Lumbar Spine Osteoarthritis (OA)
1. Introduction
It is now known that it is very common for people to have age-related changes in their spine, but without pain. Therefore, the correlation between structural changes and pain is regularly not accurate. “Pain is often not equal to damage” (2).
However, some people will go on to experience some pain, but there are lots of strategies to help cope with this as detailed below. Lumbar (lower back) osteoarthritis is the age-related change of the structures of the spine which can involve:
- The “discs” (which sit between the vertebrae).
- Osteophyte formations (bony spurs/growths).
- Facet joints (which connect each vertebra to the next).
Lumbar osteoarthritis specifically is a process that affects the cartilage of the facet joints and can cause pain due to inflammation.
Frequently Asked Questions
Lumbar spine osteoarthritis is a form of age-related changes in the low back that can cause pain, stiffness and inflammation in the joints between vertebrae (main bones that make up the spine).
- Very common – everyone will have a degree of “arthritic” changes in their spine as life progresses, but a much smaller percentage will experience pain from this.
- Pain from osteoarthritis affects approximately 14% of the UK population (1), although this percentage does increase with age.
- Lower back pain itself is common and can affect up to 85% of the population at some point in their lifetime, but 90% will improve within 6 weeks (2,3,5).
- No.
- Osteoarthritis is a common, natural, age-related occurrence and very often its symptoms can be managed.
- 80% of people over 50 years of age WITHOUT back pain have arthritic changes on an MRI scan – showing that these changes occur with time and are often not well correlated to levels of pain (2).
- Likelihood increases with age.
- Increased prevalence with family history.
- Obesity.
- More common in the Caucasian population (3).
- Pain in the lower back.
- Stiffness of the lower back.
- Decreased range of movement.
- Advanced cases can irritate the nerves which may result in leg pain, weakness or numbness.
- Exercise regularly.
- Maintain a healthy weight.
- Continue normal daily activities where possible, but pace tasks if needed.
- Medication if deemed safe and appropriate (3, 4).
- A programme of exercises prescribed by your musculoskeletal physiotherapist will often help to maintain your function.
- Osteoarthritis is typically a natural ageing process. Therefore, it should look to be managed, rather than seeking definitive cures.
- It may flare up and down over time but carrying out regular self-management can help control this.
- 90% of people with symptoms associated with Lumbar spine OA improve within 6 weeks (2,3,5).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
The main symptom is pain within the lower back, which can be one-sided, central or both sides. The effects can vary greatly from person to person, with some experiencing intermittent flare-ups of their pain and some people having a more constant, daily pain (5).
When facet joints are mostly affected, the pain will be in quite a precise area of the back and pain seen with tasks such as prolonged standing, walking or putting on shoes and socks.
Other symptoms include:
- Stiffness of the lower back.
- Decreased range of movement.
- Advanced cases can irritate the nerves which may result in leg pain, weakness or numbness.
3. Causes
This condition occurs because of an age-related natural process, however, it can be accelerated by previous trauma or injury (5).
Acute flare-ups of pain can be due to recent increased activity, or changes of activity, resulting in inflammation. This often settles with self-management and advice.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing lumbar osteoarthritis. It does not mean everyone with these risk factors will develop symptoms.
- Increased age.
- Increased BMI/obesity.
- Strong family history of osteoarthritis.
- Osteoarthritis is more common in women than men.
- Increased in Caucasian population (3).
5. Prevalence
97% of people even without back pain will experience some degree of age-related arthritic change in their spine throughout life, but only a small percentage experience pain from this (2).
Pain from osteoarthritis affects approximately 14% of the UK population (1).
Lower back pain itself is common and can affect up to 85% of the population at some point in their lifetime, but 90% will improve within 6 weeks (2,3,5).
6. Assessment & Diagnosis
Lumbar osteoarthritis that causes pain is considered a clinical diagnosis – meaning it is made largely by clinician examination, rather than by scans.
Research suggests that over 60% of people over 40 years of age without back pain have signs of disc changes, and 50% of people over 60 without back pain can present with lumbar facet arthritic changes on an MRI scan. This shows that these changes occur normally with time and are often not correlated to levels of pain. Therefore, MRI scans for this condition often do not help with diagnosis and are typically reserved for more severe or complicated cases (2).
The clinical assessment carried out by your physiotherapist involves detailed history taking, including what aggravates and eases your pain, as well as assessing various movement patterns in clinic, and a hands-on examination of the area.
