Lower back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle tension associated with insufficient physical training. Rest for 2-3 days and mild painkillers may help.

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

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

If necessary, tests such as simple x-rays and an MRI will be requested. Conservative treatment (rest, medication, physiotherapy) is generally sufficient. In rare cases, special surgery is necessary. As an alternative, there are injections into the spine under local anesthesia.

Frequently asked questions about back pain

What is the middle (lumbar) spine made of?

The spine at waist level consists of:

1. bones (vertebrae);
2. intervertebral discs (between two adjacent vertebrae there is a disc, like a pillow);
3. the joints (there are two joints at the back of each vertebra);
4. ligaments;
5. tendons;
6. the muscles and finally;
7. nerves emerging from the spine (one on the right and one on the left at each level) that stimulate the nerves in the legs.

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

Which of the following parts 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 tension in the soft tissues, i. e. muscles, ligaments and tendons. We then 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 pain. So one patient may have terrible back pain from muscle strain (without showing anything on a simple X-ray or MRI), while another patient with a large herniated disc may have no symptoms at all.

What can cause back pain?

The cause of back pain is:

1. muscular tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (over 70%);
2. wear of the intervertebral discs (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), rheumatologic diseases (e. g. , ankylosing spondylitis), Scheuermann's disease;
7. causes outside the spine, e. g. 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 generally affected: the most common cause (apart from muscle tension) is a herniated disc.

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

Can back pain be linked to body weight?

Yes, the role of increased body weight in the onset of back pain is empirically known and scientifically confirmed. This may be because an overweight person generally does not play sports and therefore has not "built up" the appropriate muscular system to protect the back from minor injuries. Overweight and obese people (with a body mass index above 25-30) are more likely to suffer from back pain.

My back hurts. Should I stop lifting weights?

In the acute phase, that is to say when the pain is recent, you should avoid lifting heavy objects. That is, you can lift a package at the supermarket, but you are not allowed to lift, for example, a heavy box. When this stage is completed and the pain disappears, you can lift small weights, but you must learn to do it correctly, that is, bend your knees and not straighten them, as weightlifters do. Additionally, the more a person exercises their spinal muscles, the more stress their back can withstand.

Generally speaking, daily life certainly involves lifting weights: the human body is designed to lift weights and to lift heavy loads, like a parent lifting their child.

Lifting weights in the gym is another matter: as a general rule, unless absolutely necessary (that is, unless the person is an athlete), it is recommended for someone with back problemsto avoid doing weight training in the gym.

Can osteoporosis cause back pain?

Only in case of fracture. These types of fractures usually occur automatically (i. e. they are not caused by a fall) and the symptoms may not be as noticeable as those of "normal" fractures, i. e. say the pain may be minimal.

What does chronic lumbago mean?

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

1. pain of a "strange" character, i. e. described as a burning sensation, "electric current";
2. the cause of the pain may appear resolved, for example, a herniated disc may be "resolved" on an MRI;
3. the patient feels the psychological impact of the pain and presents 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 persistent and prolonged stimulation of a neural pathway (i. e. , the path from the site of pain to the brain) causes "sensitization", such that the stimulus causesan exaggerated or strange response.

So a low-intensity stimulus can cause very intense pain or pain that does not correspond to the type of stimulus, such as a sensation of fire when no part of the body is heating. So, even if the anatomical cause of the pain is treated, the pain and psychological response may persist, as if imprinted in the brain. It is for this reason that for chronic back pain, medications acting on the central nervous system, such as antidepressants, are prescribed (in addition to traditional analgesics).

When should you see a doctor for back pain?

• when the pain does not go away with simple painkillers within a few days;
• when pain occurs not only in the back, but also in the leg;
• when the leg becomes numb or begins to become paralyzed;
• if back pain persists 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 triggered by a fall or accident;
• when accompanied by weight loss;
• if there is a history of cancer, osteoporosis, long-term cortisone use, intravenous drug use (eg, heroin), or alcoholism.

What are the next steps?

The doctor who examines you will take a complete medical history and examine you. Then, if necessary, examinations such as simple x-rays, a CT scan or an MRI will be carried out.

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

No. Around 70% of cases of back pain are caused by simple muscle tension and in these cases no examination is necessary.

