Understanding and Alleviating Female Lower Back Pain

Lower back pain is a major global public health issue, being the leading cause of years lived with disability (YLDs) worldwide. While there has been a modest decrease in age-standardised rates, the number of people experiencing LBP is projected to increase significantly due to population growth and ageing.

In Singapore, lower back pain is also prevalent, with rates reaching up to 80%. It typically arises from weakened or overstretched muscles, joints, and ligaments in the lower back region.

Identifying the underlying cause is crucial to finding effective pain relief. This guide explores the risk factors, symptoms, and causes of female lower back pain. We will also discuss management and treatment options, including physiotherapy of the back.

Women Most at Risk for Lower Back Pain

Studies show that women experience lower back pain more frequently than men. It can stem from various causes and a combination of anatomical, hormonal, and physiological factors.

Age and Weight

Ageing increases the risk of back pain due to wear and tear on the spinal cord and lumbar spine. Excess weight places added pressure on the lower back, leading to muscle strains, joint pain, and spinal conditions such as spinal stenosis.

Activities and Lifestyle

A sedentary lifestyle, poor posture, and physically demanding activities can cause muscle tension and chronic lower back pain. Women who frequently lift heavy objects, sit for extended periods, or engage in repetitive movements have an increased risk of experiencing back pain.

Symptoms of Female Lower Back Pain

Lower back pain in women can manifest through various symptoms, which may vary in intensity and duration. Common symptoms include:

• Dull or Aching Pain: A persistent discomfort in the lower back region
• Sharp or Stabbing Pain: Sudden, intense pain that may occur during specific movements or activities
• Radiating Pain: Discomfort extending from the lower back to the buttocks, hips, or legs 
• Stiffness: Difficulty moving or straightening the back, often accompanied by reduced range of motion
• Muscle Spasms: Involuntary contractions or tightness in the lower back muscles
• Posture Problems: Challenges in maintaining an upright posture, potentially leading to a bent or crooked stance

Possible Causes of Lower Back Pain in Women

Several health conditions can cause lower back pain in women. Below are some of the most common causes.

Dysmenorrhoea

Painful periods due to uterine contractions can cause pelvic pain that radiates to the lower back. The intensity of menstrual pain depends on individual factors such as hormonal changes and medical history. The contractions occur as the uterus sheds its lining, and in some cases, reduced blood flow to the muscles can intensify discomfort.

PMS and Premenstrual Dysphoric Disorder

Hormonal fluctuations before menstruation can trigger muscle pain, tight muscles, and back pain in women, often accompanied by other symptoms like bloating and mood changes. The fluctuation in estrogen and progesterone levels affects the body’s pain sensitivity and fluid retention, which can contribute to muscle stiffness and discomfort.

Pregnancy

Pregnancy places extra strain on the lumbar region, causing lower back pain. The body’s balance shifts as the baby grows, increasing pressure on the spine and leading to muscle strains. Additionally, hormonal changes, particularly the release of relaxin, loosen ligaments and joints, making the lower back more susceptible to pain.

Endometriosis and Adenomyosis

These conditions cause pelvic pain and inflammation, which may extend to the lower back. The pain can be chronic, with severe cases affecting daily life. Endometrial-like tissue growing outside the uterus can adhere to nearby organs, leading to irritation, scarring, and nerve compression that contribute to back pain.

Fibroids

Uterine fibroids can cause pain in the lower back due to pressure on surrounding nerves and soft tissues. Large fibroids may require medical intervention. Their growth inside or outside the uterus can also lead to increased weight and size of the uterus, shifting its position and straining the lower back.

Ovarian Cysts

Cysts in the ovaries can cause sharp pain in the lower abdomen and back, particularly when they rupture or grow large enough to press on surrounding structures. If a cyst grows significantly, it can cause ovarian enlargement, affecting nearby nerves and causing radiating pain that extends to the lower back.

Pelvic Inflammatory Disease

This infection affects reproductive organs, causing pelvic pain, lower back pain, and fever. If untreated, it may lead to long-term complications. The infection can spread to surrounding tissues and create adhesions or scarring, which may pull on the lower back and intensify discomfort.

Menopause

Hormonal changes during menopause can weaken bones and muscles, increasing the risk of back pain, compression fractures, and osteoporosis. The decline in estrogen affects bone density and joint lubrication, making the spine more prone to strain and degeneration over time.

Other Causes of Back Pain in Women

The culprits behind back pain in women are not limited to women-specific health conditions. Sometimes, lifestyle factors and general musculoskeletal issues contribute to persistent discomfort.

Poor Posture

Slouching, sitting improperly, or standing for extended periods can lead to spinal misalignment, muscle pain, and increased strain on the lumbar spine. Over time, poor posture weakens core muscles, making the lower back more vulnerable to stiffness and discomfort.

