In most cases, lower back pain is caused by hypothermia or muscle strain due to awkward movement or heavy lifting and may go away on its own. If the pain disrupts the normal rhythm of life, improvement does not occur for too long, or other suspicious symptoms are present, then the diagnosis and treatment of back pain in the lumbar region should be entrusted to a doctor.
Depending on how long the pain has been bothering the patient, doctors distinguish between:
- acute pain - less than 4 weeks,
- subacute pain - from 4 to 12 weeks,
- chronic pain - more than 12 weeks.
During the examination, the doctor explains to the patient exactly how the back hurts: it can be a sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, a sharp stab and other unpleasant sensations of varying degrees of intensity. Based on the duration, location and nature of the pain, the doctor assumes its source.
Pain in the lumbar spine: causes
Pain in the lumbar region can be related to spine problems as well as other organs and systems in the body. To understand how to heal your lower back, you need to determine what is causing the pain.
There are vertebrogenic pains caused by diseases of the spine:
- Osteochondrosis, which is manifested by problems with intervertebral discs, facet or facet joints. Disorders occur with age in every person: intervertebral discs lose moisture and elasticity, facet joints become denser and less mobile.
- Overstrain of the muscles and ligaments of the spinal column.
- Spinal nerve root compression - radiculopathy.
- Spinal injury.
- Instability of the spine due to the weakness of the ligamento-muscular system.
Nonvertebral causes include:
Neurological disorders - Lumbosacral plexopathies are nerve plexus damage that leads to the peripheral nerves of the lower extremities. It occurs with injuries and metabolic disorders.
- Dystonia is a disorder of the tone of the muscles that support the spine. In this case, the pain may be accompanied by bad posture. The disease can be congenital.
Systemic diseases - Infections affecting the vertebrae, discs, membranes of the spinal cord or the spinal cord itself, for example, osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in bone density of the skeleton, fraught with vertebral fractures.
- Rheumatic diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.
Pain from internal organs. It is caused by causes outside the spine and radiates to the lower back, sometimes in the middle, sometimes laterally - depending on the organ of origin. This includes:- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal stabbing pain in the back and side accompanies renal colic when the stone moves along the ureter.
- Aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body forms a bulge. This can cause a throbbing sensation in the abdomen.
- Diseases of the hip joints - injuries, inflammations, degenerations.
Psychogenic pain Lower back pain can be associated with an anxiety disorder or depression.
An injury to the spinal cord or lower spinal roots, called cauda equina, is a medical emergency. Compression of these structures can be caused by:
- disc herniation,
- injury,
- malignant or benign tumor,
- infection.
Compression of the spinal cord is accompanied by extremely strong bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, urinary and fecal incontinence, so it is difficult to confuse it with other conditions.
Symptoms
Low back pain is often non-specific, i. e. caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:
- Pulling, pulling or squeezing pain.
- The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, for example, hanging curtains, changing light bulbs in a chandelier, bending over repeatedly and for a long time: when washing floors, vacuuming, removing snow.
- No other symptoms.
It points to the fact that pain can be a symptom of a dangerous condition"red flags":
- Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
- Pain at rest and at night, which disturbs sleep. Nonspecific pain usually occurs with movement or prolonged static load, but disappears after rest in a comfortable position.
- General weakness is also not characteristic of nonspecific pain.
- Unexplained weight loss over the last few months. It can be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Increased body temperature, shivering. It indicates severe inflammations of various origins.
- A severe or worsening decrease in sensitivity or weakness of the leg muscles.
- Bladder or bowel dysfunction - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and the lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement combined with acute pain is a sign of nerve compression, and possibly spinal cord compression. If this situation is not treated by a doctor, the function of a nerve or part of the spinal cord can be lost forever.
- Lack of treatment effect and transition of acute pain to chronic pain.
- Characteristics of history. For example, if pain in the lower back appeared in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn't matter how long ago the diagnosis was made. Or the pain has occurred in a person who has recently undergone any serious infection, surgery or has a suddenly weakened immune system for any reason, for example, has been taking glucocorticoids for a long time or has poorly controlled diabetes. In these cases, pain in the lower back can indicate various complications.
If you have identified at least one of the above points, immediately consult a doctor for an additional examination.
