Lower back pain (lumbago)

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

In rare cases, the cause is more serious: a herniated disc (also called a 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 has lasted, where it affects, what makes it 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 as well as an MRI will be requested. Conservative treatment (rest, medication, physical therapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, there are injections into 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 there is a disc, like a pillow);
3. joints (there are two joints at the back of each vertebra);
4. connections;
5. tendons;
6. muscles and finally;
7. 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 type of joint.

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

All of the anatomical elements described in the above question have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is strain on the soft tissues, i. e. muscles, ligaments and tendons. Then we 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 the pain. So, one patient may have excruciating back pain from a muscle strain (showing nothing on a plain x-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What can cause back pain?

The cause of back pain is:

1. muscle tension in the muscles, tendons and ligaments around the spine. This is the most common reason (more than 70%);
2. wear and tear 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), rheumatological diseases (eg ankylosing spondylitis), Scheuermann's disease;
7. causes outside the spine, eg nephrolithiasis (kidney stone), abdominal aortic aneurysm, cholecystitis.

The cause of the pain can vary from age to 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 (apart from muscle strain) is a herniated disc.

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

Could 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 confirmed. This may be due to the fact that an overweight person usually does not exercise and therefore has not "built" the appropriate muscular system to protect the back from minor injuries. Overweight and obese people (with a body mass index over 25-30) are more likely to experience back pain attacks.

I have back pain. Should I stop lifting weights?

In the acute phase, i. e. when the pain is recent, heavy lifting should be avoided. That is, you can lift a package from the supermarket, but you are not allowed to lift, for example, 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, that is, bend your knees, not straighten them, as weightlifters do. Also, the more a person exercises their spinal muscles, the more strain their back can take.

Generally speaking, everyday life certainly involves lifting weights: the human body is designed to lift weights and perform heavy lifting, such as a parent lifting their child.

Lifting weights in the gym is a different matter: as a general rule, unless absolutely necessary (ie, unless the person is an athlete), it is recommended that a person with back problems avoid weight training in the gym.

Can osteoporosis cause back pain?

Only when broken. These types of fractures usually occur spontaneously (ie not caused by a fall) and the symptoms may not be as loud as with "normal" fractures, ie the pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is classified as chronic if it lasts 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" nature, i. e. it is 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 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?

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

Thus, a low-intensity stimulus may cause very intense pain or pain that does not match the type of stimulus, such as a burning sensation when there is no part of the body to be heated. Thus, even if the anatomical cause of the pain is treated, the pain and psychological response may remain, as it were, sealed in the brain. For this reason, drugs that affect the central nervous system, such as antidepressants (in addition to conventional pain relievers), are prescribed for chronic back pain.

When should you see a doctor for back pain?

• when the pain does not go away with ordinary pain relievers within a few days;
• when the pain appears not only in the back, but also in the leg;
• when the leg goes numb or starts to become paralyzed;
• if the back pain continues at night, during sleep or even wakes the sufferer 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 you have a history of cancer, osteoporosis, long-term use of cortisone, intravenous drug use (eg, heroin), or alcoholism.

What are the next steps?

The doctor who will examine you will take a complete medical history and examine you. Then, if necessary, tests such as plain X-rays, CT or MRI will be performed.

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

No. About 70% of back pain cases are caused by a simple muscle strain and in these cases there is no need for an examination.

What if the X-ray or MRI shows something?

This is very, very common: someone does a back exam and finds an x-ray finding like a herniated disc, osteophytes, etc. But that's what the word says: an x-ray finding. This means that the disk was damaged at some point. But the examination 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 at the moment is caused by this particular herniated disc. Furthermore, many "degenerative changes" occur in all people, whether they experience pain or not. Therefore, when making a diagnosis, one cannot be guided only by the results of an X-ray examination.

For the same reason, a treatment (or even an indication for surgery) for spinal problems should never be suggested simply by looking at an MRI image. It is appropriate to first take a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

Which is a more specific test for back pain: plain X-ray, CT 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 easy 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. CTit takes very few minutes and has an average cost, but at the same time there is a high dose of radiation. It depicts all the elements of the spine relatively well. This is relatively unfavorable when imaging nerves and discs.
3. MRIIt takes a lot of time, like 20 minutes, and is an uncomfortable study for people who suffer from claustrophobia. The price is high, but there is no radiation. This is the most detailed study we have and maps all the structures of the spine, especially the nerves. Creases are somewhat lacking, especially small ones. In any case, the doctor, after examining you, will choose and recommend an appropriate 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);
• For pain relief, you can use certain medications, such as analgesics, nonsteroidal anti-inflammatory drugs, etc. ;
• A visit to a physical therapist often helps, especially if done in a certain way and for specific indications;
• alternative forms of treatment such as acupuncture, yoga and pilates can provide significant benefit to 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 emergency. Studies show that staying in bed for more than 2-3 days worsens rather than cures back pain. It is generally recommended that you walk as much as possible.

If a person cannot get out of bed despite conservative treatment due to excruciating pain, this usually indicates a serious problem and should be seen by a doctor.

Should you use hot or cold for back pain relief?

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

• hot (heat) causes muscle relaxation, i. e. it relaxes muscles contracted by pain and increases blood circulation. You can use a towel 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 football). You can use an ice pack wrapped in a towel (no direct contact with the skin). An easy alternative: a bag of vegetables from the freezer.

What medications can you take for back pain?

Medicines that can be used to treat back pain include:

1. Primarily an anilide analgesic, alone or in combination with codeine or a muscle relaxant. It is the simplest and safest medicine and treatment should always start with it.
2. Nonsteroidal anti-inflammatory drugs (there are several classes). Stronger pain relievers, but with long-term use have many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
3. Glucocorticosteroid- a powerful and effective pain reliever, but with a large number of side effects in chronic use and no clearly proven benefits for back pain.
4. Opioids, i. e. morphine-type drugs. It is usually given intravenously or intramuscularly in the hospital, but some oral medications are also available.
5. Antiepileptic drugs or antidepressants, mainly for chronic pain but also for some acute conditions.

important!

All the above medicines should be taken on the recommendation of a doctor who has examined you before. It is careless and potentially dangerous to self-medicate 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 my back pain?

The role of the physical therapist is very important in the treatment of back pain. An initial program lasting a few days is most suitable, after which the patient can learn to perform the necessary exercises on his own. Severe pain is initially treated so that the patient can walk (ie, not bedridden), and when the pain subsides, exercises to strengthen the muscles and restore the spine are started. 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. body 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. range of motion exercises;
6. McKenzie mechanical diagnosis and therapy;
7. retraining, i. e. learning how to stand, sit, lift weights, etc.

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

Physiotherapy is one of the methods for treating back pain. Other methods are medication, nursing, walking, and finally spinal injections and surgery. Therefore, there must be a central person to select the methods used and evaluate 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 maintain contact to discuss the progress of the treatment. The ultimate 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 several days. It does not provide complete immobilization (hard guards, such as we use for fractures), but it limits excessive and sudden movements and thus reminds the 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 am I to need surgery for back pain?

It's a small chance. Out of 100 patients who visit a doctor for back pain, only 5-10 will eventually need surgery and that is after all other means have been exhausted (conservative treatment).

What can I do during pain-free periods to prevent back pain?

• Exercise regularly after consulting 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 problems, such as heart disease.
• Strengthening of the muscles that support the waist area (abdominal and back muscles). Consultation with your physiotherapist or physical therapist is essential.
• Stop smoking or at least reduce the amount you smoke.
• Maintain proper body weight, lose extra pounds.
• 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.

What doctor should you see for back pain?

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