Jae-seok Ahn | Director, seoul chungdam dr ahnapa clinic

When your lower back hurts, you immediately worry, "Could it be a disc?" Conversely, when you feel muscle tightness upon pressing, you might simply dismiss it as knots.

Not all severe lower back pain is due to a disc, and tight muscles don't necessarily mean only muscle pain. Both problems can occur together.

I trained at Seoul National University Hospital and obtained my board certification in anesthesiology and pain medicine in 2000, followed by a pain medicine fellowship and 4 years as director of the pain medicine department at a general hospital. Over approximately 25 years of treating pain, what I consider most important is carefully confirming a patient's symptoms rather than hastily assigning a diagnosis.

1. Check whether only your lower back hurts or if your legs are numb

If your lower back feels stiff and tight when moving after strenuous work or unfamiliar exercise, you can consider muscle strain. However, muscle pain should not be confirmed based on this alone.

If you feel a tingling sensation radiating from your buttocks down to your calf or foot, or if sensation becomes dull, it may be a symptom caused by a herniated disc pressing on a nerve. In cases where poor posture causes severe tightness in one erector spinae muscle, nerve compression at the opening where nerves exit the spine can also produce radicular pain similar to that of a disc, so accurate diagnosis by a specialist is necessary.

If numbness is accompanied by weakness, it's best not to delay your visit. Conversely, lack of leg numbness does not completely rule out disc-related pain.

2. You should also investigate why the erector spinae muscles are tight

The erector spinae muscles are a group of muscles behind the lower back that support the trunk and control movement.

Burden can vary due to prolonged sitting or habits of leaning on one buttock. Sometimes muscle tension increases as the lower back tries to protect another painful area.

That's why I don't stop at feeling the tight area. I also examine when discomfort occurs—during sitting, standing, or bending—and whether symptoms change with postural changes.

It's important to examine both the painful muscle and daily-life burdens, while not overlooking nerve or joint problems.

3. Whether an MRI is needed is determined after examination

Not everyone with lower back pain needs an MRI from the start. We check symptoms, changes in sensation and strength, and warning signs, then determine whether test results will help guide treatment.

If you've already had imaging done, please bring the images and radiology report. It's important to verify together whether the changes seen on the images explain your current pain location and symptoms.

Please note just these three things before your visit

  • Where does it hurt? The region with symptoms—lower back, buttocks, calf, foot

  • When does it change? Movements that cause discomfort, such as prolonged sitting, walking, or bending

  • Have strength or sensation changed? Changes such as dragging your foot or difficulty climbing stairs

You don't need to write extensively. A description like "When I sit, my right calf tingles all the way down, and it improves a little when I walk" is helpful for your visit.

However, if you experience new urinary or bowel dysfunction, reduced sensation in the perineal area, or rapidly progressive leg weakness, don't wait for an appointment—seek immediate emergency evaluation.

Let's examine the cause of recurring lower back pain together

If you're considering a visit for lower back pain in Dasan or Namyangju, please prepare any existing test results and previous treatment records.

At seoul chungdam dr ahnapa clinic's orthopedic department, we examine the pain location, nerve status, and postural and loading habits together to discuss necessary treatment and lifestyle management approaches.

For consultation, call 031-8088-8030
Please say, "I would like to receive a consultation about whether my lower back pain is a muscle issue or a disc problem."

This is general medical information, and diagnosis and treatment may vary depending on individual circumstances.

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