Common lower back pain at Epoch Health
Here’s a list of common diagnoses for lumbar pain that often lead people to visit us at Epoch Health:
1. Lumbar Strain/Sprain
Characteristics: Localised lower back pain, muscle tightness, worsens with movement, no nerve involvement.
Considerations: Rule out underlying structural issues; check for red flags like night pain or unexplained weight loss.
2. Lumbar Disc Herniation (e.g., L4-L5, L5-S1)
Characteristics: Radicular pain (sciatica), numbness/tingling, possible weakness in the leg, aggravated by sitting or bending forward.
Considerations: Assess for progressive neurological deficits (e.g., foot drop), severe weakness, or loss of bowel/bladder control (cauda equina syndrome—urgent referral needed).
3. Degenerative Disc Disease (DDD)
Characteristics: Chronic stiffness, deep dull ache, worsens with prolonged sitting or standing, better with movement.
Considerations: Differentiate from acute disc herniation; ensure no severe instability.
4. Facet Joint Syndrome
Characteristics: Localised pain, worsens with extension and rotation, referred pain to buttocks and posterior thigh.
Considerations: Rule out nerve root compression and inflammatory arthritis.
5. Sacroiliac Joint Dysfunction
Characteristics: Pain in lower back and buttock, worse with prolonged standing or asymmetrical movements, sometimes mimics radiculopathy.
Considerations: Rule out hip pathology and ankylosing spondylitis if morning stiffness is prolonged.
6. Spinal Stenosis
Characteristics: Pain/numbness in legs, worsens with walking (neurogenic claudication), relieved with forward bending or sitting.
Considerations: Differentiate from vascular claudication; assess for severe functional impairment.
7. Spondylolisthesis
Characteristics: Lower back pain with possible leg symptoms, pain worse with extension, tight hamstrings.
Considerations: Check for progressive slipping in younger patients; assess for instability and neurological symptoms.
8. Piriformis Syndrome (Mimicking Sciatica)
Characteristics: Buttock pain with radiating leg pain, worse with prolonged sitting, tender piriformis muscle.
Considerations: Differentiate from true lumbar radiculopathy; assess for hip dysfunction.
9. Osteoarthritis (Lumbar Spondylosis)
Characteristics: Chronic stiffness, worsens with activity, crepitus, better with mild movement.
Considerations: Ensure no signs of inflammatory arthritis or significant nerve involvement.
Red Flag Conditions to Consider:
🚩 Cauda Equina Syndrome – Saddle anesthesia, bowel/bladder dysfunction, severe weakness (urgent referral).
🚩 Spinal Fracture – Trauma history, severe pain, osteoporosis risk.
🚩 Cancer (Metastases) – Unexplained weight loss, night pain, history of cancer.
🚩 Infection (Osteomyelitis/Discitis) – Fever, history of IV drug use, immunosuppression.
🚩 Abdominal Aortic Aneurysm (AAA) – Pulsatile abdominal mass, severe sudden back pain, history of cardiovascular disease.