X-rays offer little by way of diagnosis, given the huge percentage of people that have age-related changes, and correlates poorly to the degree of pain.
MRI scans are generally only indicated for this presentation if there are symptoms to the legs (possibly indicating nerve involvements).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the management of your lumbar spine osteoarthritis. This may include modifying the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
The national guidelines for managing lower back pain state that exercise is crucial to help self-manage lower back pain (4). Evidence suggests some benefits can be seen with any form of exercise, be it yoga, walking, weight training, etc.
Other strategies that may be helpful include:
- The use of ice and/or heat with symptomatic relief.
- Pain relief medications can be helpful in some cases and should be guided by the necessary professionals.
- Regular changes of position/posture throughout the day.
- Pacing your activities can also help minimise flare-ups.
8. Rehabilitation
Any form of exercise can have a positive effect on back pain and maintaining function, however, outcomes can be improved when tailored to your abilities and needs (4), which can be worked on with your therapist.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing lumbar spine osteoarthritis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as highlighting exercise progression.
Rehabilitation will include exercises to improve range of movement and strength, and for task-specific goals, e.g. playing with grandchildren, gardening.
9. Lumbar Spine Osteoarthritis (OA)
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Our early programme focuses on some basic movement-based exercises to try and improve the general movement of the back.
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- 910
At this stage we look at integrating more strength and stability focused exercises. This is to increase the strength around the abdomen, lower back and hips.
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In our advanced programme, we aim to progress the strength of the back and legs to try and reduce the stress on the spine where possible and in doing so increase your ability to perform day-to-day tasks.
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10. Return to Sport / Normal life
Guidelines suggest you should continue normal life as able. Therefore, you are safe to continue to do the things you can do (4). Pacing activities (doing moderate amounts over a longer period) can be helpful for some people to help prevent flare-ups that may occur from doing a lot in one go.
If aiming to return to or continue to play a specific sport, further physiotherapy assessment and specific rehabilitation could be of benefit to target areas for improvement such as strength or flexibility.
11. Other Treatment Options
Manual therapy (hands-on) treatment can be effective in treating lower back pain, but it should be in addition to regular exercise, not instead of (4).
National guidelines indicate that treatments such as radio frequency denervation (a safe procedure to reduce nerve impulses to an area) may be considered for chronic back pain where conservative methods have proved ineffective (4).
Surgical options are much more limited with the back. However, in the rarer cases where nerves become involved and symptoms begin to affect the legs with pain/weakness/numbness, this can be considered (4).
12. Links for Further Reading
- Chartered Society of Physiotherapy – “Back Pain MythBusters” https://www.csp.org.uk/system/files/myth_busters_leaflet_-_final.pdf
- Versus Arthritis
https://versusarthritis.org/about-arthritis/conditions/osteoarthritis-oa-of-the-spine/ - NHS Osteoarthritis Info
https://www.nhs.uk/conditions/osteoarthritis/
25 locations and counting across the UK
References
- National Health Service (NHS). (2025).
Arthritis. https://www.nhs.uk/conditions/arthritis/ - Wiggins, G. C., & Howard, B. A. (2021). Imaging features of the aging spine. Neuroimaging Clinics of North America, 31(3), 329–341.
https://pubmed.ncbi.nlm.nih.gov/34322188/ - Nelson, A. E., Golightly, Y. M., Cleveland, R. J., Schwartz, T. A., & Callahan, L. F. (2023). Biomarkers and longitudinal changes in lumbar spine degeneration and low back pain: The Johnston County Osteoarthritis Project. Arthritis Care & Research, 75(5), 820–828.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10200763/ - National Institute for Health and Care Excellence (NICE). (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE guideline [NG59]).
https://www.nice.org.uk/guidance/ng59/chapter/Recommendations
Turgut, M., & Bayar, M. A. (2022). Spondylosis: A comprehensive review on etiology, diagnosis and treatment. World Health Journal, 3(1), 21–30. https://revistamedical.com/index.php/whj/article/view/52
Other Conditions in
Lower Back, Long Term Conditions, Orthopaedics
Spondylolysis
An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Mechanical Back Pain
Lower back pain caused by structures in the back, such as joints, bones and soft tissues.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Coccydynia
Coccydynia is the medical term used to describe pain in your coccyx (tail bone).
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.