Lower back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle tension and insufficient physical training. Rest for 2-3 days and maybe some mild pain relievers will solve the problem.

Less commonly, 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 causes pain, numbness, leg weakness, difficulty urinating, etc.

The treatment of back pain begins with a detailed history (when the pain started, how long it lasts, where it affects, what makes the situation 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 should be ordered. Conservative treatment (rest, drugs, physical therapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, injections are given in the spine under local anesthesia.

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 is a disc like a cushion);
3. joints (each vertebra has two joints at the back);
4. ribbons;
5. tendons;
6. muscles and finally;
7. the 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 kind of joint.

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

All of 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 stretching of the soft tissues, i. e. muscles, ligaments and tendons. Then we say that the pain is "muscular".

The following paradox is also true: during an X-ray examination, the image does not always correspond to the intensity of the pain. So one patient can have terrible back pain from a muscle strain (without a plain x-ray or MRI showing anything) while another patient with a large herniated disc has no symptoms.

What can cause back pain?

Causes of back pain include:

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

The cause of pain can vary by age.

Yes, the causes change with age because the structure of the spine changes. In young people, the intervertebral disc is usually affected: the most common cause (besides muscle strain) is a herniated disc.

In old age, wear and tear on the back elements of the spine (e. g. joints) increases, so the most common causes are osteoarthritis and lumbar spondylolisthesis, as well as fractures due to osteoporosis.

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 proven. This may be because an overweight person usually does not exercise, and therefore has not "built" the right muscle system to protect his back from minor injuries. Overweight and obese people (body mass index greater than 25-30) are more likely to experience back pain. .

I have a backache. Should I stop lifting weights?

In the acute phase, that is. if the pain is recent, heavy lifting should be avoided. In other words, you can lift a package from the supermarket, but you must not, for example, lift a heavy box. When this stage is over and the pain is gone, you can lift small weights, but you need to learn how to do it correctly, which is to bend your knees and not straighten them, as weightlifters do. In addition, the more you exercise your spinal muscles, the more strain your back can take.

In general, everyday life certainly involves weight lifting: the human body is designed for weight lifting and heavy lifting, such as a parent lifting a child.

Lifting weights in the gym is a different matter: as a general rule, unless absolutely necessary (i. e. 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 breakage. These types of fractures usually occur automatically (so they are not caused by a fall) and the symptoms may not be as noisy as "normal" fractures, e. g. pain can be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is considered chronic if it persists for more than 3 months without interruption. The 3-month limit is not arbitrary: it can be observed that patients suffering from back pain lasting longer than 3 months have certain characteristics that make treatment difficult:

1. pain of a "strange" character, i. e. it is described as a burning sensation, "electrical current";
2. the cause of the pain may appear to resolve, 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?

A common theory of chronic pain is that persistent and prolonged stimulation of a neural pathway (ie, the path from the pain site to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.

Thus, a low-intensity stimulus may cause very intense pain, or may cause pain that does not correspond to the type of stimulus, such as a burning sensation, when there is no part of the body that heats up. Thus, even if the anatomical cause of the pain is treated, the pain and the psychological reaction may remain, as if etched into the brain. This is why drugs that affect the central nervous system, such as antidepressants, are prescribed for chronic back pain (in addition to traditional pain relievers).

When should you see a doctor for back pain?

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

What are the next steps?

The doctor examining you will take a complete medical history and examine you. Then, if necessary, tests such as plain X-ray, CT or MRI are carried out.

Do I need an X-ray if I have back pain?

No. About 70% of back pain is caused by a simple muscle strain, and in these cases no investigation is needed.

What if the X-ray or MRI shows something?

This is very, very common: someone does a back exam and discovers x-ray findings like herniated discs, osteophytes, etc. But that's what the word says: X-ray findings. This means that the disk was damaged at some point. But the investigation does not reveal when this injury occurred, e. g. recently or a long time ago, so for us it does not prove that the back pain is currently caused by this herniated disc. Also, many "degenerative lesions" occur in all people, whether they feel pain or not. Therefore, when establishing a diagnosis, it is not possible to be guided only by the results of the X-ray examination.

For the same reason, you should never recommend the treatment (or even the indication for surgery) of spinal problems just by looking at an MRI image. It is advisable to first carry out the medical history and clinical examination, and then correlate the MRI findings with the patient's symptoms.

