What causes right lower lumbar pain during cervical flexion?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: February 17, 2025 • View editorial policy

From the Guidelines

Right lower lumbar pain during cervical flexion is most likely caused by referred pain from the cervical spine, specifically the C5-C6 and C6-C7 disc levels, which share a common nerve root with the lower back 1.

Key Points to Consider

  • The convergence of nociceptive inputs from the cervical and lumbar spine on the dorsal horn of the spinal cord is thought to mediate this phenomenon, resulting in the perception of pain in the lower back 1.
  • Mechanical pain associated with facet joints, intervertebral discs, muscles, or fascia represents the majority of nontraumatic cervical or neck pain, and may contribute to referred pain in the lower back 1.
  • Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800mg every 8 hours for 7-10 days, or muscle relaxants like cyclobenzaprine 5-10mg every 8 hours for 3-5 days, may provide relief from symptoms.

Important Considerations

  • A thorough evaluation of the patient's medical history is critical to accurately guide imaging and treatment, as cervical neuropathic pain can have various etiologies, including tumor, infection, inflammation, and vascular causes 1.
  • Clinical signs or symptoms suggesting meningitis, neck soft-tissue infection, or upper respiratory infection should be managed according to separate clinical guidelines 1.

From the Research

Possible Causes of Right Lower Lumbar Pain during Cervical Flexion

  • Cervical radiculopathy, which describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine 2
  • Degenerative disease in the cervical spine, which can cause cervical radiculopathy and subsequent pain in the lower lumbar region during cervical flexion 2, 3
  • Changes in the foraminal size and nerve root motion during cervical flexion, which can exacerbate pain in patients with cervical disc herniation or cervical spondylosis 3
  • Referred pain from the cervical spine, which can cause pain in the lower lumbar region during cervical flexion 4, 5

Mechanisms of Pain

  • Compression or irritation of nerve roots in the cervical spine, which can cause pain in the upper extremities and potentially refer pain to the lower lumbar region 2, 3
  • Changes in the foraminal size and nerve root motion during cervical flexion, which can exacerbate pain in patients with cervical disc herniation or cervical spondylosis 3
  • Degenerative changes to the vertebrae, which can cause spinal stenosis and subsequent pain in the lower lumbar region during cervical flexion 5

Diagnosis and Treatment

  • A thorough history and physical examination are necessary to diagnose the cause of right lower lumbar pain during cervical flexion 4, 5
  • Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT), may be necessary to confirm the diagnosis and guide management 4, 5
  • Treatment options may include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and epidural steroid injections, depending on the underlying cause of the pain 2, 4, 5, 6

Related Questions

What are the appropriate Emergency Medical Services (EMS) questions and treatment options for a 71-year-old patient presenting with back pain?
What are the signs or symptoms of radiculopathy or spinal stenosis with low back pain?
What is the cause of persistent lumbar and cervical pain in a 51-year-old male with a history of disc degeneration and bone growths, despite partial improvement in right knee symptoms after corticosteroid injection?
What's the next step if cervical spine x-ray is normal but there's clinical concern for radiculopathy?
What is the next step in managing a 37-year-old male with chronic back pain, status post multiple spinal surgeries, currently controlled with oxycodone (OxyCodone) 5-10mg per day, as needed (PRN), with improving mental health but persistent back pain?
What is the most likely explanation for the sudden onset of dyspnea, lightheadedness, palpitations, and fatigue in a 78-year-old woman with a history of asymptomatic heart failure and hypertension, currently experiencing tachycardia, tachypnea, hypotension, and decreased oxygen saturation, with bilateral basilar crackles, an S3 heart sound, and lower extremity edema, with an ejection fraction of 35%?
Is long-term use of baclofen (GABA receptor agonist) safe?
What is the protocol for discontinuing an intravenous (IV) insulin infusion?
What are the risks of pregnancy in patients with alcoholic liver cirrhosis (liver scarring due to alcohol use)?
What are the differential diagnoses for a 19-year-old male experiencing recurrent tightness in his left calf and left toes?
What is the most likely diagnosis for a skin lesion with a rolled, pearly border, telangiectasia, and a central crust in a patient with a history of heavy sun exposure?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.