In most cases, lower back pain is caused by hypothermia or muscle strain due to awkward movement or heavy lifting and can go away on its own. If the pain disrupts the normal rhythm of life, if improvement does not occur for a very long time, or if there are other suspicious symptoms, the diagnosis and treatment of back pain in the lower back should be entrusted to a doctor.
Depending on how much the pain bothers the patient, doctors distinguish the following:
- acute pain - less than 4 weeks,
- subacute pain - from 4 weeks to 12 weeks,
- chronic pain - more than 12 weeks.
During admission, the doctor determines with the patient how his back hurts: it can be sharp pain in the lower back when moving, periodic pain in the lower back, constant dull pain, sharp stabbing pain and other unpleasant sensations of various degrees. intensity. Depending on the duration, location and nature of the pain, the doctor assumes what is its source.
Back pain: causes
Pain in the lower back can be associated with both spinal problems and other organs and systems of the body. To understand how to treat the lower back, you need to determine what is causing the pain.
There are vertebrogenic pains caused by diseases of the spine:
- Osteochondrosis manifested by problems with intervertebral discs, facet or facet joints. In any person, disorders occur with age: the intervertebral discs lose moisture and elasticity, the facet joints become tighter and less mobile.
- Excessive tension of the muscles and ligaments of the spine.
- Compression of spinal nerve roots - radiculopathy.
- Spinal injury.
- Instability of the spine due to the weakness of the ligamentous-muscular system.
Non-vertebral causes include:
Neurological disorders - Lumbosacral plexopathies are nerve plexus injuries affecting the peripheral nerves of the lower extremities. It occurs with injuries and metabolic disorders.
- Dystonia is a violation of the tone of the muscles that support the spine. In this case, pain may be accompanied by poor posture. The disease can be congenital.
Systemic diseases - Infections affecting the vertebrae, discs, membranes of the spinal cord or the spinal cord itself, eg osteomyelitis, epidural abscess.
- Malignant and benign tumors, metastases.
- Osteoporosis is a decrease in the density of skeletal bones, fraught with vertebral fractures.
- Rheumatic diseases such as inflammatory spondyloarthropathy or ankylosing spondylitis.
Pain from internal organs. It originates from causes outside the spine and radiates down the back, sometimes medially, sometimes laterally, depending on the organ of origin. These include:- Diseases of the gastrointestinal tract - most often pancreatitis.
- Diseases of the urinary system - infections such as pyelonephritis and urolithiasis. When the stone moves along the ureter, renal colic is accompanied by severe paroxysmal stabbing pains in the back and side.
- Aortic aneurysm is a rare, dangerous pathology in which the wall of the largest artery in the body bulges. This can cause a pulsating sensation in the abdomen.
- Diseases of hip joints - injuries, inflammations, degeneration.
Psychogenic pain Lower back pain can be related to anxiety disorder or depression.
An injury to the spinal cord or lower spinal cord, called cauda equina, is a medical emergency. Compression of these structures can cause:
- herniated disc,
- injury,
- malignant or benign tumor,
- infection.
Spinal cord compression is accompanied by extremely severe bilateral back pain, muscle weakness in the legs, even paralysis, numbness of the lower extremities, and incontinence, so it is difficult to confuse it with other conditions.
Symptoms
Often, back pain is non-specific, that is, it is caused by harmless musculoskeletal disorders. In this case, patients describe the following complaints:
- Aching, pulling or squeezing pains.
- The appearance or intensification of pain when a person stands or sits for a long time, lifts something heavy, does physical work with raised arms, for example, hangs curtains, changes light bulbs in a chandelier, bends down repeatedly and for a long time: when washing floors, vacuuming, cleaning snow.
- No other symptoms.
It is indicated by the fact that pain can be a sign of some dangerous situation"red flags":
- Over 50 years old. The risk of osteoporosis and tumors is higher in this age group.
- Pain at rest and at night, interferes with sleep. Non-specific pain usually appears with movement or prolonged static load, but disappears after resting in a comfortable position.
- General weakness is also not characteristic of non-specific pain.
- Unexplained weight loss over the past few months. This can be a sign of long-term systemic inflammation in the body caused by autoimmune diseases and tumors.
- Increased body temperature, shivering. It indicates severe inflammation of various origins.
- Severe or progressive loss of sensation or weakness in leg muscles.
- Bladder or bowel dysfunction - involuntary bowel movements or vice versa, urinary retention or constipation. Nerves from the lower parts of the spinal cord go to the pelvic organs and lower limbs. They contain both sensory and motor fibers. Numbness or loss of movement combined with sharp pain is a sign of compression of a nerve and possibly the spinal cord. If this condition is not treated by a doctor, the function of a nerve or part of the spinal cord can be lost forever.