Diagnostics
Pain is a subjective symptom, so a survey and examination by a doctor plays a big role in establishing a diagnosis. The doctor prescribes additional examinations depending on which diagnosis he proposes. For an accurate diagnosis, perform:
- Laboratory tests— complete blood count, biochemical blood test, general urine test, tests to detect infections, autoimmune diseases.
- Electroneuromyography- study of conduction of impulses along nerve fibers, which enables precise determination of the location of the lesion in neurological disorders.
- Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI), which will help to see all the structures of the spinal column, the presence of hernias, compression of the spinal nerve root.
- Ultrasonographykidney and abdominal cavity - performed if pathology of internal organs is suspected.
- Assessment of bone condition: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.
If the doctor is completely sure that the pain in the lower back is non-specific, he can prescribe treatment based only on the examination, without additional tests.
Often, with pain in the lower back, a person does not go to the doctor, but only comes for an MRI of the spine. This approach can be confusing for the patient: studies have shown that most adults have asymptomatic herniated discs. The patient attributes the pain to this MR finding and does not seek further medical attention. As a result, a person suffers from discomfort for a long time, takes painkillers uncontrollably and develops complications and side effects.
Which doctor should I contact?
First, if you have lower back pain, you can also consult a general practitioner. He will suggest what is causing the pain and, depending on that, will refer you to another specialist. You can skip this step and make an appointment with a neurologist right away.
If, after a specialized examination, the neurologist suspects a pathology outside the spine, he can refer to:
- rheumatologist,
- surgeon,
- urologist,
- gastroenterologist,
- endocrinologist,
- oncologist.
Doctors of all these specialties periodically encounter the symptom of pain in the lower back, because it has a large number of possible causes.
If a diagnosis of mechanical pain has been made, the patient will be treated by physical therapy specialists, a reflexologist, a physiotherapist and a massage therapist.
How to cure lower back pain
- OperationThey are used mainly for signs of compression of the spinal cord or spinal nerve root, when the patient experiences limb paresis or urination disorder. These symptoms can be caused by an intervertebral hernia, tumor or injury. Also, a consultation with a neurosurgeon can be recommended to the patient in case of chronic pain when conservative treatment is ineffective within 12 weeks. The decision to operate is made only after visualization of the spine.
Research has shown that uncomplicated disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs achieve good results in 90% of patients with low back pain.
- Conservative treatmentincludes medical and non-medical methods.
Drug treatment is carried out using non-steroidal anti-inflammatory drugs that relieve pain and inflammation, as well as muscle relaxants that relax muscles.
Drug-free treatment includes:
- Physiotherapy— aims to quickly remove pain and inflammation, as well as accelerate tissue regeneration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
- Acupuncture- inserting special sterile needles into biologically active points to reduce pain and relax muscles.
- Massage— improves the mobility of the spine and joints, promotes proper load distribution on the back muscles.
- Physical therapy- allows you to relax and strengthen your back muscles. Exercises are effective for both acute and chronic back pain.
If the patient has pain for longer than 12 weeks, we are talking about chronic pain. Antidepressants with analgesic effects, as well as cognitive behavioral psychotherapy, are added to her treatment with all the above-mentioned methods.
Bed rest does not provide advantages in the treatment of mechanical lower back pain and is not an alternative to the above methods. Moreover, it should be avoided as much as possible for the patient. Prolonged rest in bed leads to stiff joints, muscle tension and significantly slows down recovery.
Consequences
Acute non-specific low back pain has a favorable prognosis. Of those who seek treatment immediately, 70-90% improve within a few days. The frequency of relapse depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, which requires treatment with antidepressants with an analgesic effect. If the pain is caused by compression of the spinal nerve root by a hernia, then it can be accompanied by numbness of the limbs, as well as problems with urination and defecation.
Prevention
Help prevent lower back pain by:
- Moderate exercise for 150 minutes a week: walking, swimming, exercises for the core muscles: abdomen, lower back, pelvic floor, thighs and buttocks.
- Maintaining a healthy weight.
- Warm up every 40-60 minutes with a long static position.
- Thigh muscle stretching exercises.
- Correct body position when lifting weights: you should squat, not lean forward.
- Prevention of reduced bone density by taking calcium and vitamin D, early detection of osteoporosis by densitometry. This is especially important for the elderly and postmenopausal women.
- Maintenance of general somatic and psychological health.