In most cases, lower back pain is caused by hypothermia or muscle tension from awkward movements or carrying heavy loads 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 bothers 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 clarifies with the patient exactly how much the back hurts: it can be sharp pain in the lower back when moving, periodic pain in the lower back, d'constant dull pain, sharp shooting pain and other unpleasant sensations of varying degrees. intensity. Depending on the duration, location and nature of the pain, the doctor determines its origin.
Pain in the lumbar spine: causes
Pain in the lumbar region can be associated with both spinal problems and other organs and systems of the body. To understand how to heal your lower back, you need to determine the cause of the pain.
There are vertebrogenic pains caused by spinal diseases:
- Osteochondrosis, manifested by problems with intervertebral discs, facets or facet joints. Problems occur with age in all people: the intervertebral discs lose their hydration and elasticity, the facet joints become denser and less mobile.
- Overwork of the muscles and ligaments of the spine.
- Compression of spinal nerve roots - radiculopathies.
- Spine injury.
- Instability of the spine due to weakness of the ligamentous-muscular system.
Non-vertebral causes include:
Neurological disorders
- Lumbosacral plexopathies are lesions of the nerve plexus at the origin of the peripheral nerves of the lower limbs. Occurs with injuries and metabolic disorders.
- Dystonia is a violation of the tone of the muscles that support the spine. In this case, the pain may be accompanied by poor posture. The disease can be congenital.
Systemic diseases
- Infections affecting the vertebrae, discs, spinal cord membranes or the spinal cord itself, e. g. osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in skeletal bone density, fraught with vertebral fractures.
- Rheumatological diseases, such as inflammatory spondyloarthropathy or ankylosing spondylitis.
Pain in internal organs.It is caused by causes outside the spine and radiates to the lower back, sometimes to the middle, sometimes to the side - depending on the source organ. These include:
- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. Severe paroxysmal shooting pain in the back and side accompanies renal colic as the stone moves along the ureter.
- Aortic aneurysm is a rare and dangerous condition in which the wall of the body's largest artery forms a bulge. This can cause a throbbing sensation in the abdomen.
- Hip joint diseases - injuries, inflammation, degeneration.
Psychogenic pain
Lower back pain may be associated with an anxiety disorder or depression.
An injury to the spinal cord or lower spinal roots, called a 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 severe bilateral back pain, muscle weakness of the legs, even paralysis, numbness of the lower extremities, urinary and fecal incontinence, it istherefore difficult to confuse it with other conditions.
Symptoms
Often, lower back pain is non-specific, meaning it is caused by harmless musculoskeletal disorders. Patients in this case describe the following complaints:
- Aching, pulling or squeezing pain.
- The onset or intensification of pain when a person stands or sits for a long time, lifts something heavy, performs physical work with raised arms, such as hanging curtains, changing light bulbs in achandelier, bending repeatedly and for prolonged periods: when washing floors, vacuuming, removing snow.
- No other symptoms.
The fact that pain may be a symptom of a dangerous condition is indicated by"red flags":
- Age over 50. This age group is at higher risk of osteoporosis and tumors.
- Pain at rest and at night, disturbing sleep. Nonspecific pain usually appears during 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 in recent months. This may be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Increased body temperature, chills. Indicates severe inflammation of various origins.
- Severe or increasing decrease in sensitivity or weakness in the leg muscles.
- Insufficient bladder or bowel function - involuntary bowel movements or, conversely, urinary retention or constipation. Nerves from the lower parts of the spinal cord travel to the pelvic organs and lower extremities. They contain both sensory and motor fibers. Loss of sensation or movement associated with sharp pain is a sign of compression of a nerve, and possibly the spinal cord. If this situation is not treated by a doctor, the function of the nerve or part of the spinal cord may be lost forever.
- Lack of treatment effect and transition from acute pain to chronic pain.
- Characteristics of medical history. For example, if lower back pain appears in a patient with a prior diagnosis of osteoporosis or malignancy. It doesn't matter how long ago the diagnosis was made. Or pain has appeared in a person who has recently suffered a serious infection, surgery or whose immune system is greatly weakened for some reason, for example, has been taking a glucocorticoid for a long time or has poorly controlled diabetes. In these cases, lower back pain can indicate various complications.
