Osteoarthritis of the lower back (lumbar spondylosis): symptoms and treatment

Osteoarthritis is the most common type of arthritis in the UK. The NHS explains that it causes joints to become painful and stiff, because the protective cartilage on the ends of the bones breaks down, causing pain, swelling and problems moving the joint, and bony growths can develop. Versus Arthritis describes a joint in which the coating of cartilage thins and the surface becomes rougher so it no longer moves as smoothly.

The lumbar spine is the lower part of the back. Versus Arthritis states that osteoarthritis in the spine is referred to as spondylosis, so lumbar osteoarthritis and lumbar spondylosis are used for the same thing. These changes do not always cause pain: Versus Arthritis points out that almost all of us will have some changes in our joints as we get older, but we may not be aware of them, and that joints can sometimes still work well even though their structure is altered.

The main symptoms of osteoarthritis are pain and stiffness, and problems moving the joint, according to the NHS. Versus Arthritis adds that symptoms vary from day to day and often improve with the right treatment, and that the joint may be swollen, may not move as freely as before and may make grating or cracking sounds.

In the lower back the same symptoms show up as an aching or stiff back. The NHS points out that other conditions can cause back pain, including a pulled muscle, a slipped disc, sciatica and ankylosing spondylitis, and very rarely a serious problem such as a broken bone, cancer or infection. That is why a GP assessment matters when pain is persistent or unusual.

• Aching or stiffness in the lower back, often worse with use.

• Stiffness that is brief in the morning, rather than lasting a long time.

• Crackling or grating sensations on movement, which can also occur in healthy joints.

• Pain that varies from day to day and may come and go.

• Difficulty carrying out everyday activities when symptoms are more continuous or severe.

The NHS says to see a GP if back pain does not improve after treating it at home for a few weeks, stops you doing your day-to-day activities, or leaves you worried or struggling to cope. Other reasons include losing weight without trying, a lump or swelling in the back or a change in its shape, pain that does not improve with rest or is worse at night, pain that is worse when sneezing, coughing or pooing, and pain that comes from the top of the back between the shoulders.

The NHS says to ask for an urgent GP appointment or call 111 if you feel hot, cold, shivery or generally unwell, or if the pain is severe, starts suddenly or is getting worse quickly. Call 999 or go to A&E for pain, tingling, weakness or numbness in both legs, a loss of feeling around the genitals or anus, changes in bladder or bowel function, changes in sexual function, chest pain, or back pain that started after a serious accident. Do not drive yourself to A&E.

The NHS says the exact cause of osteoarthritis is not known, but several things are thought to increase the risk. These include joint injury, other conditions such as rheumatoid arthritis or gout, age, family history, obesity and being a woman. Versus Arthritis also lists having an unusual joint shape, previous damage that did not heal well, being overweight and having had a repetitive or physical job.

The NHS adds that exercise or a job that puts frequent strain on your joints and forces them to bear an excessive load can increase your risk, and that being overweight or obese increases the strain on your joints and the risk of developing osteoarthritis.

Versus Arthritis says a GP is likely to be able to diagnose osteoarthritis from what you describe, your medical history and an examination, without further tests or specialist referral unless there is doubt about the cause. The GP will ask when symptoms started, what makes them better or worse, how they have changed and how they affect daily life, then check for tenderness, creaking, bony swelling, stiffness or restricted movement and weakness of the supporting muscles.

The NHS says X-rays and blood tests are not usually necessary but may be used to rule out other causes such as rheumatoid arthritis or a fracture. If the picture suggests something other than osteoarthritis, for example prolonged morning stiffness, the GP may think about other joint conditions. In many areas the NHS says you may be able to refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without seeing a GP first.

The NHS says osteoarthritis is a long-term condition that cannot be cured, but it does not necessarily get worse over time and it can sometimes gradually improve. Mild symptoms can be managed with regular exercise, losing weight if overweight, suitable footwear and devices that reduce strain on joints. More severe symptoms may need painkillers and a structured exercise plan with a physiotherapist, and only in a small number of cases is surgery considered.

For back pain in general, the NHS advises staying active, taking anti-inflammatory medicine such as ibuprofen if suitable and noting that paracetamol on its own is not recommended for back pain, using ice or heat packs wrapped in a tea towel, and trying exercises and stretches. If pain is severe or not improving, other treatments listed by the NHS include group exercise and physiotherapy, manual therapy, CBT to help cope with pain and, for long-term lower back pain only, a procedure to seal off some of the nerves so they stop sending pain signals.

Versus Arthritis suggests pacing yourself, because doing too much on a good day can lead to more pain afterwards, and changing position regularly, as keeping the same posture for long periods puts joints under more strain. Heat or ice, and supportive footwear, can help. An occupational therapist can advise on adapting the home or workplace, and a physiotherapist can help you start exercising.

The NHS recommends at least 150 minutes of moderate aerobic activity every week plus strength exercises on 2 or more days to keep generally healthy, and, if you work at a desk, a chair at the right height with regular breaks to move around.

Most people with lumbar osteoarthritis are looked after in the NHS by their GP, a physiotherapist or an NHS MSK service, and need no scan or specialist. The NHS says surgery is only considered in a small number of cases where other treatments have not helped or the damage is particularly severe.

Private routes, such as seeing a physiotherapist or a spinal consultant, can shorten waits for assessment or imaging. Treatment recommendations follow the same principles, and imaging is not needed for everyone, so it is reasonable to ask what a scan would change before paying for one.