Where should we start looking at lower back pain and discomfort?

Lower back pain is very common, but it does not always arise from the same cause.

In some cases, the condition is centered on muscle and joint tension or restricted movement; in other cases, irritation of the lumbar nerve may cause leg pain and numbness. There are also conditions that must be checked first, such as trauma, fractures, or infection.

When your lower back hurts, it is recommended to examine the following in this order.

1. Is the pain limited to the lower back?
2. Is it difficult to bend or straighten your waist?
3. Is the pain moving down from the buttocks to the legs?
4. Do your legs feel numb or weak?
5. Are there any danger signs such as trauma or high fever?

My lower back itself hurts.

This occurs when the center or one side of the lower back feels stiff, and pain arises during sitting, standing up, or bending.

Several possibilities may be considered, including muscle and joint tension, lumbar sprain, repetitive loading, and nonspecific low back pain.

I have difficulty straightening my back.

This is a case where it is difficult to straighten the back when rising from a seated position, or when pain is severe at the moment of standing up after bending.

We must examine the protective response of muscles trying to avoid pain, sprains, restricted joint movement, and symptoms related to nerves together.

Pain travels down into my buttock or leg.

This is a case where pain extends from the lower back or buttocks to the thigh, calf, and foot.

The pain may be due to irritation of the lumbar nerves, or it may be pain transmitted from muscles and joints around the lower back and pelvis.

My legs feel numb or have reduced sensation.

In cases where numbness, burning sensation, sensory loss, and weakness are more prominent than pain.

It can check not only lumbar nerve issues but also peripheral nerves, blood circulation, and systemic conditions.

My legs hurt after walking for a long time, but I feel better when sitting.

This is a case where leg pain and numbness occur when walking or standing, but symptoms improve when sitting or bending the waist.

Neurogenic claudication due to spinal stenosis can be assessed, but vascular problems and hip disorders must also be distinguished.

If you have the following symptoms, prompt medical evaluation may take priority over routine pain management.

• Sudden loss of leg strength or gradual weakening
• Dragging a foot or falling frequently
• Sudden change in bowel and bladder control
• Numbness of sensation in the perineum or inner buttocks
• Pain begins after a severe fall or traffic accident.
• High fever and chills may occur together.
• If there is a history of cancer, infection, or osteoporosis and new pain occurs
• It does not subside even with rest and continues to worsen at night.
• There is weight loss that is difficult to explain.

Even if there are no warning signs, it is advisable not to delay treatment if pain worsens rapidly or interferes with sleep, walking, or work.

Functional problems in the muscles and joints around the lower back

Maintaining the same posture for a long time or suddenly increasing physical activity can cause muscles to become excessively tense and joint movement to decrease.

Lumbar sprain

Lifting heavy objects, twisting the body, falling, or exercising can damage the muscles and ligaments around the lower back.

Changes related to disc

Changes in the intervertebral discs can also occur in people without pain. Conversely, it may also affect lower back pain and leg nerve symptoms, so both imaging and current symptoms must be evaluated together.

Stimulation of the lumbar nerve

If you experience pain radiating to the leg, numbness, sensory changes, or muscle weakness, a neurological examination may be necessary.

Spinal canal stenosis and degenerative changes

Symptoms may worsen when standing or walking, and improvement may occur when sitting or bending the waist.

Problems with the hip joint and other organs

Hip problems, as well as issues with the pelvis and the urinary tract, can also be felt as lower back pain. If you experience groin pain, abdominal pain, changes in urination, and fever, please report them together.

Many common cases of lower back pain are evaluated with history taking and physical/neurological examinations.

Medical History Taking

• When did the pain start?
• In what situation did it begin?
• In which posture and movement does it worsen?
• Does the pain radiate down to the leg?
• Is there numbness and muscle weakness?
• whether there is trauma, fever, or a history of disease

Movement examination

We examine in which direction pain and restriction occur when bending, straightening, and rotating the lower back.

Evaluation of muscle and joint function

We examine the movement of the lower back, pelvis, and hip joint area, as well as muscle tension and how force is applied.

Neurological examination

If there are leg symptoms, we examine muscle strength, sensation, reflexes, and gait.

Assessment of Daily Living Function

We check for any limitations during walking, sitting down and standing up, putting on shoes, lifting objects, and sleeping movements.

Through such an evaluation, we determine whether Chuna manual therapy can be considered or if imaging studies or assessments from other medical institutions are needed first.

Not all lower back pain requires treatment.

In the following situations, imaging studies may be considered.

• Significant trauma or risk of fracture
• Progressive muscle weakness
• Changes in urination and defecation, and sensation in the perineal region
• suspected infection or tumor
• Structural confirmation to change the treatment direction
• Symptoms and functional impairment persist despite appropriate treatment.

