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Pain in the lower back (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle strain combined with insufficient physical training. Rest for 2-3 days and maybe mild sedatives can solve the problem.

In rarer cases, the cause is more serious: a herniated disc (also known as a herniated disc), spondylolisthesis, fracture or tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the legs, difficulty urinating, etc.

Treatment of back pain begins with a detailed history (when the pain started, how long it lasts, where it affects, what makes it worse, etc. ), followed by a physical examination. Other parts of the body that can cause back pain similar to back pain should be examined, such as the kidneys and abdomen.

If necessary, tests such as plain x-rays and MRIs will be required. Conservative treatment (rest, medications, physiotherapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, there are injections in the back under local anesthesia.

Pain in the lower back

Frequently asked questions about back pain

What does the middle (lumbar) spine consist of?

The lumbar spine consists of:

  1. bones (vertebrae);
  2. intervertebral discs (between two adjacent vertebrae there is a disc, like a pillow);
  3. knots (there are two knots at the back of each vertebra);
  4. ligaments;
  5. tendons;
  6. muscles and in the end;
  7. nerves exiting the spine (one on the right and one on the left at each level) that provide nerve stimulation to the legs.

In a broader sense, the intervertebral disc is also a type of joint.

Which of the following elements of the spine can cause back pain?

All the anatomical elements described in the question above have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is soft tissue strain, d. m. th. muscles, ligaments and tendons. Then we say that the pain is "muscular".

The following paradox is also true: the image during an x-ray examination does not always correspond to the intensity of the pain. So one patient may have excruciating back pain from a muscle strain (with nothing showing on a plain X-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What can cause back pain?

The cause of back pain is:

  1. muscle tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (more than 70%);
  2. intervertebral disc wear (for example, disc herniation);
  3. joint damage;
  4. spondylolisthesis;
  5. fractures (as a result of trauma, as well as automatically as a result of osteoporosis or metastases);
  6. Other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (eg ankylosing spondylitis), Scheuermann's disease;
  7. causes outside the spine, for example, nephrolithiasis (kidney stones), abdominal aortic aneurysm, cholecystitis.

The cause of pain can vary from age to age.

Yes, the reasons change with age, because the structure of the spine changes. In young people, the intervertebral disc is usually affected: the most common cause (apart from muscle strain) is disc herniation.

In old age, wear and tear on the back elements of the spine (such as joints) increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and fractures due to osteoporosis also begin to appear.

Can back pain be related to body weight?

Yes, the role of increased body weight in the occurrence of back pain is empirically known and scientifically confirmed. This may be due to the fact that an overweight person usually does not play sports and therefore has not "built" the right muscular system to protect the back from minor injuries. People who are overweight and obese (with a body mass index of more than 25-30) are more likely to experience attacks of back pain.

I have backache. Should I stop lifting weights?

In the acute phase, d. m. th. when the pain is last, heavy lifting should be avoided. That is, you can lift a package from the supermarket, but you are not allowed to lift, for example, a heavy box. When this phase is over and the pain goes away, you can lift small weights, but you need to learn how to do it correctly, that is, to bend your knees and not to straighten them, as weightlifters do. In addition, the more a person exercises the muscles of the spine, the more stress the back can withstand.

In general, everyday life certainly involves lifting weights: the human body is designed to lift weights and do heavy lifting, such as a parent lifting their child.

Lifting weights in the gym is another matter: as a general rule, unless absolutely necessary (ie if the person is not an athlete), it is recommended that a person with back problems avoid weight training in the gym.

Can osteoporosis cause back pain?

Only in case of a fracture. These types of fractures usually occur spontaneously (ie not caused by a fall) and symptoms may not be as loud as with "normal" fractures, d. m. th. pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is classified as chronic if it continues for more than 3 months without interruption. The limit of 3 months is not arbitrary: it has been observed that patients suffering from back pain for more than 3 months have several characteristics that make treatment difficult:

  1. pain with a "strange" character, d. m. th. described as a burning sensation, "electricity";
  2. the cause of the pain may appear to have resolved, for example, a herniated disc may "resolve" on an MRI;
  3. the patient experiences the psychological impact of pain and exhibits symptoms such as anxiety and depression.