Which is the more specific examination for back pain: plain X-ray, CT or MRI?

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

1. conventional radiographya very quick and easy test that costs very little. But it only shows the bones. This means that the 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 it has a high radiation dose. It represents all the elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and discs.
3. MRIIt takes a long time, like 20 minutes, and is an uncomfortable test for people with claustrophobia. The costs are high, but there is no radiation. This is our most detailed examination, mapping all the structures of the spine, especially the nerves. It is somewhat lacking in screws, especially the small ones. In any case, after examining you, the doctor will select and recommend the appropriate test.

How is back pain usually treated?

• in most cases, rest and some simple home measures help, for example "hot and cold" and waist protection (belt);
• You can use certain medicines like pain relievers, non-steroidal anti-inflammatory drugs, etc. to relieve the pain. ;
• It often helps to visit a physiotherapist, especially if it is done in a certain way and based on specific indications;
• alternative forms of treatment such as acupuncture, yoga and pilates can have significant benefits for individual patients;
• Sometimes spinal injections can 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 an emergency. Studies have shown that staying in bed for more than 2-3 days worsens rather than cures back pain. In general, it is recommended to walk as much as possible.

If a person is unable to get up due to excruciating pain despite conservative treatment, this usually indicates a serious problem and should see a doctor.

Should you use heat or cold to relieve back pain?

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

• heat (warm) causes muscle relaxation, i. e. it relaxes muscles contracted from pain and increases blood circulation. You can use clothes heated on a radiator or take a warm bath (not hot).
• cold prevents pain fibers from conducting pain (e. g. athletes apply coolant while playing soccer). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). A simple alternative: a bag of vegetables from the freezer.

What medicines can you take for back pain?

Medicines that can be used to treat back pain include:

1. Mainly an anilide analgesic, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest drug and should always be the starting point for treatment.
2. Nonsteroidal anti-inflammatory drugs (there are several classes). They are stronger pain relievers, but when taken chronically, they have many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
3. Glucocorticosteroid- It is a powerful and effective pain reliever, but it has many side effects when used chronically, without a clearly proven beneficial effect on back pain.
4. Opioids, e. g. morphine-type drugs. It is usually given intravenously or intramuscularly in the hospital, but some oral medications are also available.
5. Antiepileptics or antidepressants, mainly for chronic pain, but also for certain acute conditions.

Important!

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

How can a physiotherapist help my back pain?

The role of the physical therapist is very important in the treatment of back pain. An initial program of several days is most suitable, after which the patient can learn to perform the necessary exercises independently. Severe pain is initially treated so that the patient can walk (i. e. not bedridden), and when the pain subsides, muscle strengthening and spinal rehabilitation begin. 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 even cycling;
3. trunk stabilization and proprioception exercises that "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 improve range of motion;
6. mechanical diagnosis and therapy McKenzie;
7. retraining, that is. learning to stand, sit, lift weights, etc.

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

Physiotherapy is one way to treat back pain. Other methods are medication, grooming, walking, and finally injections and spine surgery. That is why we need a central person who selects the methods used and evaluates 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 physical therapist, with whom the patient should keep in touch to discuss the progress of the treatment. The doctor is ultimately responsible for the patient's progress.

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

A simple soft pad can be used for a few days. It does not provide complete immobilization (rigid protective covers like the ones we use for fractures), but it limits excessive and sudden movements and thus reminds the back patient of correct posture, especially at work.

Long-term chronic 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 strengthening program to eventually eliminate the need for protection.

How likely is it that I will need surgery for my back pain?

Chances are slim. Out of 100 patients who see a doctor for back pain, only 5-10 will need surgery, and this happens after all other remedies (conservative treatment) have been exhausted.

What can I do during times when my back does not hurt 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 appropriate for other health conditions, such as heart disease.
• Strengthen the muscles supporting the lower back (abdominal and back muscles). Consultation with your physiotherapist or physiotherapist is essential.
• Quit smoking or at least reduce the amount you smoke.
• Maintains the right body weight and sheds excess weight.
• Help your spine: learn how to lift weights, how to stand up, what mattress to sleep on and how to sleep, how to sit at a desk, etc.

Which doctor should be consulted for back pain?

It is worth seeing a doctor who specializes in the spine, such as a neurosurgeon or orthopedic surgeon.