Summary
Lower back pain — pain in the lumbar spine — is the most common pain condition in the United States and the number one reason patients visit MAPS Centers for Pain Control across Chicagoland. It can stem from degenerative disc disease, pinched nerves, muscle strain, traumatic injury, or poor posture and mechanics. Symptoms range from localized aching to radiating leg pain, numbness, and tingling. Effective non-surgical treatments include physical therapy, targeted injections, nerve ablation, and newer restorative procedures — most covered by Medicare. The key message from MAPS pain specialist Adarsh Shukla, MD, LCP-C: don’t wait. Earlier treatment means better outcomes.
If there is one type of pain that connects people across age groups, occupations, and activity levels in the Chicago area, it’s lower back pain. Research from the National Institutes of Health puts one in four American adults in the category of current lower back pain sufferers. And over a lifetime, roughly eight in ten people will experience it significantly enough to seek care.
At MAPS Centers for Pain Control — with eight locations across Chicagoland — lower back pain is the single most common complaint physicians treat. “Low back pain is by and large the most common complaint we see,” says Adarsh Shukla, MD, a double-board-certified pain management specialist at MAPS. “Most people at some point in their lives will experience some type of back pain requiring treatment.”
This article covers what lower back pain actually is, what most commonly causes it, how to recognize when symptoms are serious, and what treatment options are available — without surgery.
What Is the Lower Back, Exactly?
The lumbar spine — the region most people mean when they say “my lower back” — consists of five large vertebrae (L1 through L5) stacked between the thoracic spine above and the sacrum below. Between each vertebra sits a cushioning disc. Branching outward from the spinal cord at each level are nerve roots that travel into the legs, hips, and pelvis.
This region bears the majority of the body’s mechanical load during sitting, standing, lifting, and movement. That load-bearing responsibility, combined with the complexity of the surrounding structures, makes the lumbar spine the most vulnerable region of the spine to both injury and degeneration.
“When we think of the back, generally we split it into three different segments — the cervical, thoracic, and lumbar,” explains Dr. Shukla. “Cervical being the neck, thoracic is that mid-back, and then the lumbar is your lower back. So generally speaking, when people are coming in saying ‘my back hurts’ or ‘my low back hurts,’ we’re usually talking about that lumbar spine.”
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Common Causes of Lower Back Pain
Lower back pain is a symptom — not a diagnosis. Its causes are many, and identifying the specific source is essential for choosing the right treatment. Here are the most frequent causes Dr. Shukla sees at MAPS.
Degenerative Disc Disease and Lumbar Arthritis
The discs between lumbar vertebrae gradually lose water content and height over time. As they thin, the cushioning they provide diminishes, and the facet joints — small joints at the back of each vertebral level — begin to bear more load, often developing arthritis in response. This wear-and-tear process is the most common underlying driver of chronic lower back pain.
What patients often find surprising is how long this process can develop without producing any symptoms at all. “The processes inside your body that were happening that led to this were happening long before that,” Dr. Shukla tells his patients. “It could be years of degeneration that was happening in your body, and it just didn’t present as a symptom until very recently.”
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Lumbar Radiculopathy — A Pinched Nerve
When a disc herniates or a bone spur develops in the lumbar spine, it can compress one of the nerve roots exiting the spinal canal. The result is radiculopathy — a pinched nerve that generates pain not just in the lower back, but along the path of the affected nerve into the buttocks, hip, or leg.
“A radiculopathy is basically a term for a pinched nerve in your back that can cause some pain in your low back as well as pain in your legs — in addition to any nerve-type symptoms like numbness, tingling, burning in the legs or the feet,” says Dr. Shukla.
When the sciatic nerve is involved — the large nerve running from the lower spine through the gluteal region and down each leg — the condition is referred to as sciatica. It is among the most disabling forms of lower back pain because of how far the pain travels and how significantly it can limit mobility.
Related: Back Pain That Radiates: When Pain Travels to the Legs or Hips
Mechanical Lower Back Pain
Not all lower back pain involves disc or nerve pathology. Mechanical low back pain results from how the body moves and the cumulative load placed on lumbar structures through daily habits and posture.
“Mechanical back pain is generally attributable to poor posture, poor positioning when lifting, just poor mechanics overall with anything from sitting to walking,” explains Dr. Shukla. In Chicago’s workforce — commuters spending extended time seated, hospital and healthcare workers bending repeatedly over patients, office professionals logging long hours at desks — this category of lower back pain is extremely prevalent.
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Traumatic Lower Back Injury
Sudden injuries — whether from a car accident on the Kennedy Expressway, a fall on an icy sidewalk in January, or a workplace incident — are a significant source of acute lower back pain. These events can strain or tear lumbar muscles and ligaments, herniate discs, or fracture vertebrae.
