Low back pain is often called lumbago or lumbodinia. Lumbago or "lumbago" is an attack of sharp pain in the lower back, which is usually associated with hypothermia and exertion. Lumbago occurs in many people and is often the cause of temporary disability. Often the cause of lumbago can be sports injuries or sprains, but sometimes the factor that provokes the pain remains unknown. Lumbago is characterized by pain without radiation in the legs. Low back pain (lumbago) can occur acutely and gradually progress throughout the day. There is often stiffness in the morning and gradually the stiffness turns into a pain syndrome. Spinal curvature (analgesic scoliosis) is also possible as a result of muscle spasm. The pain itself may be due to muscle spasm, which in turn is associated with other causes. This can be overload or sprains, sports injuries, disc herniation, spondyloarthritis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the causal relationship of the onset of malaise with exertion, hypothermia, but often the pain occurs for no apparent reason. Sometimes back pain can occur even after sneezing, bending or wearing shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.
Unlike lumbago, the term lumbodinia does not mean acute pain, but subacute or chronic pain. As a rule, the pain with lumbodia appears gradually over several days. The pain may also appear in the morning and may decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable body position). It is also characteristic of lumbodia that the pain is relieved by lying down in a certain position. Patients with lumbodia have difficulty performing routine activities such as washing or putting on shoes due to muscle spasms. Due to the disease, there is a decrease in the volume of trunk movements (leaning forward or to a lesser extent leaning to the side or lengthening). Due to the pain syndrome, the patient often has to change his position when it is necessary to sit or stand. Unlike lumbago, muscle spasm is less pronounced and usually does not cover the entire lower back and often shows signs of spreading spasm on one side.
Causes of back pain
Back pain is a symptom. The most common causes of back pain are diseases (injuries) of the muscles, bones and intervertebral discs. Sometimesback paincan be caused by diseases of the abdominal cavity, pelvis and chest. Such pains are called reflected pains. Abdominal diseases (eg appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), pelvic infections, ovarian infections - all these diseases can occurback pain. . . Even a normal pregnancy can lead to low back pain due to pelvic sprains, muscle spasms due to stress and nerve irritation.
Oftenback painis associated with the following diseases:
- Nerve root compression, which causes symptoms of sciatica and is most often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is sharp, there is radiation and impaired sensitivity in the innervation zone of the nerve root. Disc herniation occurs mainly as a result of disc degeneration. There is a protrusion of the gelatinous part of the disc from the central cavity and pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at age 30 and older. But the mere presence of a hernia does not always have an effect on nerve structures.
- Spondylosis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) occur, which can affect nearby nerves, leading to pain.
- Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience pain in the lower back radiating to both legs. Low back pain can occur as a result of standing or walking.
- Cauda equina syndrome. This is an emergency medical service. Cauda equina syndrome occurs as a result of compression of the elements of the cauda equina (end of the spinal cord). A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atony). This syndrome requires urgent surgery.
- Pain syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and soreness at certain points (trigger points), a decrease in the volume of muscle movement in the painful areas. The pain syndrome is reduced by relaxing the muscles located in the painful areas. In fibromyalgia, pain and soreness are common throughout the body. Fibromyalgia is not characterized by tightness and muscle pain.
- Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
- Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially worse in the morning.
- Tumors, most commonly cancer metastases, can be a source of discomfort in the lower back.
- Inflammation of the nerves and thus the manifestations of pain (in the chest or in the lumbar region) can be caused by damage to the nerves themselves (for example, in shingles)
- Given the variety of causes of symptoms, such as acute or subacute low back pain, it is very important to thoroughly assess the patient and perform all necessary diagnostic procedures.
Symptoms
Pain in the lumbosacral region is the main symptom of lumbago, lumbodinia, lumboisalgia.
- The pain may radiate to the front, side or back of the leg (lumbar ischalgia) or may be localized only in the lumbar region (lumbago, lumbodinia).
- The feeling that the lower back hurts may increase after exercise.
