What Causes Lower Back Pain? 7 Common Causes and How to Tell Them Apart

"Lower Back Pain" Isn't a Diagnosis

When someone tells me they have lower back pain, I know where it hurts. I don't yet know why. That distinction matters more than most people realize. A sharp pain that shoots down your leg and a dull ache that builds through the workday can both be called "lower back pain," yet they usually have different causes, and they respond to different treatment.

Many patients arrive at our White Oak office after months of being treated for the symptom. They've had pills, a heating pad, maybe a round of physical therapy, and the pain keeps returning. Often that's because nobody pinned down the cause. I'm Dr. Anthony Consales, and after 35+ years of treating backs, here are the seven causes I see most often, how they tend to feel, and what to do about them.

This is general education, not a diagnosis. Only an exam can tell you what's happening in your back.

1. Disc Herniation or Bulging Disc

The discs between your vertebrae act as cushions. When the outer wall weakens, the soft center can push outward and press on a nearby nerve.

What it tends to feel like: Deep low back pain, often with pain, numbness, or tingling traveling into the buttock or leg. Sitting, coughing, or bending forward usually makes it worse.

We explain how this is treated without surgery in our guide to herniated discs, spinal decompression, and StemWave.

2. Sciatic Nerve Irritation

Sciatica isn't a cause by itself. It's what you feel when the sciatic nerve is irritated, often by a disc, a narrowed canal, or a tight piriformis muscle.

What it tends to feel like: Burning or electric pain that follows a path from the low back through the buttock and down one leg. If it keeps coming back, see what causes sciatica flare-ups or our sciatica page.

3. Spinal Stenosis

Stenosis is a narrowing of the spinal canal, usually from age-related changes such as bone spurs, thickened ligaments, and bulging discs.

What it tends to feel like: Back and leg discomfort that comes on with walking or standing and eases when you sit or lean forward, like on a shopping cart. It's most common after 50. Read more in our stenosis guide.

4. Facet Joint Irritation and Arthritis

The small joints at the back of your spine guide and limit motion. When they wear, stiffen, or get stressed, they become a pain source of their own.

What it tends to feel like: A localized ache or stiffness that's worse first thing in the morning or after standing a long time, and often worse when you lean backward or twist.

5. Misalignment and Restricted Joint Motion

When spinal joints or the pelvis stop moving the way they should, nearby muscles tighten to protect them. Over time, the compensation pattern itself becomes a source of pain.

What it tends to feel like: A "locked up" or catching feeling, pain on one side of the low back, and stiffness that eases a bit with movement. Chiropractic adjustments and structural integration are designed to restore motion and release the muscles that guard these areas.

6. Muscle and Ligament Strain

A sudden lift, a twist, or a long weekend of yard work can overload soft tissue. Most simple strains settle within a few weeks. But when tissue doesn't heal fully, it can become a chronic trouble spot.

What it tends to feel like: Achy, sore, and tender to the touch, usually without pain traveling into the leg. Chronic cases are where tools like StemWave acoustic wave therapy and Class IV laser therapy can help restart healing in tissue that has stalled.

7. Inflammation and Nutritional Stress

This is the cause most people never hear about. Chronic inflammation, poor sleep, and nutritional gaps can make tissue slower to repair and more reactive to every small stress, so a back that should have recovered keeps flaring.

What it tends to feel like: Pain that lingers longer than the original injury would explain, often alongside fatigue, digestive trouble, or poor sleep. That's why we look at the whole person. Nutrition Response Testing helps identify what your body is asking for so your structural treatment has the raw materials to hold. (New to NRT? Start with our complete guide.)

Why Causes Overlap

Real backs rarely have one tidy cause. A patient might have a mildly bulging disc, stiff facet joints, and tight guarding muscles, plus inflammation that keeps all of it irritated. Treat just one layer and the others keep the pain going. This is why single-treatment approaches so often give temporary relief, and why we combine therapies in a coordinated plan. Our whole-body approach lays out how: signal the healing, fuel the repair, and make the results hold.

When to Get Care Right Away

Most back pain is not an emergency. But go to the ER or call 911 if your back pain comes with any of these:

• Loss of bladder or bowel control
• Numbness in the groin or inner thighs
• Sudden, severe weakness in one or both legs
• Pain after a significant fall or accident
• Fever or unexplained weight loss along with back pain

When to Come See Us

Make an appointment if your pain has lasted more than a couple of weeks, keeps coming back, travels into a leg, or hasn't responded to what you've already tried. Your first visit is a real evaluation, not a rushed adjustment. We review your history and prior imaging, find which of these causes are involved, and recommend a plan, which might include spinal decompression for disc-related pain, StemWave, laser therapy, adjustments, and nutritional support. If you need a referral elsewhere, we'll tell you.

Patients tell us the difference is being treated as a whole person. One patient came in with lower back pain so bad it felt locked up, along with sore feet and constant fatigue. After care at our office she told us her foot pain was gone, she could touch her toes again, and her energy was wonderful. Results vary, but this is what comes from finding all the causes, not just the loudest one.

Learn more about our approach to chronic back pain, or call (412) 678-9123 to schedule. You can also contact us online. We're at 3045 Jacks Run Rd, White Oak, open Monday, Wednesday, and Thursday (9AM-1PM and 3-7PM), and we serve North Huntingdon, McKeesport, Irwin, Greensburg, and the surrounding area.