What is the scientific explanation for this strange type of back pain?

The prevailing theory of chronic pain is that continuous and prolonged stimulation of a nerve pathway (ie, the pathway from the site of pain to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.

Thus, a low-intensity stimulus may cause very strong pain or pain that does not correspond to the type of stimulus, such assh. feeling as if you are on fire when there is no part of the body that is being heated. Thus, even if the anatomical cause of the pain is treated, the pain and the psychological response may remain, as if embedded in the brain. It is for this reason that for chronic back pain, drugs that affect the central nervous system, such as antidepressants (in addition to conventional painkillers), are prescribed.

When should you see a doctor for back pain?

  • when the pain does not go away with simple pain relievers within a few days;
  • when the pain appears not only in the back, but also in the legs;
  • when the leg becomes numb or starts to become paralyzed;
  • if the back pain continues at night, during sleep or even wakes the patient from sleep;
  • if you have problems with urination, bowel movements and/or sexual function;
  • when accompanied by fever;
  • when caused by a fall or accident;
  • when accompanied by weight loss;
  • if there is a history of cancer, osteoporosis, long-term use of cortisone, intravenous drug use (eg, heroin), or alcoholism.

What are the next steps?

The doctor who will examine you will take a complete medical history and examine you. Then, if necessary, tests such as plain X-ray, CT or MRI will be performed.

Should I have an X-ray if I have back pain?

No. About 70% of back pain cases are caused by a simple muscle strain and in these cases there is no need for examination.

What if an X-ray or MRI shows something?

This is very, very common: someone does a back exam and discovers an x-ray finding like a herniated disc, osteophytes, etc. But that's what the word says: an x-ray finding. This means that the drive was damaged at some point in time. But the examination does not tell us when this damage occurred, d. m. th. recently or a long time ago, so it doesn't prove to us that the back pain is actually caused by this particular herniated disc. Furthermore, many "degenerative changes" occur in all people, whether they experience pain or not. Therefore, when a diagnosis is made, it cannot be guided only by the results of an x-ray examination.

For the same reason, treatment (or even indication for surgery) for spinal problems should never be suggested simply by looking at an MRI image. It is appropriate to first perform a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

Which is a more specific test for back pain: plain x-ray, CT scan, or MRI?

There is no single answer to this question. Each test has indications and each test has disadvantages:

  1. conventional radiographyit is a very quick and simple test that costs very little. But it only shows the bones. This means that a fracture, scoliosis or kyphosis, or spondylolisthesis is clearly visible, but the intervertebral discs and nerves are not visible.
  2. CT scanit takes very few minutes and has an average cost, but at the same time there is a high dose of radiation. It describes all the elements of the spine relatively well. This is relatively unfavorable when imaging nerves and discs.
  3. MRIIt requires a long time, for example 20 minutes, and is an unsuitable examination for people suffering from claustrophobia. The cost is high, but there is no radiation. This is the most detailed exam we have and maps all the structures of the spine, especially the nerves. It somewhat lacks cramps, especially the small ones. In any case, the doctor, after examining you, will choose you and recommend an appropriate test.

How is back pain usually treated?

  • in most cases, rest and some simple measures at home help, for example, "hot and cold" and lumbar (belt) protection;
  • To relieve pain, you can use certain medications, such as analgesics, nonsteroidal anti-inflammatory drugs, etc. ;
  • Visiting a physiotherapist often helps, especially if it is done in a certain way and for specific indications;
  • alternative forms of treatment such as acupuncture, yoga and Pilates can provide significant benefits for individual patients;
  • Sometimes spinal injections may also be used.
  • In relatively rare cases, the above (conservative) treatment is ineffective and surgical intervention is required.

Does rest mean I have to stay in bed?

Only for 2-3 days and only in case of emergency. Studies have shown that staying in bed for more than 2-3 days worsens back pain rather than cures it. It is generally recommended to walk as much as possible.

If a person is unable to get out of bed despite conservative treatment due to excruciating pain, this usually indicates a serious problem and should be seen by a doctor.

Should you use hot or cold to relieve back pain?

