Pinched Nerve in the Lower Back: Symptoms and Treatment

A pinched nerve in the lower back occurs when excessive pressure is applied to a nerve, leading to pain, numbness, or weakness. Also known as radicular back pain, this condition is typically caused by compression, inflammation, or injury to a spinal nerve root.

A herniated disc, spinal stenosis, and degenerative disc disease can contribute to a pinched nerve. These conditions also can lead to shooting pain, muscle weakness, and difficulty standing.

A pinched nerve in the lower back, often caused by a herniated or slipped disc or other condition mentioned earlier, can lead to various symptoms that can significantly impact daily life. These symptoms may include:

• Sharp or shooting pain in the lower back
• Pain that travels down the buttocks, thighs, or legs
• Numbness or tingling sensation along the path of the affected nerve (usually down the leg)
• Muscle weakness in the legs or feet
• Difficulty standing or walking for extended periods
• Worsening pain with certain movements or positions, such as bending or sitting
• Reduced range of motion in the lower back or legs
• Worsening pain at night or with prolonged rest
• Worsening pain with activity that improves with rest

Various conditions can lead to pinched nerves in the lower back, each with different causes and symptoms. Understanding the types of pinched nerves in this region is crucial for identifying and managing the underlying issues. Here are some potential causes of a pinched nerve in the lower back.

Herniated Disc

Your discs cushion the bones that form the spine. A herniated disc occurs when the soft inner core of a spinal disc pushes through the tough outer layer, sometimes pressing on nearby nerves. This can result in pain, numbness, tingling, and weakness in the lower back and legs, often exacerbated by movements like bending or twisting.

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal. This can put pressure on your spinal cord and nerve roots. This condition occurs mostly in those over 50. However, younger people with a spinal injury are also at risk. Spinal stenosis can lead to symptoms such as back and leg pain, numbness, weakness, and cramping.

Degenerative Disc Disease

Degenerative disc disease involves the gradual breakdown of spinal discs, leading to decreased disc height and potential nerve compression. Under normal circumstances, spinal discs provide cushioning between vertebrae and absorb pressure put on the spine.

Those affected may have chronic low back pain, stiffness, and radiating pain into the buttocks or legs, aggravated by activities that involve bending or lifting. If a nerve is affected, leg numbness or weakness may also occur.

Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips forward over the one below it, potentially leading to nerve compression. Symptoms may include lower back pain, pain radiating down the leg, and muscle weakness—particularly during activities that involve bending or lifting. Other conditions that can lead to a pinched nerve in the lower back include:

• Benign (noncancerous) or cancerous tumors
• Infections such as osteomyelitis (a bacterial or fungal bone infection) or fungal infections
• Trauma or injury
• Rheumatoid arthritis (RA), an autoimmune disease that causes joint inflammation, pain, and swelling

Risk Factors

Risk factors associated with developing a pinched nerve in the lower back include:

• A sedentary lifestyle or lack of regular exercise
• Being overweight
• Occupations or activities that involve repetitive motions, heavy lifting, or prolonged sitting
• Genetics or family history of spinal conditions
• Smoking
• Previous spinal injuries or surgeries
• Poor posture or incorrect body mechanics
• Engaging in activities with high-impact or sudden twisting motions
• Aging that causes spinal discs and joints to undergo wear and tear over time
• Multiple pregnancies
• Back trauma or injury

Diagnosing a pinched nerve in the lower back typically involves a combination of a medical history review, physical examination, and diagnostic tests.

Based on the findings from these diagnostic steps, your healthcare provider can confirm the presence of a pinched nerve, identify its location and severity, and develop a personalized treatment plan to reduce symptoms and address the underlying cause.

Medical History and Physical Examination

Your healthcare provider will start by discussing your symptoms, medical history, and any relevant factors such as recent injuries or activities that may have contributed to your condition. A physical examination will be conducted to assess your range of motion, muscle strength, reflexes, and areas of tenderness or pain.

Neurological Examination

A neurological examination evaluates nerve function by testing sensations, reflexes, and muscle strength in specific areas associated with the affected nerve.

