Lumbar Spine Conditions: Lower Back Assessment & Management
Introduction
The lumbar spine (lower back) is the most load-bearing region of the spine. It allows bending, lifting, walking, and sitting while protecting the nerve roots that travel into the legs.
Because of these mechanical demands, the lumbar spine is the most common source of back pain and nerve-related leg symptoms. Lower back and leg pain can arise from several structures including disc irritation, nerve root involvement, joint stress, muscular overload, spinal canal narrowing, or a combination of factors.
Get WISE - Get WELL
- Get ON
Although symptoms may feel similar, the underlying drivers can differ significantly.
Identifying the primary cause of symptoms is essential. Effective management depends on distinguishing between mechanical sensitivity, nerve irritation, age-related structural change, joint irritation, and more specific lumbar conditions.
Each major lumbar condition is outlined below. Select the page that most closely matches your symptoms for a detailed explanation and management guidance.
In addition, we have dedicated patient education pages that address common questions — such as imaging findings, recovery timelines, exercise guidance, and when to seek urgent review. These are designed to provide deeper clarity beyond diagnostic labels and can be found at the bottom of the page.
Non-Specific Lower Back Pain
This is the most common type of lower back pain. Symptoms are usually localised to the lower back and may feel stiff, tight, or sore. Pain often fluctuates with posture and activity and does not usually cause progressive leg weakness or significant neurological symptoms.
Most episodes improve with proportionate load management and progressive rehabilitation.
Lumbar Disc Herniation (Slipped Disc)
A lumbar disc herniation occurs when disc material protrudes and may irritate a nearby nerve root. This can cause lower back pain combined with leg symptoms such as tingling, numbness, or pain travelling below the knee.
Symptoms often worsen with sitting, coughing, or prolonged bending.
Sciatica
Sciatica describes a symptom pattern where irritation of the sciatic nerve causes pain that travels from the lower back into the buttock and down the leg.
Leg-dominant pain, pins and needles, burning sensations, or electric-type pain are common features. Not all leg pain is true sciatica, which is why proper assessment matters.
Lumbar Degenerative Disc Disease (DDD)
A common MRI description of age-related disc changes. Often seen even in people without pain, and not automatically the cause of symptoms. Understanding context prevents unnecessary fear.
Lumbar Spinal Stenosis
Lumbar spinal stenosis refers to narrowing within the spinal canal that may affect nerve roots. It is more common with increasing age.
Typical symptoms include leg heaviness, aching, or weakness when walking, often relieved by sitting or bending forward. Walking tolerance may gradually reduce over time.
Lumbar Facet Joint Pain
The facet joints are small stabilising joints at the back of the spine. Irritation here typically causes localised lower back pain, often one-sided, sometimes referring into the buttock or upper thigh but rarely below the knee.
Pain is commonly aggravated by prolonged standing, extension (leaning back), or twisting movements.
Spondylolisthesis and Retrolisthesis
A small shift of one vertebra relative to another. Can be incidental or associated with back pain and occasionally leg symptoms.
→ Read more about Spondylolisthesis
Sacral Insufficiency Fracture (SIF)
A stress fracture that can occur without major trauma, more common in older adults or those with reduced bone density. Often presents as severe lower back/buttock pain and difficulty weight-bearing.
Discitis (Spinal Infection) - URGENT
Rare, but important. May present as severe constant back pain, often worse at night, with systemic features such as fever, feeling unwell, or unexplained weight loss.
Cauda Equina Syndrome (CES) - EMERGENCY
Rare, but urgent. Symptoms may include new bladder or bowel disturbance, numbness around the saddle/groin region, or rapidly worsening leg weakness. These signs require immediate emergency assessment.