Both methods have been tested and help, depending on the situation. The mechanism of action is different:

  • heat (warmth) causes muscle relaxation, d. m. th. relaxes muscles contracted by pain and increases blood circulation. You can use a heated cloth on the radiator or take a warm (not hot) bath.
  • cold prevents pain fibers from transmitting pain (for example, athletes apply coolant while playing football). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). An easy alternative: a bag of frozen vegetables.

What medicines can you take for back pain?

Medications that can be used to treat back pain include:

  1. Primarily an anilide analgesic, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest remedy and treatment should always begin with it.
  2. Non-steroidal anti-inflammatory drugs (there are several classes). Stronger sedative drugs, but when taken chronically have many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticosteroid- a powerful and effective pain reliever, but with a large number of side effects when used chronically and no clearly proven benefits for back pain.
  4. Opioids, d. m. th. morphine-type drugs. It is usually given intravenously or intramuscularly in a hospital, but some oral medications are also available.
  5. Antiepileptic or antidepressant medications, mainly for chronic pain, but also for some acute conditions.

Important!

All the above medications should be taken on the recommendation of a doctor who has previously examined you. It is careless and potentially dangerous to self-medicate by listening to friends, getting ideas from the Internet, or talking to your doctor on the phone without checking first.

How can a physiotherapist help me with back pain?

The role of a physical therapist is very important in the treatment of back pain. The most suitable is an initial program that lasts a few days and then the patient can learn to perform the necessary exercises on his own. Severe pain is first treated so that the patient can walk (ie, not bedridden), and when the pain subsides, exercises are started to strengthen the muscles and realign the spine. The program may include:

  1. Immediate relief measures such as electrotherapy (eg TENS), ultrasound, diathermy, massage;
  2. aerobic exercise, such as walking, swimming or hydrotherapy, and in some cases cycling;
  3. trunk stabilization and proprioception exercises, which "teach" the muscles to better support the spine;
  4. strengthening exercises, such as abdominal and back exercises (not at the beginning of the program);
  5. exercises to develop range of motion;
  6. mechanical diagnosis and McKenzie therapy;
  7. retraining, d. m. th. learning how to stand, sit, lift weights correctly, etc.

If you have back pain, should you see a physiotherapist or a doctor first?

Physiotherapy is one of the methods for treating back pain. Other methods are medication, care, walking and finally spinal injections and surgery. Therefore, there should be a central person who will select the methods used and evaluate the patient's progress.

It is best for a patient with back pain to see a doctor first to rule out rare and serious causes of back pain. The doctor then refers the patient to a physiotherapist, with whom the patient should keep in touch to discuss the progress of the treatment. The ultimate responsibility for the patient's progress rests with the physician.

Should I wear a talisman (belt) for back pain?

A simple soft pillow can be used for several days. It does not provide complete immobilization (rigid braces, like the ones we use for fractures do), but it limits excessive and sudden movements and thus reminds the back patient of proper posture, especially at work.

Chronic long-term use has the opposite effect as the spinal muscles atrophy, leading to increased pain. In conclusion, it should be noted that when used for 1-2 weeks, the amulet can be useful. It is best used in conjunction with a spinal muscle strengthening program to ultimately eliminate the need for protection.

How likely am I to need surgery for my back pain?

It's a small chance. Out of 100 patients who go to the doctor for back pain, only 5-10 will eventually require surgery, and that's after all other remedies (conservative treatments) have been exhausted.

What can I do during my pain-free periods to prevent back pain?

  • Exercise regularly in consultation with your doctor. Walking and swimming are two excellent exercises that strengthen the spine. Before you start exercising, ask your doctor what exercises are okay for other health problems, such as heart disease.
  • Strengthen the muscles that support the waist area (abdominal and back muscles). Consultation with your physical therapist or physical therapist is essential.
  • Quit smoking or at least reduce the amount of smoking.
  • Maintain proper body weight, lose excess weight.
  • Help your spine: learn how to lift weights, how to stand, which mattress to sleep on and how to sleep, how to sit at a desk, etc.

Which doctor should you see for back pain?

You may want to see a doctor who specializes in the spine, such as a neurosurgeon or orthopedic surgeon.