Dr. Shukla identifies traumatic injury as one of the most frequent presentations at MAPS: “That could be somebody who’s had a fall or a car accident or another type of accident resulting in an injury to the low back.” Prompt evaluation after trauma is critical; injuries that seem manageable early often worsen and transition into chronic pain when left untreated.
Muscular Strain and Overuse
Athletic activity, heavy lifting, and physically demanding work can strain the lumbar muscles acutely. In younger patients especially, this is a frequent source of lower back pain. “A younger athlete who has a muscular strain,” Dr. Shukla notes, “or just somebody who has some mechanical low back pain from overuse or overload or just wear and tear of the back.” While muscular strain often resolves more readily than structural causes, recurrent strains in the same region signal an underlying pattern — usually muscle imbalance or movement dysfunction — that should be addressed.
Recognizing Lower Back Pain Symptoms
Lower back pain presents differently depending on its cause. Understanding the character of your symptoms is one of the key pieces of information a pain specialist uses to narrow down a diagnosis.
4 Key Symptom Patterns to Know:
- Localized lumbar aching — A dull, persistent ache centered in the lower back that worsens with prolonged sitting, standing, or specific movements. Often associated with degenerative disc disease, facet arthritis, or muscular strain.
- Radiating pain into the leg — Pain that travels from the lower back into the buttock, hip, or down the leg, sometimes reaching the foot. A hallmark of radiculopathy or sciatica caused by a compressed nerve root.
- Neurological symptoms — Numbness, tingling, burning, or weakness in the lower extremities. These indicate nerve involvement and should prompt prompt evaluation. Significant weakness in the legs or any change in bladder or bowel function requires immediate care.
- Pain with movement or position — Pain that is clearly worse in specific positions (bending forward, arching backward, twisting, or rising from a seated position) can help point toward specific structural causes such as disc herniation, facet joint irritation, or sacroiliac joint dysfunction.
When to See a Pain Specialist for Lower Back Pain
A pervasive and costly misconception about lower back pain is that it’s best managed with patience — that waiting it out is a reasonable strategy. Dr. Shukla is direct on this point: “My advice is always address it sooner rather than later. We know that with back pain, the longer you wait to address it, the more likely it is that that pain becomes chronic and long lasting.”
Even lower back pain that resolves on its own warrants evaluation, because underlying structural causes — degenerative discs, arthritic joints, compressed nerves — remain present and will almost certainly produce a recurrence.
Seek evaluation promptly if you experience:
- Lower back pain lasting more than two to three weeks without meaningful improvement
- Pain radiating into the buttock, hip, or leg
- Numbness, tingling, or weakness in the legs or feet
- Back pain following a fall, accident, or injury
- Pain that is worsening rather than improving
- Symptoms disrupting sleep, work, or normal daily activities
Non-Surgical Treatment Options for Lower Back Pain
At MAPS, all available lower back pain treatments are non-surgical. The approach is individualized, progressive, and built on a team model — physicians, physical therapists, and specialists working together toward the patient’s long-term recovery.
“I can reduce your pain,” says Dr. Shukla. “But once beyond that, there’s almost a lifestyle that has to be committed to — that a patient has to commit to — to sustain that relief.”
Physical Therapy
Physical therapy is the foundation of lower back pain recovery at MAPS and the treatment Dr. Shukla advocates for most strongly across all patient types. “Physical therapy is probably one of the most important players in the realm of treatments for low back pain,” he says. “It’s ultimately where the patient will learn to correct a lot of the things that may have led to their back pain — strengthen the areas that may be weak, improve the range of motion or flexibility in the areas that are not moving properly.”
Completing a formal PT program is not the finish line — it’s the beginning. Home exercise routines developed in therapy need to continue regularly and indefinitely. “Most of the time they give you a home exercise regimen,” Dr. Shukla notes. “You have to continue doing that two, three, four times a week as much as you can. If you can stay committed to that, then you have sustained pain relief.”
Targeted Injection Treatments
For patients whose pain is too severe to allow effective participation in physical therapy, or who need added relief beyond what therapy provides, injection-based treatments offer meaningful, targeted relief. Common options at MAPS include:
- Epidural Steroid Injections: Anti-inflammatory medication delivered to the space around compressed spinal nerve roots — particularly effective for radiculopathy and disc-related pain
- Facet Joint Injections: Targeting the small joints between vertebrae that generate axial (localized) lower back pain in degenerative and arthritic conditions
- Medial Branch Nerve Blocks: Diagnostic and therapeutic blocks of the small nerves supplying the facet joints
- Radiofrequency Ablation (Nerve Ablation): Heat is used to disable the nerves transmitting pain signals from arthritic facet joints; relief can last 12 or more months
Dr. Shukla is careful to frame these treatments correctly for patients: “I’m so glad that this treatment provided pain relief for you, but the problem that led to your pain is still there — so you need to fix that. What this injection has done is it’s given you a window of opportunity to correct the muscular imbalances, the postural inefficiencies, the weaknesses in your body.”
