What Causes Lower Back Pain — and When Should You See Someone?

Lower back pain is one of the most common reasons people seek medical care. If your back has been bothering you, you’re not alone — and in most cases, you can feel better with the right help.

Understanding what causes lower back pain is a useful first step. It can help you recognize what’s going on and decide when to reach out to a health care provider.

Common Causes of Lower Back Pain

Back pain can come from many different sources. Here are the most common:

Muscle or ligament strain

This is the most common culprit. When the muscles and ligaments that support your spine get overstretched or torn, the result is that familiar dull ache or sharp spasm in your lower back. It often feels worse when you move in a certain direction — bending forward, twisting, or trying to stand after sitting for a while.

What tends to cause it: lifting something heavy without bending your knees, making a sudden awkward movement, or overexerting yourself after a long stretch of inactivity. People with weak core muscles are especially vulnerable because their spine ends up doing more work than it should.

Herniated disc

The discs in your spine act as shock absorbers between each vertebra. When one of those discs bulges or ruptures, it can press on nearby nerves and produce sharp, shooting pain — sometimes radiating from your lower back into your buttock or leg. Coughing, sneezing, or sitting for a long time can make it flare. You might also notice numbness or a tingling sensation in your leg or foot.

What tends to cause it: jobs or hobbies involving repeated heavy lifting or twisting, long hours of sitting with poor posture, and smoking (which reduces blood flow to the discs and speeds up their breakdown). Carrying extra body weight also puts added stress on the discs over time.

Sciatica

Sciatica isn’t a diagnosis on its own — it’s a symptom. It describes the pain that happens when the sciatic nerve, which runs from your lower back through your hip and down into your leg, gets compressed or irritated. People often describe it as a burning or electric sensation that travels down one leg, sometimes all the way to the foot. It can feel like a sharp "zing" that comes and goes, or a constant ache that makes sitting or walking difficult.

What tends to cause it: a herniated disc or bone spur pressing on the nerve is the most common trigger. Long periods of sitting — at a desk or during a long commute — can also aggravate it. Pregnancy is another common contributor due to the added pressure on the pelvis and lower spine.

Spinal stenosis

Spinal stenosis occurs when the spinal canal — the channel housing your spinal cord and nerves — narrows and puts pressure on the nerves inside. The leg symptoms are often more noticeable than the back pain itself: cramping, weakness, or numbness that gets worse the longer you walk or stand upright. Many people find that leaning slightly forward, like over a shopping cart, brings relief.

What tends to cause it: this is largely an age-related condition. Arthritis, bone spurs, and thickened ligaments build up over time and gradually narrow the canal. Prior back injuries can accelerate the process.

Degenerative disc disease

As we age, the discs in our spine naturally lose height and flexibility. Degenerative disc disease describes this gradual breakdown — and despite the name, it’s not necessarily a dramatic condition. The pain tends to be a persistent, low-grade ache that flares with bending or lifting and may ease with walking or changing positions. It typically comes and goes over years, with some days noticeably better than others.

What tends to cause it: aging is the primary driver, but smoking, obesity, and physically demanding work can speed up disc breakdown. Genetics plays a role too — if a parent had disc problems, you may be more likely to as well.

Poor posture

Poor posture is a slow burn. It rarely causes a dramatic injury, but over months and years it quietly shifts strain onto the wrong structures. The result is typically a dull, diffuse ache that builds throughout the day — often accompanied by tightness in the hips or across the upper back.

What tends to cause it: long hours at a desk, extended drives, scrolling on your phone with your head tilted down, unsupportive footwear, and carrying heavy bags on one shoulder. Weak core and hip muscles are a major underlying factor. When those muscles aren’t doing their job, your lower back picks up the slack.

What Causes Lower Back Pain in Women?

The conditions above can affect anyone — but for women, a few additional factors can make lower back pain more likely, more intense, or harder to trace back to an obvious cause. Hormones, reproductive health, and major life stages all have a real impact on how the lower back feels.

Hormonal changes

Estrogen helps maintain the strength and flexibility of connective tissue throughout the body, including the ligaments around the spine. When estrogen levels shift — during the menstrual cycle, perimenopause, or menopause — those ligaments can become looser and more susceptible to strain. This is one reason some women notice their back pain worsens at certain points in their cycle.

Pregnancy

Pregnancy presents a double challenge for the lower back. As the baby grows and the belly shifts forward, the center of gravity changes — putting new demands on the muscles and joints of the lower back and pelvis. At the same time, the body releases a hormone called relaxin that loosens ligaments in preparation for childbirth. That loosening is necessary, but it can also leave the lower back feeling unstable and tender, especially in the second and third trimesters.

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. In addition to pelvic pain, it can cause lower back pain — particularly around menstruation. If your lower back pain consistently flares with your period or seems tied to your reproductive cycle, it’s worth raising with your health care provider. Endometriosis is often underdiagnosed and can go unrecognized for years without the right conversation.

When Should You See a Health Care Provider for Lower Back Pain?

Most back pain improves on its own within a few weeks — especially if it came on after physical activity or a specific movement. But certain symptoms are a signal to get checked sooner rather than later.

Contact a health care provider promptly if you notice:

• Numbness or tingling in your legs or feet
• Weakness in one or both legs
• Changes in bladder or bowel control
• Back pain that started after a fall or injury
• Pain that has lasted more than six weeks
• Pain accompanied by fever or unexplained weight loss
• Pain that wakes you up at night

These can be signs of a more serious underlying condition. And even if your pain doesn’t check any of those boxes, you don’t have to tough it out — if it’s affecting your daily life, it’s worth a conversation.

How CoxHealth Can Help With Lower Back Pain

At CoxHealth, you don’t have to figure this out alone. Our providers can help identify what’s causing your pain and create a plan to address it — whether that’s physical therapy, imaging, medication management, or a referral to a specialist.

Your first step is talking to a primary care provider.

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