Spinal Stenosis, Osteoarthritis, Osteoporosis

These conditions affect the spinal canal and bones, leading to chronic pain and mobility issues. Spinal stenosis can compress nerves, while osteoporosis increases fracture risk. Osteoarthritis contributes to cartilage breakdown, causing joint inflammation and stiffness in the spine.

Herniated Disc

A bulging disc can press on nerves in the spinal cord, causing pain, numbness, and leg pain. Severe cases may require medical intervention. When the disc material protrudes, it can irritate nearby nerves, leading to sharp or radiating pain down the lower back and legs.

Degenerative Disc Disease

The natural ageing process can lead to disc wear and tear, reducing spinal flexibility and leading to chronic lower back pain. As discs lose hydration and cushioning, the vertebrae may rub together, triggering inflammation and nerve irritation.

Piriformis Syndrome and Sciatica

Piriformis muscle tightness can compress the sciatic nerve, causing pain that radiates from the lower back to the legs. This condition often worsens with prolonged sitting or sudden movements that engage the lower back and hips.

Sacroiliac Joint Pain

Inflammation in the sacroiliac joints can cause sharp pain in the lower back and hips, often worsening with movement. These joints connect the spine to the pelvis, and when they become irritated, they can disrupt normal walking and sitting postures.

Degenerative Spondylolisthesis

This condition occurs when vertebrae slip out of place, causing instability in the lumbar region and nerve compression. The misalignment can lead to persistent lower back pain, especially during physical activities.

Tailbone Pain (Coccydynia)

Injury or prolonged pressure on the coccyx can result in persistent lower back pain, especially when sitting. Falls, childbirth, or repetitive strain from activities like cycling can aggravate this condition.

Kidney and Bladder Disease

Kidney stones and infections can cause pain that radiates to the lower back. Urine tests and blood tests help diagnose these conditions. Since the kidneys are located near the lower back, infections or blockages can lead to deep, aching pain that may be mistaken for musculoskeletal issues.

Female Lower Back Pain Pain Management

Managing lower back pain in women requires a combination of lifestyle adjustments, therapeutic interventions, and, in some cases, medical treatments. While some pain may resolve with simple changes in posture and movement, persistent or severe discomfort may need targeted therapy or medical attention. The key is to identify the underlying cause and adopt the right approach.

To relieve pain and improve quality of life, consider the following treatment options:

Incorporate Lifestyle Modifications

Small adjustments in daily habits can have a significant impact on long-term spinal health. Improving posture, using ergonomic furniture, avoiding heavy lifting, and adjusting sleeping positions can reduce strain on the lumbar spine.

Do Gentle Stretches

Gentle stretching exercises help alleviate muscle tension and improve flexibility in the lower back and surrounding muscles. Regular stretching can also enhance circulation, promoting faster muscle recovery.

Take a Rest

Cold therapy and heat application, such as a warm bath or heating pad, can soothe tight muscles and reduce inflammation. Alternating between cold and heat therapy may provide more relief for different types of pain.

Take Over-the-Counter Pain Medications

Muscle relaxants and over-the-counter pain relievers can help manage mild to moderate back pain. However, prolonged use should be monitored to avoid potential side effects or dependency.

Steroid Injections

Epidural steroid injections (ESI) involve injecting anti-inflammatory medication (a steroid or corticosteroid) into the epidural space, the area around the spinal nerves in the lower back. It helps reduce inflammation and swelling, which can relieve pressure on nerves and nerve roots. It potentially provides pain relief for severe pain.

Surgery

Surgical intervention is typically a last resort. Physical therapy may be an alternative for many women, helping strengthen muscles and improve mobility. A thorough evaluation by a specialist is essential to determine if surgery is necessary.

Consider Physical Therapy Sessions

Physiotherapy for lower back pain programmes can target muscle imbalances and provide exercises to support the spine and relieve pain. Customised therapy plans at Phoenix Rehab can help address specific pain triggers and improve overall function.

Seek Physiotherapy Sessions

Physiotherapy can help women with chronic lower back pain by focusing on body mechanics and strengthening exercises. Long-term physiotherapy may also prevent future injuries by improving core stability and posture.

When to See a Doctor

Seek medical attention if:

• Pain persists for weeks despite home care.
• There is a history of spinal cord injury.
• Severe cases involve neurological symptoms like numbness or weakness.
• Pain worsens or spreads to the legs.
• There are warning signs of infection, such as fever or unexplained weight loss.

A healthcare professional may recommend X-rays, MRI scans, or additional tests to determine the underlying cause and appropriate treatment.

Final Words

Female lower back pain can arise from various health conditions, lifestyle factors, and reproductive changes. Understanding the causes and risk factors allows women to take proactive steps in pain management. If symptoms persist or worsen, consulting a healthcare professional ensures effective treatment options for long-term relief.