- Lack of effect from treatment and progression of acute pain to a chronic state.
- Features of medical history. For example, if back pain appears in a patient with a previously established diagnosis of osteoporosis or a malignant tumor. It doesn't matter how long ago the diagnosis was made. Or the pain occurred in a person who has recently had a serious infection, surgery, or has a severely compromised immune system for any reason, such as long-term glucocorticoid therapy or poorly controlled diabetes. In these cases, back pain can indicate various complications.
If you have identified at least one of the listed points, immediately consult a doctor for further examination.
Diagnostics
Pain is a subjective symptom, so the questioning and examination by a doctor plays a big role in the diagnosis. Depending on the diagnosis, the doctor prescribes additional examinations. For an accurate diagnosis, perform:
- Laboratory tests— complete blood count, biochemical blood test, general urine test, tests for detection of infections, autoimmune diseases.
- Electroneuromyography- the study of the conduction of impulses along nerve fibers allows to accurately determine the location of the lesion in neurological disorders.
- Imaging using radiography, computed tomography (CT), magnetic resonance imaging (MRI)., will help to see all the structures of the spinal column, the presence of hernias, compression of the spinal nerve roots.
- Ultrasonographykidneys and abdominal cavity - performed in case of suspicion of pathology of internal organs.
- Assessment of bone status: densitometry - for suspected osteoporosis, bone scintigraphy - for malignant lesions.
If the doctor is absolutely sure that the back pain is non-specific, he can prescribe treatment based on the examination alone, without further examinations.
Often, with lower back pain, a person does not consult a doctor, but comes for an MRI of the spine on his own. This approach can be confusing for the patient: studies show that most adults have asymptomatic herniated discs. The patient attributes the pain to this MRI finding and does not seek further medical attention. As a result, a person feels discomfort for a long time, takes painkillers without control, complications and side effects arise.
Which doctor should I see?
First, if you have back pain, you can also see a general practitioner. He will suggest what is causing the pain and refer to another specialist depending on that. You can skip this step and make an appointment with a neurologist right away.
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 encounter the symptom of back pain from time to time, because it has a large number of possible causes.
If mechanical pain is diagnosed, the patient will be treated by physical therapists, reflexologists, physiotherapists and massage therapists.
How to treat lower back pain
- SurgeryThey are mainly used for symptoms of compression of the spinal cord or spinal nerve roots, when the patient experiences paresis of a limb or urinary disorder. These symptoms can be caused by an intervertebral hernia, tumor or injury. Also, in case of chronic pain in which conservative treatment is ineffective within 12 weeks, the patient may be advised to consult a neurosurgeon. The decision to operate is made only after visualization of the spine.
Research shows that uncomplicated disc herniations can be successfully treated conservatively without surgery. Rehabilitation programs achieve good results in 90% of patients with back pain.
- Conservative treatmentincludes drug and non-drug methods.
Drug treatment is carried out using non-steroidal anti-inflammatory drugs that relieve pain and inflammation, as well as muscle relaxants that relax muscles.
Non-drug treatments include:
- Physiotherapy— aimed at quickly eliminating pain and inflammation, as well as accelerating tissue regeneration and muscle relaxation. The most effective methods: magnetic therapy, laser therapy and shock wave therapy.
- Acupuncture- inserting special sterile needles into biologically active points to reduce pain and relax muscles.
- Massage— improves the mobility of the spine and joints, helps to properly distribute the load on the back muscles.
- Physical therapy- allows you to relax and strengthen your back muscles. Exercises are effective in both acute and chronic back pain.
If the patient has pain for more than 12 weeks, we talk about chronic pain. In its treatment, antidepressants with an analgesic effect, as well as cognitive behavioral psychotherapy are added to all of the above methods.
Bed rest is not beneficial in the treatment of mechanical back pain and is not an alternative to the above methods. Moreover, it should be avoided as much as possible for the patient. Prolonged bed rest leads to joint stiffness, muscle strain and significantly slows down recovery.
Results
Acute non-specific low back pain has a favorable prognosis. 70-90% of those who seek immediate treatment 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 can be accompanied by numbness in the limbs, as well as problems with urination and defecation.
Prevention
Help prevent lower back pain by:
- 150 minutes of moderate exercise per week: walking, swimming, exercises for core muscles: abdomen, lower back, pelvic floor, thighs and hips.
- Maintaining a healthy weight.
- Warming up with a long static position every 40-60 minutes.
- Thigh muscle stretching exercises.
- Correct body position when lifting weights: squat, not lean forward.
- Prevention of loss of bone density by taking calcium and vitamin D, early diagnosis of osteoporosis by densitometry. This is especially important for older people and postmenopausal women.
- Protection of general somatic and psychological health.