What happens if an X-ray or MRI reveals 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. That means the disk was damaged at some point. But the exam does not tell us when this injury occurred, i. e. recently or a long time ago, so it does not prove to us that the back pain is currently caused by this particular herniated disc. Additionally, many "degenerative changes" occur in everyone, whether they feel pain or not. Therefore, when establishing a diagnosis, one cannot be guided only by the results of an x-ray examination.

For this same reason, treatment (or even indication for surgery) for spinal problems should never be suggested simply by looking at an MRI image. A history and clinical examination should first be carried out, then the MRI results should be correlated with the patient's symptoms.

Which test is more specific for back pain: standard 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 radiographyis a very quick and simple test that costs very little. But it only shows 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 scantakes very few minutes and has an average cost, but at the same time requires a high radiation dose. It represents relatively well all the elements of the spine. This is relatively disadvantageous when imaging nerves and discs.
3. MRIThis exam takes a long time, for example 20 minutes, and is an impractical test 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 structures of the spine, especially the nerves. It is somewhat lacking in flaws, especially the small ones. In any case, the doctor, after examining you, will select and recommend a suitable 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 protection (belt);
• To relieve pain, you can use certain medications, such as painkillers, non-steroidal anti-inflammatory drugs, etc. ;
• A visit to a physiotherapist is often useful, 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 to each patient;
• Spinal injections may also sometimes be used.
• In relatively rare cases, the above (conservative) treatment is ineffective and surgical intervention is necessary.

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 to 3 days worsens rather than cures back pain. It is generally recommended to walk as much as possible.

If a person cannot get out of bed despite conservative treatment due to unbearable pain, this usually indicates a serious problem and should be consulted 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:

• hot (heat) causes muscle relaxation, that is to say, relaxes the muscles contracted by pain and increases blood circulation. You can use a heated cloth on a radiator or take a lukewarm (not hot) bath.
• cold prevents pain fibers from transmitting pain (for example, athletes apply coolant when playing soccer). You can use an ice pack wrapped in a cloth (without direct contact with the skin). A simple alternative: a bag of vegetables from the freezer.

What medications can you take for back pain?

Medications that may be used to treat back pain include:

1. Mainly an analgesic from the anilide group, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest medicine, and treatment should always begin with it.
2. Nonsteroidal anti-inflammatory drugs (there are several classes). Stronger painkillers, but when taken chronically, they cause many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
3. Glucocorticosteroid- a powerful and effective analgesic, but with a large number of side effects when used chronically and without clearly proven benefit for back pain.
4. Opioids, i. e. morphine-type drugs. Usually given intravenously or intramuscularly in the hospital, but some oral medications are also available.
5. Antiepileptic medications or antidepressants, primarily for chronic pain, but also for some acute conditions.

Important!

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

How can a physical therapist help me with my back pain?

The role of a physiotherapist is very important in the treatment of back pain. The most appropriate is an initial program lasting several days, after which the patient can learn to perform the necessary exercises on their own. Severe pain is initially treated so that the patient can walk (that is, not bedridden), and when the pain subsides, exercises begin to strengthen the muscles and restore the spine. The program may include:

1. immediate relief measures such as electrotherapy (e. g. 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, 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 therapy McKenzie;
7. retraining, i. e. learning to stand, sit, lift weights, etc. correctly.

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

Physiotherapy is one of the methods of treating back pain. Other methods are medication, treatment, walking and finally injections and spinal surgeries. There must therefore be a central person who will select the methods used and evaluate the patient's progress.

It is best for a patient suffering from back pain to first consult a doctor in order to exclude rare and serious causes of back pain. The doctor then refers the patient to a physiotherapist, with whom the patient should remain in contact to discuss the progress of the treatment. Final responsibility for the patient's progress rests with the physician.

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

A simple soft pad can be used for a few days. It does not ensure complete immobilization (rigid protections, such as those used for fractures, allow this), but it limits excessive and sudden movements and thus reminds the patient of a correct posture, particularly at work. .

Long-term chronic use has the opposite effect of atrophying the spinal muscles, 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 is it that I will need surgery for my back pain?

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

What can I do during times when I don't have pain to prevent back pain?

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

Which doctor to consult in case of back pain?

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