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Lower back pain (low back pain)

Back pain (lumbar pain) is a very common symptom. The most common causes are muscle strain and insufficient physical training. Resting for 2-3 days and maybe taking a mild pain reliever will do the trick.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, leg weakness, difficulty urinating, etc.Treatment of back pain begins with a detailed medical history (when the pain started, how long it lasted, where it affected, how it worsened, etc. ) and then a physical examination. Other parts of the body that may cause back pain similar to back pain should be checked, such as the kidneys and abdomen.If necessary, tests such as plain X-rays and MRI will be ordered. Conservative treatment (rest, medications, physical therapy) is usually sufficient. In rare cases, special surgery is required. As an alternative, spinal injections can be given under local anesthesia.lower back pain

Frequently asked questions about back pain

What does the mid (lumbar) spine consist of?

The spine in the lower back is made up of:
  1. Bones (vertebrae);
  2. intervertebral disc (a pillow-like disc between two adjacent vertebrae);
  3. joints (two joints at the back of each vertebra);
  4. ligament;
  5. tendon;
  6. Muscles, last;
  7. Nerves emerging from the spine (one on the right and one on the left in each layer) provide nerve stimulation to the legs.
In a broader sense, an intervertebral disc is also a type of joint.

Which of the following areas 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 one can cause pain. The most common cause of back pain is strains of soft tissues, namely muscles, ligaments, and tendons. Then we say the pain is "muscular".The following paradox is also true: the images during an X-ray examination do not always correspond to the intensity of pain. So one patient may have severe back pain from a muscle strain (showing no symptoms on a plain X-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What causes back pain?

Causes of low back pain are:
  1. Muscle tightness in the muscles, tendons, and ligaments surrounding the spine. This is the most common reason (more than 70%);
  2. Disc wear (such as disc herniation);
  3. joint damage;
  4. Spondylolisthesis;
  5. Fractures (occurring spontaneously due to trauma, as well as due to osteoporosis or metastasis);
  6. Other rare causes, such as bone tumors, inflammation (discitis), rheumatic diseases (such as ankylosing spondylitis), Scheuermann's disease;
  7. Causes other than the spine, such as kidney stones, abdominal aortic aneurysm, cholecystitis.
Causes of pain may vary by age.Yes, the cause changes with age because the structure of the spine changes. In young people, the intervertebral discs are often affected: the most common cause (besides muscle strain) is a herniated disc.In old age, wear and tear on the posterior elements of the spine, such as the joints, increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and fractures due to osteoporosis also begin to occur.

Is back pain related to weight?

Yes, the role of weight gain in the development of back pain is empirically known and scientifically proven. This may be because overweight people generally do not participate in sports and therefore do not "build" the proper muscle system to protect the back from minor injuries. Overweight and obese people (body mass index over 25-30) are more likely to experience back pain.

I have back pain. Should I stop lifting weights?

During the acute phase, when pain is recent, heavy lifting should be avoided. That is, you can lift a package from the supermarket, but not, say, a heavy box. When this phase is over and the pain subsides, you can lift light weights, but you'll need to learn how to do it properly, i. e. , bending your knees instead of straightening them like a weightlifter. Additionally, the more a person exercises their spinal muscles, the more stress is placed on their back. In general, everyday life certainly involves lifting weights: the human body is designed to lift and lift weights, such as a parent lifting a child.Lifting weights in the gym is another story: Generally speaking, people with back problems are advised to avoid lifting weights in the gym unless absolutely necessary (i. e. unless the person is an athlete).

Can osteoporosis cause back pain?

Only in case of fracture. These types of fractures usually occur spontaneously (i. e. not caused by a fall) and the symptoms may not be as noisy as a "normal" fracture, i. e. the pain may be minimal.

What does chronic low back pain mean?

Back pain is classified as chronic if it lasts for more than 3 months without interruption. The 3-month limit is not arbitrary: it has been observed that patients with back pain for more than 3 months have certain characteristics that make treatment difficult:
  1. Pain with "strange" characteristics, described as burning, "electrical";
  2. The cause of the pain appears to be resolved, for example, a herniated disc may be "resolved" on an MRI;
  3. Patients experience the psychological effects of pain and exhibit symptoms such as anxiety and depression.

What's the scientific explanation for this strange back pain?

A popular theory of chronic pain is that persistent and prolonged stimulation of neural pathways (i. e. , the pathways from the site of pain to the brain) causes "sensitization, " whereby stimulation causes exaggerated or strange responses.Therefore, low-intensity stimulation may cause very intense pain or pain that does not correspond to the type of stimulation, such as feeling like you are on fire when no part of the body is warming up. Therefore, even if the anatomical cause of pain is treated, the pain and psychological responses may remain, as if imprinted on the brain. It is for this reason that for chronic back pain, in addition to traditional painkillers, drugs affecting the central nervous system, such as antidepressants, are prescribed.

When should you see a doctor for back pain?

  • When pain does not go away within a few days of using simple pain relievers;
  • When pain occurs not only in the back but also in the legs;
  • When the legs become numb or begin to paralyze;
  • If back pain persists at night, during sleep, or even wakes the patient from sleep;
  • If you have urinary, bowel and/or sexual function problems;
  • 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 cortisone use, intravenous drugs (such as heroin), or alcohol abuse.

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 plain X-rays, CT or MRI will be performed.

If I have back pain, do I need to get an X-ray?

No. About 70 percent of back pain cases are caused by a simple muscle strain, and no tests are needed in these cases.

What if an X-ray or MRI shows something?

