What should you check first when experiencing lower back pain?

Lower back pain can occur due to various reasons such as muscle and joint tension, sudden sprains, repetitive postures and movements, or irritation of the disc or nerves.

Therefore, when the lower back hurts, it is important to examine the following points before definitively determining the disease name.

• When did the pain start?
• In which movement does it worsen?
• Is the pain limited to the lower back?
• Is it going down to the buttocks or legs?
• Do your legs feel numb or weak?
• Have you experienced any major trauma or high fever?

Many common cases of lower back pain can be assessed to determine the current condition and initial treatment direction through a detailed history taking and physical/neurological examination.

If the center of your lower back or one side feels stiff

Pain may occur when sitting for a long time, standing up, bending or straightening the waist. This is commonly seen in cases where muscles and joints around the lower back are tense or have reduced movement, such as mild sprains.

When you feel stiff in the morning or after resting for a long time and then moving.

After a long period of inactivity, your lower back may feel stiff upon the first movement. The content to be confirmed varies depending on whether it improves slightly while moving or remains severe even after time has passed.

Cases where symptoms worsen after prolonged sitting

If you sit for long periods, as with work or driving, the muscles around your lower back and pelvis can easily become tense. However, do not attribute the cause solely to posture; instead, consider activity level, sleep, exercise habits, and changes in pain together.

Cases where symptoms worsen when standing or walking

If you experience discomfort in both your lower back and legs when standing or walking for a long time, but feel relief when sitting or bending your waist, this may indicate a condition related to the space through which the lumbar nerves pass.

If pain or numbness extends down to the leg

If pain descends from the lower back or buttocks to the thigh, calf, and foot, or if numbness accompanies it, nerve function including muscle strength, sensation, and reflexes must be assessed together.

Muscle and joint functional problems

Maintaining one posture for a long time or performing more than usual work may cause excessive tension in the muscles around the waist and restrict joint movement.

Lumbar sprain

Pain may occur after lifting heavy objects, twisting the body suddenly, or spraining the back during exercise or daily movements.

Changes related to disc

If changes occur in the disc between the vertebrae, back pain or leg symptoms may appear. However, even if disc changes are visible on an MRI, there are people who experience no pain; therefore, the cause is not determined based on imaging alone.

Stimulation of the lumbar nerve

If you experience pain radiating from the lower back to the leg, along with numbness, reduced sensation, or weakness, you should have a condition related to the nerves evaluated.

Spinal canal stenosis and degenerative changes

In middle-aged and older adults, symptoms may occur where the legs become painful or numb when walking or standing, but improve when sitting or bending the waist.

problems with the hip joint or other organs

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

In treating lower back pain, we do not simply press only the painful area.

Medical History Taking

We examine the onset and cause of pain, location of pain, positions that worsen it, leg symptoms, and history of past diseases and treatments.

Lumbar movement examination

We check which direction causes pain when you bend forward, straighten, bend sideways or rotate your lower back.

Pelvic and hip joint function examination

We check the range of motion of the pelvis and hip joint that move together with the lower back, as well as muscle tension and strength.

Neurological examination

If there is leg pain and numbness, we examine muscle strength, sensation, reflexes, and gait.

Assessment of daily functioning

We check which movements are restricted when standing up from a chair, putting on shoes, walking, turning over in bed, and lifting objects.

Through such an evaluation, we determine whether Chuna manual therapy is considered or if imaging studies or visits to other medical institutions are needed first.

If you have the following symptoms, a prompt medical evaluation may take priority over standard lumbar treatment.

• If leg strength suddenly drops or gradually weakens
• If you experience dragging your leg or frequent falls
• If bowel and bladder control suddenly changes
• If sensation is dull in the perineum or inner buttocks
• In cases where severe pain occurs after a major fall or traffic accident
• If high fever or chills occur as well
• If there is a history of cancer, infection, or osteoporosis and new pain occurs.
• If pain continues to worsen even with rest, or if there is severe night pain

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.

Not all cases of lower back pain require imaging.

Many common cases of lower back pain can have their initial treatment direction determined through history taking and physical examination. However, imaging studies may be considered in the following cases.

• In cases where there is trauma suspected to be a fracture
• If leg muscle weakness is progressing
• If there are changes in urination and defecation, or sensation in the perineum.
• In cases where infection or tumor is suspected
• When a decision must be made regarding whether to perform surgery or a procedure.
• If symptoms and functional decline continue despite appropriate treatment

The changes visible on the imaging do not always correspond to the actual pain. Along with the photos, we must examine current movement and nerve function, as well as difficulties in daily life.

Activity and lifestyle management

In the early stages of severe pain, you may temporarily reduce lifting heavy objects and repetitive bending. However, if there are no special warning signs, it is better to walk within a reasonable range and maintain daily activities rather than lying down for a long time.

Chuna manual therapy

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

After treatment, we check the range of motion for bending and straightening the back, the ability to sit down and stand up, changes in walking, and pain levels.

Acupuncture treatment and pharmacopuncture treatment

It may be used selectively after checking pain and muscle tension around the lower back and pelvis and the patient’s overall condition.

Exercise and Rehabilitation

Once the pain subsides, gradually restore movement of the lumbar spine and hip joint, as well as function of the trunk and gluteal muscles.

Pain relievers 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 and daily life are difficult, analgesics, NSAIDs, or injections are sometimes used alongside them.

Overexerting yourself while pain is masked by medication can add strain to tissues that have not yet recovered, and the more medications are taken or injections are received repeatedly, the more risks follow, such as gastrointestinal, kidney, and cardiovascular strain, tissue weakening at the injection site, and elevated blood sugar. Once acute pain subsides, recovery continues through Korean medicine treatment to regain movement of the lower back and pelvis and muscle function.

In the following cases, Chuna manual therapy may be considered after history taking and physical examination.

• When there is lower back pain accompanied by limited movement
• 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 age, history of trauma and surgery, osteoporosis, and neurological symptoms.