Advanced Procedures: Spinal Cord Stimulation
For patients with chronic, treatment-resistant lower back pain, spinal cord stimulators represent a well-studied, effective option. These implantable devices modulate pain signals traveling toward the brain, reducing perceived pain levels significantly for appropriately selected patients. Clinical evidence supports their effectiveness in reducing chronic pain and lowering reliance on prescription pain medications.
Restorative Treatment: Multifidus Muscle Stimulation
Among the most promising newer developments in lower back pain care is multifidus muscle stimulation — an implantable device that directly rehabilitates the deep postural muscle most commonly found to be atrophied in chronic lower back pain patients.
Unlike palliative treatments that manage symptoms while active, this approach actively restores muscle function. “By being able to stimulate that muscle with an implantable stimulator, we can actually restore the function of that muscle,” explains Dr. Shukla. “That’s what I mean by restorative treatments — we’re not just managing symptoms, we’re actually trying to restore function in a patient.”
Medications
Oral medications play a supporting role in lower back pain care, primarily during the acute phase when getting symptoms under control quickly is the priority. These may include anti-inflammatory medications (OTC and prescription), muscle relaxants for spasm-related pain, and other medications as clinically appropriate. Medication management at MAPS is ethical, evidence-based, and always used in coordination with the broader treatment plan.
Does Medicare Cover Lower Back Pain Treatment?
Yes. MAPS accepts Medicare, and the vast majority of lower back pain treatments — including physical therapy, steroid injections, facet joint procedures, radiofrequency ablation, and spinal cord stimulation — are covered. “If a patient has general Medicare coverage, we will be able to treat them and provide almost all of the treatments that we have available to us,” says Dr. Shukla.
FAQs: Lower Back Pain
Q: Is lower back pain always caused by a disc problem?
A: No. While herniated or degenerated discs are a common cause, lower back pain can also originate from the facet joints, muscles, sacroiliac joints, nerve roots, or a combination of structures. This is why a physical examination and appropriate imaging are essential before assuming a cause.
Q: What’s the difference between lower back pain and sciatica?
A: Lower back pain refers to pain localized to the lumbar region. Sciatica is a specific condition in which the sciatic nerve — running from the lumbar spine through the buttock and down the leg — becomes compressed or irritated, producing radiating leg pain, often with numbness or tingling. Sciatica typically has a lumbar cause (like a herniated disc), so the two often coexist.
Q: How long will it take for my lower back pain to get better?
A: That depends significantly on the cause and severity, and on how early treatment is sought. Dr. Shukla is clear with his patients that because back pain usually develops over years, recovery isn’t measured in days or weeks. “Something that developed over years and years of wear and tear or improper mechanics can’t just be fixed in a short amount of time.” With the right treatment plan and patient commitment, meaningful and lasting relief is achievable.
Q: Can I make my lower back pain worse by exercising?
A: The wrong exercise, or exercise without proper guidance, can aggravate certain back conditions. But movement — the right kind, prescribed by a physical therapist — is one of the most important elements of recovery. Avoiding all movement due to pain usually makes things worse over time, not better. A MAPS specialist can help determine what activity is appropriate for your specific condition.
Q: What if I’ve already had injections before and they didn’t help?
A: The type, placement, and timing of injection treatment matters significantly. If prior injections were not effective, it may indicate that the pain source wasn’t accurately targeted, or that additional contributors were present. At MAPS, the diagnostic process is thorough precisely to avoid this — and there are multiple treatment pathways available when one approach hasn’t provided the relief a patient needs.
Recovery Is a Journey — But the Path Is Clear
Lower back pain is one of the most treatable conditions in modern pain medicine — but it requires the right diagnosis, a committed care team, and a patient willing to engage in the recovery process.
“You shouldn’t think that there’s no hope or there’s no recovery for you,” Dr. Shukla says. “There is so much that we can offer — and the great thing about that is that there’s so much that’s fully covered and supported by Medicare. A patient who is sitting at home right now suffering from back pain doesn’t need to be doing so.”
MAPS physicians and their teams have helped thousands of Chicagoland patients move from debilitating lower back pain back to active, full lives. Whether you’re dealing with a new flare-up or years of chronic pain, a path forward exists — and it starts with a single conversation.
Call MAPS at 773-917-8400 or schedule your consultation online at mwpain.com. Eight convenient Chicagoland locations: Chicago North Side, Chicago Midway, Des Plaines, Franklin Park, Hazel Crest, Woodridge, Frankfort, and St. John, Indiana.
Reviewed by Adarsh Shukla, MD, LCP-C, Board-Certified Pain Management Specialist, MAPS Centers for Pain Control. This content is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for diagnosis and treatment.
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