In most cases, lower back pain is caused by hypothermia or muscle tension 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 there are other suspicious symptoms, 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 bothered the patient, doctors distinguish:
- acute pain - less than 4 weeks,
- subacute pain - from 4 to 12 weeks,
- chronic pain - more than 12 weeks.
At the appointment, the doctor explains to the patient exactly how the back hurts: it can be sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp piercing pain and other unpleasant sensations of varying degrees of intensity. Based on the duration, localization 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 both spine problems and 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 is vertebrogenic pain caused by diseases of the spine:
- Osteochondrosis manifested by problems with the intervertebral discs, facet or facet joints. Disorders appear with age in every person: the intervertebral discs lose moisture and elasticity, the facet joints become denser and become less mobile.
- Overstrain of the muscles and ligaments of the spine.
- Compression of the spinal nerve roots - radiculopathies.
- Spinal cord injury.
- Instability of the spine due to weakness of the ligamentous-muscular system.
Nonvertebral causes include:
Neurological disorders - Lumbosacral plexopathies are damage to the nerve plexus that innervates the peripheral nerves of the lower extremities. 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, eg osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in the density of skeletal bones, 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 in the back, sometimes in the middle, sometimes laterally - depending on the source organ. They include:- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the excretory system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal piercing pain in the back and sides 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 pulsing sensation in the abdomen.
- Diseases of the hip joints - injuries, inflammations, degenerations.
Psychogenic pain Lower back pain can be related to anxiety disorder or depression.
Injury to the spinal cord or the lower roots of the spine, called the cauda equina, is a medical emergency. Compression of these structures can be caused by:
- herniated disc,
- 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 limbs, 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:
- Aching, pulling, or pressing 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 repeatedly and for a long time: when washing floors, vacuuming, cleaningon snow.
- No other symptoms.
The fact that pain can be a symptom of some dangerous condition is shown by"red flags":
- Age over 50 years. This age group has a higher risk of osteoporosis and tumors.
- Pain at rest and at night, preventing sleep. Nonspecific pain usually occurs with movement or prolonged static loading, but disappears after rest in a comfortable position.
- General weakness is also not characteristic of nonspecific pain.
- Unexplained weight loss over the past few months. It can be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Increased body temperature, chills. It indicates severe inflammation of various origins.
- Severe or increasing numbness or weakness in the muscles of the legs.
- Impaired bladder or bowel function - involuntary bowel movement or, conversely, retention of urine or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower limbs. They contain both sensory and motor fibers. Loss of sensation or movement combined with sharp pain is a sign of nerve and possibly spinal cord compression. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord can be lost forever.
- Lack of treatment effect and transition of acute pain to chronic.
- Features of the medical history. For example, if the pain in the lower back occurs 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 had a serious infection, surgery, or has a severely reduced immune system for some reason, for example, has been on 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 listed points, immediately consult a doctor for an additional examination.
Diagnosis
Pain is a subjective symptom, so examination and examination by a doctor play a huge role in diagnosis. The doctor prescribes additional tests depending on the diagnosis he offers. For an accurate diagnosis, perform:
- Laboratory researches— complete blood count, biochemical blood test, general urine test, tests to detect infections, autoimmune diseases.
- Electroneuromyography- study of the conduction of impulses along the nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
- Imaging by radiography, computed tomography (CT), nuclear magnetic resonance (MRI), which will help to see all the structures of the spine, the presence of a hernia, the compression of the roots of the spinal nerves.
- Ultrasoundkidneys and abdominal cavity - is performed when pathology of internal organs is suspected.
- Assessment of bone status: densitometry - in case of suspicion of osteoporosis, bone scintigraphy - in case of malignant formations.
If the doctor is absolutely sure that the pain in the back is non-specific, he can prescribe treatment only based on an examination, without additional research.
Often, with pain in the lower back, a person does not go to a doctor, but only comes for an MRI of the spine. This approach can be confusing for the patient: studies show that most adults have asymptomatic herniated discs. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person experiences discomfort for a long time, uncontrollably takes painkillers, 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 tell you what the pain is due to and, depending on that, he 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, a neurologist suspects a pathology outside the spine, he may refer to:
- rheumatologist,
- surgeon,
- urologist,
- gastroenterologist,
- endocrinologist,
- oncologist.
Doctors from all these specialties periodically encounter the symptom of pain in the lower back, since there are a large number of possible causes.
If a diagnosis of mechanical pain is established, the patient will be treated by physiotherapists, reflexologists, physiotherapists and massage therapists.
How to cure lower back pain
- surgeryThey are used mainly for signs of compression of the spinal cord or spinal nerve roots, when the patient experiences paresis of a limb or a violation of urination. These symptoms can be caused by an intervertebral hernia, a tumor, or an injury. Also, 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.
Studies show 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 drug and non-drug methods.
Drug treatment is carried out with the help of non-steroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.
Non-drug treatment includes:
- Physiotherapy— aims to quickly eliminate pain and inflammation, as well as accelerate tissue recovery and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
- Acupuncture- introducing special sterile needles into biologically active points to reduce pain and relax muscles.
- Massage— improves the mobility of the spine and joints, helps to properly distribute the load on the back muscles.
- Physiotherapy- 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 more than 12 weeks, we are talking about chronic pain. In her treatment, antidepressants with an analgesic effect, as well as cognitive-behavioral psychotherapy, are added to all the above methods.
Bed rest provides no benefit in the treatment of mechanical low back pain and is not an alternative to the above methods. It should also be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle tension and significantly delays recovery.
Consequences
Acute non-specific low back pain has a favorable prognosis. Of those who seek treatment right away, 70-90% improve within a few days. The frequency of relapses depends on lifestyle. In some patients, the pain becomes chronic and lasts more than 12 weeks, necessitating treatment with antidepressants with an analgesic effect. If the pain is caused by compression of the spinal nerve roots by a hernia, then it may be accompanied by numbness in the limbs, as well as problems with urination and defecation.
Prevention
Help prevent lower back pain:
- Moderate exercise for 150 minutes per week: walking, swimming, exercises for the main muscles: abdomen, back, pelvic floor, thighs and buttocks.
- Maintaining a healthy weight.
- Warm up every 40-60 minutes with a long static position.
- Exercises for stretching the thigh muscles.
- Correct body position when lifting weights: you should squat, not lean forward.
- Prevention of reduced bone density by calcium and vitamin D intake, early diagnosis of osteoporosis by densitometry. This is especially important for the elderly and postmenopausal women.
- Maintenance of general somatic and psychological health.