Even if disc herniation or degenerative changes are visible on imaging, symptoms may be absent; conversely, even if imaging appears normal, actual pain and restricted movement can still be present.

Therefore, treatment should not be based solely on images; current symptoms and function must also be evaluated.

Activity and lifestyle management

Rather than lying down for a long time, maintain daily activities within your possible range. However, lifting heavy objects that significantly worsen pain and repetitive bending can be temporarily reduced.

Chuna manual therapy

After evaluating limitations in movement of the lumbar spine and pelvis, as well as joint and muscle function, it may be considered as part of the treatment plan.

After treatment, we recheck the range of motion for bending and straightening the back, sitting down and standing up, walking, and changes in pain.

It is inappropriate to claim that Chuna manual therapy pushes the disc back in or directly widens a narrowed spinal canal.

Acupuncture therapy

It may be performed according to the patient’s condition after checking pain and muscle tension around the lower back and pelvis.

pharmacopuncture treatment

After evaluating pain and inflammatory responses and the patient's health status, it may be considered selectively.

Exercise and Rehabilitation

Once the pain subsides, gradually restore movement of the lumbar spine and hip joint, function of the trunk and gluteal muscles, and walking and daily activities.

Medication and injection therapy

Much lower-back pain can be treated with the Chuna manual therapy, acupuncture, pharmacopuncture, and exercise described above. However, in the acute stage, when pain is so severe that sleep becomes difficult and daily life falls apart, analgesics, NSAIDs, steroid injections, or nerve blocks are sometimes used alongside them.

However, these treatments lower pain; they do not restore movement of the lower back and pelvis, muscle function, or the factors behind recurrence. The burden that builds up with repeated use also needs to be considered.

• Taking NSAIDs for a long time can increase the risk of gastrointestinal bleeding, reduced kidney function, and strain on blood pressure and the heart.
• Frequent steroid injections can weaken tissues such as tendons and ligaments at the injection site, and systemic side effects such as raised blood sugar and reduced bone health have also been reported.
• Pushing too hard while pain is masked can add strain to tissues that have not yet recovered.

So if medication or injections are needed repeatedly, rather than continuing the same prescription, it is better to re-evaluate the following.

• repetitive movements causing pain
• Movement of the lumbar spine and hip joint
• Function of trunk and buttock muscles
• Walking and sitting to standing
• repetitive loads in work and exercise
• Degree of actual return to daily life after treatment

Once the acute pain has settled, regaining the remaining movement of the lower back and pelvis and muscle function becomes the center of recovery. Chuna manual therapy, based on a Korean medicine doctor's examination, directly assesses joint and muscle movement and helps this recovery process, and it can be planned together with acupuncture, pharmacopuncture, and exercise.

Please also tell your Korean medicine doctor about the medications you take and the timing and number of recent injections. Do not stop or reduce prescribed medication on your own; discuss it with the prescribing clinician.

Surgery and collaborative care

If leg strength is steadily weakening, or cauda equina syndrome is suspected, such as loss of bladder or bowel control or numbness in the saddle area, prompt collaborative care and surgical evaluation are needed. The same applies when major trauma or infection is suspected. In these situations, surgery can be an essential choice to protect the nerves.

On the other hand, surgery should not be decided in a hurry just because a disc looks large on imaging or because pain has lasted a long time. Even when surgery resolves the problem area, there are reports that, particularly after spinal fusion, strain can shift to the adjacent segments above and below and to the surrounding muscles, creating new functional problems. If surgery has been recommended, it is best to weigh your response to non-surgical treatment, the degree of functional limitation, and the recovery plan after surgery before deciding.

Even after surgery, once the operated area has stabilized, Korean medicine treatment such as Chuna manual therapy can help in regaining the function of the surrounding joints and muscles. When to start and how intensive it should be are decided in consultation with the surgical team.

In the following cases, it may be considered after history taking and physical examination.

• If movement is restricted along with lower back pain
• If pain recurs when sitting, bending, and standing up
• In cases where muscles around the lower back and pelvis are excessively tense
• If there are no neurological warning signs and functional recovery is needed
• When acupuncture, pharmacopuncture treatment, and exercise need to be planned together.

Even for the same lower back pain, the technique and intensity must vary depending on the patient's age, history of trauma and surgery, osteoporosis, and neurological symptoms.

• Do not maintain one posture for a long time; change your posture in between.
• Walk and maintain activity within a feasible range.
• Temporarily control movements that significantly worsen the pain.
• Record leg pain and numbness, as well as changes in muscle strength.
• Avoid self-correction by having someone else forcefully press or twist your lower back.
• After the pain subsides, gradually restore movement and muscle strength.
• If new muscle weakness or changes in urination or defecation occur, seek evaluation immediately.