Persistent Left Lower Back Pain: Causes and Next Steps - Internal Medicine

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Left flank pain?


Hello, doctor.
I have been experiencing soreness and pain in my left lower back for a while.
Upon visual inspection, I notice a slight protrusion in the left lower back area.
I consulted a nephrologist, and both X-rays and urinalysis came back normal, but the pain persists.
Sometimes, my left leg also feels sore and numb.
What could this issue be? Which specialist should I see? Thank you.

Xiao Yi, 30~39 year old female. Ask Date: 2016/07/06

Dr. Wu Jiyu reply Internal Medicine


If you are experiencing general left flank pain, many individuals often first seek help from a nephrologist.
If you have undergone kidney ultrasound, X-rays, and urinalysis, and all results are normal, this indicates that the issue is not related to the kidneys.
However, if the pain persists and you sometimes experience numbness in your left leg, it is advisable to consult a neurosurgeon to determine if the pain is caused by lumbar nerve compression.
Thank you for your inquiry.
The Nephrology Department at Changhua Hospital cares about your well-being.

Reply Date: 2016/07/06

More Info


Persistent left lower back pain can be a complex issue, and it’s important to approach it with a comprehensive understanding of potential causes and appropriate next steps. Based on your description, there are several possibilities to consider.

Firstly, the presence of a slight protrusion in the left lower back area could suggest a musculoskeletal issue, such as a muscle strain, ligament sprain, or even a herniated disc. These conditions can lead to localized pain and may also cause referred pain or sensations in the lower extremities, such as numbness or tingling in the left leg. The fact that you have already consulted a nephrologist and had normal X-rays and urine tests is a good step, as it helps rule out kidney-related issues.

Given that your pain persists despite normal imaging and lab results, it may be beneficial to explore other potential causes. Here are some considerations:
1. Musculoskeletal Disorders: Conditions such as lumbar strain, sacroiliac joint dysfunction, or even degenerative disc disease can lead to chronic pain in the lower back. A physical examination by a specialist in orthopedics or physical medicine and rehabilitation (PM&R) can help identify any musculoskeletal abnormalities.

2. Nerve Compression: If the pain radiates down your leg, it could indicate nerve involvement, such as sciatica, which is often caused by a herniated disc or spinal stenosis. An MRI of the lumbar spine may be warranted to assess for any nerve compression.

3. Referred Pain: Sometimes, pain in the lower back can be referred from other areas, such as the hips or pelvis. Conditions like hip bursitis or even issues related to the sacroiliac joint can manifest as lower back pain.

4. Inflammatory Conditions: If there is a suspicion of an inflammatory condition, such as ankylosing spondylitis, a rheumatologist may be able to provide further insights and testing.

5. Lifestyle Factors: Consider your daily activities, posture, and ergonomics. Poor posture, prolonged sitting, or improper lifting techniques can contribute to chronic back pain. Engaging in regular stretching and strengthening exercises can help alleviate some of the discomfort.


Next Steps:
1. Consult a Specialist: Since you have already seen a nephrologist, it may be beneficial to consult an orthopedic specialist or a PM&R physician. They can perform a thorough physical examination and may recommend imaging studies like an MRI if necessary.

2. Physical Therapy: Engaging in physical therapy can be highly beneficial. A physical therapist can design a tailored exercise program to strengthen the muscles supporting your back, improve flexibility, and address any postural issues.

3. Pain Management: If the pain is significant, discussing pain management options with your healthcare provider is important. This could include non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or even corticosteroid injections if indicated.

4. Lifestyle Modifications: Incorporate regular physical activity, maintain a healthy weight, and practice good posture. Ergonomic adjustments in your workspace can also help reduce strain on your back.

5. Follow-Up: Keep a detailed record of your symptoms, including any changes in pain intensity, location, and associated symptoms. This information can be valuable for your healthcare provider in determining the best course of action.

In summary, persistent left lower back pain can stem from various causes, and a multidisciplinary approach is often the most effective way to address it. By consulting the appropriate specialists and considering physical therapy and lifestyle modifications, you can work towards alleviating your pain and improving your quality of life.

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