This situation is very, very common: Someone gets their back checked and the X-ray shows a herniated disc, osteophytes, etc. But that's what the word says: X-ray discovery. This means that the disk was corrupted at some point in time. But the examination does not tell us when this injury occurred, that is, when it occurred. Recently or a long time ago, so it doesn't prove to us that the current back pain is caused by this specific herniated disc. Additionally, many "degenerative changes" occur in all people, whether they experience pain or not. Therefore, the diagnosis cannot be guided solely by X-ray examination results. For the same reason, treatment of spinal problems (or even indications for surgery) should never be recommended solely by looking at MRI images. The appropriate approach is to first perform a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

Which test for back pain is more specific: a plain X-ray, a CT scan, or an MRI?

There is no single answer to this question. Every test has indications, and every test has disadvantages:
  1. conventional radiographyis a very quick and simple test that costs very little. But it only shows bones. This means that fractures, scoliosis or kyphosis, or spondylolisthesis are clearly visible, but the discs and nerves are not.
  2. CT scanIt only takes a few minutes and the cost is average, but at the same time the radiation dose is high. It depicts all elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and discs.
  3. MRIThe examination takes a long time, such as 20 minutes, which is inconvenient for people with claustrophobia. The cost is high, but there is no radiation. This is the most detailed examination we perform, mapping all the structures of the spine, especially the nerves. It's a bit lacking in kinks, especially the small kinks. Regardless, your doctor will select and recommend the appropriate test after examining you.

How is back pain usually treated?

  • In most cases, rest at home and some simple measures will help, such as "heat and cold" and lumbar protection (waist belt);
  • To relieve pain, certain medications can be used, such as analgesics, nonsteroidal anti-inflammatory drugs, etc. ;
  • A visit to a physiotherapist can often be helpful, especially if the condition is treated in some way;
  • Alternative therapies such as acupuncture, yoga, and Pilates can provide significant benefits to individual patients;
  • Spinal injections are also sometimes used.
  • In relatively rare cases, the above (conservative) treatments are ineffective and surgical intervention is required.

Does rest mean I have to stay in bed?

2-3 days only and emergencies only. Research shows that staying in bed for more than 2-3 days can worsen back pain rather than cure it. It is generally recommended to walk whenever possible.If a person is still unable to get out of bed despite conservative treatment due to unbearable pain, this usually indicates a serious problem and should see a doctor.

Should you use heat or cold compresses to relieve back pain?

Both methods are tested and helpful, depending on the situation. The mechanisms of action are different:
  • Heat (warmth) causes muscle relaxation, which relaxes muscles that have contracted in response to pain and increases blood circulation. You can use a cloth heated on a radiator or take a warm bath (not hot).
  • Cold prevents pain fibers from conducting pain (for example, athletes use coolant when playing football). You can use an ice pack wrapped in a cloth (do not touch the skin directly). An easy option: grab a bag of vegetables from the refrigerator.

What medications can you take to treat back pain?

Medications that can be used to treat back pain include:
  1. Mainly aniline analgesics, used alone or in combination with codeine or muscle relaxants. This is the simplest and safest medicine and treatment should always begin with it.
  2. NSAIDs (there are several types). Painkillers have strong effects, but long-term use has many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticoids- A powerful and effective pain reliever, but it has numerous side effects with long-term use and has no clear proven benefit for back pain.
  4. Opioids, morphine-like drugs. It is usually given by IV or intramuscular injection in the hospital, but some oral medications are also available.
  5. Antiepileptic drugs, or antidepressants, are used primarily to treat chronic pain but are also used in some acute conditions.
important!All of the above medications should be taken according to the recommendations of the doctor who has previously examined you. Taking medications on your own by 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 physical therapist help me relieve back pain?

The role of a physical therapist is very important in the treatment of back pain. What is most appropriate is an initial program lasting a few days, after which the patient can learn to perform the necessary exercises on his or her own. Treat severe pain initially to enable the patient to walk (i. e. , not be bedridden), and when the pain subsides, begin exercises to strengthen the muscles and restore the spine. The plan 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 sometimes even cycling;
  3. Trunk stabilization and proprioception exercises "teach" 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 Treatment McKenzie;
  7. Retraining, which is learning how to stand, sit, lift, etc. properly.

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

Physical therapy is one of the treatments for back pain. Other methods include medications, nursing care, walking, and finally injections and spinal surgery. Therefore, there must be a central figure who selects the methods to be used and evaluates the patient's progress.For people with back pain, it's a good idea 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 stay in touch to discuss treatment progress. The ultimate responsibility for the patient's disease progression lies with the physician.

Should I wear an amulet (belt) if I have back pain?

A simple ottoman will last for several days. It does not provide complete immobilization (a rigid guard like the ones we use for broken bones), but it limits excessive and sudden movements, thereby reminding back patients of correct posture, especially while working.Long-term chronic use can have the opposite effect, causing spinal muscles to atrophy, leading to increased pain. In summary, it is important to note that the amulet becomes effective after 1-2 weeks of use. It is best used in conjunction with a spinal muscle strengthening program to ultimately eliminate the need for protection.

What are the chances that I will need surgery for back pain?

This is a small chance. Only 5-10 out of 100 patients who seek medical attention for back pain ultimately require surgery, and this is after all other treatments (conservative treatment) have been exhausted.

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

  • Exercise regularly after consulting your doctor. Walking and swimming are two excellent exercises for strengthening your spine. Before you start exercising, ask your doctor which exercises may treat other health problems, such as heart disease.
  • Strengthen the muscles that support your lower back (abdominal and back muscles). It is crucial to consult your physical therapist or physiotherapist.
  • Quit smoking or at least reduce the amount you smoke.
  • Maintain a proper weight and lose excess weight.
  • Help your spine: Learn how to lift weights, how to stand, what mattress to sleep on and how to sleep on it, how to sit at your desk, and more.

Which doctor should I see for back pain?

You may want to see a spine specialist, such as a neurosurgeon or orthopedic surgeon.