- Sometimes the pain can get worse at night or when sitting for a long time, for example during a long car ride.
- Perhaps the presence of tingling and weakness in the part of the leg that is located in the area of innervation of the compressed nerve.
For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:
- Recent history of injury, such as a fall from a height, a car accident or similar accidents.
- The presence of minor injuries in patients over the age of 50 (eg falling from a low height as a result of sliding and landing on the buttocks).
- History of long-term use of steroids (for example, these are patients with bronchial asthma or rheumatic diseases).
- Any patient with osteoporosis (mostly elderly women).
- Any patient over 70 years of age: at this age there is a high risk of cancer, infections and diseases of the abdominal organs that can cause lower back pain.
- History of oncology
- The presence of infectious diseases in the recent past
- Temperature above 100F (37. 7 C)
- Drug use: Drug use increases the risk of infectious diseases.
- Lower back pain worsens at rest: as a rule, this pain is associated with oncology or infections, and such pain can be in ankylosing spondylitis (ankylosing spondylitis).
- Significant weight loss (for no apparent reason).
- The presence of any acute nerve dysfunction is a signal for emergency medical care. For example, it is a violation of walking, foot dysfunction, as a rule, are symptoms of acute nerve damage or compression. In certain circumstances, such symptoms may require urgent neurosurgery.
- Bowel or bladder dysfunction (both incontinence and urinary retention) may be a sign of emergency medical care.
- Failure of the recommended treatment or increased pain may also require medical attention.
The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.
Diagnosis
Medical history is important for an accurate diagnosis, as various conditions can cause lower back pain. The time of onset of pain, the relationship with exercise, the presence of other symptoms such as cough, fever, bladder or bowel dysfunction, the presence of seizures and more. A physical examination is performed: identification of pain points, presence of muscle spasm, examination of the neurological status. If there is a suspicion of diseases of the abdominal cavity or pelvic organs, an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, blood tests of urine).
If somatic genesis of lower back pain is ruled out, then instrumental examination methods such as radiography, CT or MRI may be prescribed.
X-ray is the initial method of examination and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.
CT allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).
MRI is the most informative research method that allows the diagnosis of morphological changes in various tissues.
Densitometry is needed when osteoporosis is suspected (usually in women over 50)
EMG (ENMG) is used to determine the conduction disturbance of nerve fibers.
Laboratory tests (blood tests, urine tests, blood biochemistry) are prescribed mainly to rule out inflammatory processes in the body.
Pain treatment
After establishing the diagnosis and confirming the vertebral genesis with lumbago and lumbodia, a certain treatment for low back pain is prescribed.
In acute pain, rest for 1-2 days is required. Bed rest can reduce muscle tension and muscle spasm. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome decreases within a few days without the use of medication, just because of rest.
Medicines. NSAIDs are used for pain syndrome. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also carries certain risks. Given that all drugs in this group have many side effects, taking drugs in this group should be short-term and under the mandatory supervision of a physician.
Muscle relaxants can be used to relieve spasms. But the use of these drugs is effective only in the presence of spasm.
Steroids can be used to treat pain, especially when there are signs of sciatica. However, due to the presence of pronounced side effects, the use of steroids should be selective and short-lived.
Manual therapy. This technique can be very effective in the presence of muscle blocks or subluxation of the facet joints. Mobilizing motor segments can reduce both muscle spasm and lower back pain.
Physiotherapy. There are many modern physiotherapy procedures that can simultaneously reduce pain and inflammation, improve microcirculation (eg electrophoresis, cryotherapy, laser therapy, etc. ).
Exercise therapy. Exercise is not recommended for acute lower back pain. The connection of the training therapy is possible after the reduction of the pain syndrome. In the presence of chronic pain, exercise can be very effective in strengthening the muscular corset and improving the biomechanics of the spine. Exercise should be chosen only with a physiotherapist, as often independent exercise can lead to increased pain. Systemic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can preserve the functionality of the spine and significantly reduce the risk of pain syndromes.