If you have identified at least one of the points listed, consult a doctor immediately for further examination.
Diagnostic
Pain is a subjective symptom, therefore investigation and examination by a doctor play an important role in the diagnosis. The doctor prescribes additional tests depending on the diagnosis he mentions. For an accurate diagnosis, perform:
- Laboratory tests— complete blood count, biochemical blood test, general urine test, tests for infections, autoimmune diseases.
- Electroneuromyography- study of the conduction of impulses along nerve fibers, which makes it possible to accurately determine the location of the lesion in neurological disorders.
- Imaging by x-ray, computed tomography (CT), magnetic resonance imaging (MRI), which will allow you to see all the structures of the spine, the presence of hernias, compression of the spinal nerve roots.
- Ultrasoundkidneys and abdominal cavity - carried out if pathology of internal organs is suspected.
- Assessment of bone condition: densitometry - in case of suspected osteoporosis, bone scintigraphy - in case of malignant lesions.
If the doctor is absolutely sure that the low back pain is not specific, he can prescribe treatment based solely on an examination, without additional tests.
Often, in case of lower back pain, a person does not consult a doctor, but only comes for an MRI of the spine on their own. This approach can be confusing for the patient: studies have shown that most adults have an asymptomatic herniated disc. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person suffers discomfort for a long time, takes painkillers uncontrollably and develops complications and side effects.
Which doctor should I contact?
Firstly, if you suffer from lower back pain, you can also consult a GP. He will suggest the cause of the pain and, based on this, will refer you to another specialist. You can skip this step and make an appointment with a neurologist immediately.
If a neurologist, after a specialized examination, suspects a pathology outside the spine, he may refer to:
- rheumatologist,
- surgeon,
- urologist,
- gastroenterologist,
- endocrinologist,
- oncologist.
Doctors of all these specialties are periodically faced with the symptom of low back pain, because it has a large number of possible causes.
If a diagnosis of mechanical pain has been established, the patient will be treated by physiotherapy specialists, reflexologist, physiotherapist 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 has paresis of a limb or a urinary disorder. These symptoms can be caused by an intervertebral hernia, tumor or injury. Also, consultation with a neurosurgeon may be recommended to the patient in the event of chronic pain when conservative treatment proves ineffective within 12 weeks. The surgical decision is only made after visualization of the spine.
Studies have shown that simple disc herniations can be successfully treated without surgery using conservative methods. Rehabilitation programs obtain good results in 90% of patients suffering from low back pain.
- Conservative treatmentincludes medicinal and non-medicinal methods.
Drug treatment is carried out using nonsteroidal anti-inflammatory drugs, which relieve pain and inflammation, as well as muscle relaxants, which relax the muscles.
Non-drug treatment includes:
- Physiotherapy— it is aimed at quickly eliminating pain and inflammation, as well as accelerating tissue restoration and muscle relaxation. The most effective methods: magnetotherapy, laser therapy and shock wave therapy.
- Acupuncture- insertion of special sterile needles into biologically active points to reduce pain and relax muscles.
- Massage— improves mobility of the spine and joints, promotes good distribution of the load on the back muscles.
- Physical therapy- helps relax and strengthen the back muscles. The exercises are effective for acute and chronic back pain.
If the patient has felt pain for more than 12 weeks, it is called chronic pain. In its treatment, antidepressants with analgesic effect, as well as cognitive-behavioral psychotherapy, are added to all of the above methods.
Bed rest does not provide any benefit in the treatment of mechanical low back pain and is not an alternative to the methods above. Additionally, this should be avoided as much as possible for the patient. Prolonged bed rest causes joint stiffness, muscle tension and significantly slows recovery.
Consequences
Acute non-specific low back pain has a favorable prognosis. Of those who seek treatment immediately, 70 to 90 percent 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, requiring 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 of the limbs, as well as problems with urination and defecation.
Prevention
Helps prevent lower back pain:
- Moderate exercise for 150 minutes per week: walking, swimming, exercises for the core muscles: stomach, lower back, pelvic floor, thighs and buttocks.
- Maintain a healthy weight.
- Warm up every 40 to 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 decreased bone density by taking calcium and vitamin D, early diagnosis of osteoporosis by densitometry. This is especially important for older people and postmenopausal women.
- Maintain general somatic and psychological health.