if you are old or have osteoporosis, you should consider that possibility. Ribs can fracture. but lumbar vertebrae do not have ribs. A part of the lumbar vertebra called the transverse process may fracture in instances involving strong muscle contraction in the lower back. Muscles can tear, also, but this typically involves a sudden load on the back or spine or hips, or a strong contraction caused by lifting or holding something. Additionally, ligaments may tear. If you were to tear a ligament (basically, pain is how people refer to a torn ligament) in the lower back this would quite possible feel like a burning pain, and would be localized, but you would most likely remember whatever happened that caused the tear.
Pain that comes on suddenly, especially if you recall the precipitating event (ex: a car crash), is likely to be a muscle strain, a ligament sprain, a disc injury, or a fracture. Pain that comes on slowly and over time is more likely to be a postural issue, or a repetitive stress issue. Postural and repetitive motion injuries can be to the muscle, ligament, or disc. To address the root cause, the development of the pain is important. If it is a sudden injury then the goal is recovery from an injury. If the pain set in slowly then you quite likely need to make changes to the way you use your body.
Importantly, you may consider a tumor in your lower back. Men of a certain age must consider prostate cancer. Other cancers, including many cancers which women may be diagnosed with, can metastasize to the spine or hips. Cancer is often felt like a deep, boring pain that is not relieved by rest and which seems to get worse over time. Be sure to consult a doctor if you think this describes your pain.
So, there you have it. You now have a bit more education you can use to try to identify the part of your back that truly hurts and to maybe figure out the right way to describe it to your chiropractor or doctor. Figuring out the problem is a great first step for addressing it.
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