Imaging Studies

Your healthcare provider will likely use one or more imaging studies to help diagnose the issue. Here are some potential scans that could be ordered:

• X-ray: X-rays can help visualize bone structures and detect abnormalities such as bone spurs or fractures.
• Magnetic resonance imaging (MRI): An MRI provides detailed images of soft tissues like spinal discs, nerves, and surrounding structures. It can reveal herniated discs, nerve compression, or other spinal issues.
• Computed tomography (CT) scan: In some cases, a CT scan may provide additional information about spinal structures.

Electrodiagnostic Tests

When a healthcare provider orders electrodiagnostic tests, they want to see how your nerves and muscles function. Potential tests include electromyography (EMG) and nerve conduction studies (NCS).

EMGs and NCSs are tests used to check the health of your nerves and muscles.

An EMG measures the electrical activity in your muscles when you move and when you’re at rest. This helps identify nerve damage, muscle disorders, or other issues affecting your muscle function. An NCS focuses on how well nerves send electrical signals to muscles. It can detect nerve damage, pinched nerves, or other problems that slow down or disrupt nerve function.

These tests are often done together to best understand any issues affecting your nerves and muscles.

Treatment depends on the severity of symptoms, the underlying cause of the pinched nerve, and individual patient factors. Talk with a healthcare provider to develop a comprehensive treatment plan tailored to your needs.

The treatment for a pinched nerve in the lower back often aims to relieve pain, reduce inflammation, restore nerve function, and address the underlying cause. Here are common treatments and strategies:

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) can help reduce pain and inflammation. Meanwhile, oral corticosteroids (e.g. prednisone, methylprednisolone) or steroid injections may be prescribed to reduce inflammation around the affected nerve. Muscle relaxants can help alleviate muscle spasms and improve mobility.

Physical Therapy

Stretching and strengthening exercises can improve flexibility and reduce pressure on the nerve. They also can enhance muscle support for the spine. So, your healthcare provider may recommend physical therapy if you have a pinched nerve in the lower back. Physical therapists can also teach you how to properly walk, dress, lift, and perform other activities to prevent worsening.

Surgery

In severe cases or when conservative treatments are ineffective, surgical options may be recommended to decompress (take pressure off of) the nerve and stabilize the spine. These surgical procedures can include:

• Disc replacement surgery
• Discectomy, or removing part of a herniated disc
• Laminectomy, or removing part of the bone that forms the spinal canal to relieve pressure
• Spinal fusion or joining vertebrae together
• Foraminotomy which enlarges an opening in a spinal bone where a nerve passes through

Preventing a pinched nerve in the lower back involves adopting healthy habits, maintaining proper posture, and reducing activities that strain the spine. Here are some additional preventive measures:

• Incorporate regular exercise into your routine
• Maintain a healthy weight
• Follow a diet rich in calcium, phosphorus, and vitamin D
• Use ergonomically-designed furniture
• Wear comfortable, low-heeled shoes
• Lift objects with your knees and leg muscles, engaging stomach muscles, and keeping your head in line with your back
• Avoid twisting while lifting, and keep objects close to your body
• Avoid smoking to improve blood flow to the lower spine
• Change sitting positions frequently
• Take breaks to walk around

When a nerve in the lower back is compressed or irritated, it may cause pain, numbness, tingling, or weakness from the lower back through the buttock or hip and down the leg on one or both sides. This may significantly affect mobility and daily activities.

In rare but severe cases, a pinched nerve in the lower back affecting the nerve roots at the base of the spinal cord can cause cauda equina syndrome. This syndrome is characterized by lower back pain, loss of bladder/bowel control, and leg weakness and requires immediate medical attention.

A pinched nerve in the lower back can lead to significant discomfort and limitations in daily activities. Preventive measures such as maintaining a healthy lifestyle, practicing proper body mechanics, and seeking prompt medical attention can reduce the risk of developing a pinched nerve.

Talk with a healthcare provider for personalized care and a treatment plan tailored to your needs.