Few people experience lower back pain at least once in their lifetime. This is how we pay for upright walking and our daily habits.
In addition to injuries that affect the spine, muscles, nerves, and ligaments, it should also be remembered that back pain can sometimes be caused by internal diseases (diseases of the kidneys, gastrointestinal tract, and female reproductive organs) in the lower back.
Symptoms of low back pain can range from dull to severe. The pain may go away on its own or become chronic (symptoms have been present for more than three months).
dangerous! You should consult your doctor immediately if:
- Sudden lower back pain after a significant back injury;
- A sharp rise in temperature, vegetative disorder, loss of consciousness, sweating, difficulty breathing;
- Involuntary emptying of the bowel and bladder occurs;
- numbness in the groin area;
- Weakness, paralysis or paralysis of the lower extremities, impaired sensitivity;
- Stomach pain that increases sharply when coughing or sneezing;
- Symptoms appear on the background of dramatic weight loss, long-term steroid use, immunodeficiency;
- In the family history, there are cases of cancer, inflammation or degenerative diseases of bone and cartilage tissue.
Why does the back hurt in the lower back?
myofascial pain
Muscle strains or spasms can develop gradually or occur suddenly. Under high loads, the injury affects not only muscle fibers, but also ligamentous apparatus and fascia.
Lower back muscle pain occurs when:
- Lifting weights or being overworked at work or sports;
- Participate in sports from time to time. Muscles are especially vulnerable if you are inactive during the work week and then spend a few hours in the gym on the weekends;
- The weight of one's own body has increased dramatically, and the muscles have not had time to grow;
- Sitting or standing in uncomfortable positions for long periods of time;
- Carry a bag on one hand or shoulder each day;
- Postural disorders. When you're not lethargic, the spine performs its best support and protection functions. The muscles in your lower back experience the least stress when you are seated below your waist with good support and distribute your weight evenly across your legs in a standing position.
Myositis (inflammation) of the lower back muscles can be suspected if back pain follows a bruise, fracture, sprain, hypothermia, infectious disease, or an established worm invasion. Due to the inflammation of the muscle fibers, there is persistent severe pain, where "nodules" - spasms are felt in the muscles. Inflammation can be acute or chronic. The course of the disease is long, the pain is unstable, and the pain is aggravated by lying down and sitting for a long time, in the afternoon or when the weather changes. Touching the muscles can cause soreness and discomfort, the lower back muscles are under constant tension, inflammatory edema develops, and local and whole body temperature increases.
Muscle spasms can invade the roots of the spinal nerves, so the attack often resembles sciatica or pictures of sciatica - severe burning pain in the back of the thigh and calf, numbness in the extremities, and loss of sensitivity. The muscle tone evident in myositis causes the patient to assume a forced posture, he walks and lies stooped, flexing his legs to move.
How to treat spinal muscle pain? NSAIDs and pain relievers are used to reduce inflammation and pain. The drug can be taken in the form of tablets, ointments, injections, transdermal patches and gradually release the active substance. Stimulating and warming ointments are also used to reflexively increase blood flow to the muscles of the lower back. The influx of blood helps flush out inflammation and the products of tissue breakdown.
Injectable corticosteroids and vasoconstrictors help reduce inflammatory edema.
If the cause of myositis is infection or poisoning of the body with helminth toxins, antibiotics or deworming drugs are used initially. In this case, warm ointments or compresses should not be used.
Spinal disorders involving nerve endings
In the lumbar region, the vertebrae are separated by discs of elastic cartilage that protect the spine from injury, but they themselves are subject to wear and aging.
Usually, the disc is a jelly-like nucleus pulposus surrounded by a denser annulus fibrosus. The elasticity of the core is due to its ability to bind and retain moisture: when the load increases, it accumulates water, the elasticity increases, and when the pressure decreases, the core releases the water and becomes flatter.
Osteochondrosis in the area of the vertebral body develops when the discs are dystrophic (they "dry out") or when there is a local overload. Most of the time, low back pain is due to the lower poles of their discs that bear the greatest load while sitting, when weights are lifted in front of them. At the same time, the intervertebral disc is torn, displaced, and the vertebral ligaments are damaged, with constant pain and throbbing.
Spinal pain has several mechanisms of development:
- Violation of the surrounding tissues of the spine, especially the microcirculation in the spinal canal, causing congestion and edema. This condition develops against the background of hypothermia, hyperthermia, inflammatory processes.
- Degeneration process of spinal fixation ligaments. The increased mobility of the vertebrae results in slight displacement and unphysiological compression of the vertebrae, which can lead to damage to nerves, blood vessels, and the formation of hernias.
- Axial compression of the vertebrae during weightlifting or damage to the vertebrae during excessive rotation (rotation).
- Sterile inflammation. Disruption of the nucleus results in the release of sensitive factors into the spinal canal. The nerve endings become irritated, causing spasms in the muscles that invade adjacent vertebrae - above and below the hernia. Gradually, the reaction covers the entire lumbar region and causes any movement to cause pain.
Weak discs can rupture, causing the nucleus to herniate, herniate, or prolapse, and eventually lead to herniation. The appearance of a hernia can put pressure on the spinal cord and spinal nerve roots. In this condition, there is a sharp throbbing pain in the lower back that radiates along the strangled nerve. The most famous case of sciatic nerve compression (sciatica) is severe pain in the back of the thigh and calf, numbness in the limb on the side of the hernia, muscle weakness, and involuntary folding of the leg.
Lumbar pain worsens when sitting and standing, turning, and leaning. There is usually a protective muscle response - painful contractions (forming rollers) of the muscles on both sides of the spine, isolating the sector from unwanted movement. Osteochondrosis subsequently leads to the appearance of sciatica (inflammation of the spinal nerve roots).
Root syndrome is dangerous when the lower back nerves that innervate an internal organ (the horn of the cauda equina) are pinched. At the same time, stomach pain, bladder and bowel dysfunction, men have drug efficacy problems, women have gynecological diseases.
Many patients, because of the pain in the lower back, take a pain-relieving position - leaning to the left, and if the right side is painful, lie on the right side. If the hernia is on the left side. Another characteristic is severe pain (ringing symptoms) when the hernia in the intervertebral space is pressed.
How to treat if you have pain in your back due to osteochondrosis:
- During a pain attack, you can take an anaesthetic position - lying on your back with a roller under your knee. Sleeping on a hard surface is also recommended;
- From pain relievers, NSAIDs can be taken orally or injected on both sides of the spine in a lumbar hotel;
- Use topical stimulants as distraction therapy—mustard creams, iodine tablets, pepper patches, and ointments;
- Eliminate muscle spasms through manual therapy, acupuncture, vacuum massage, reflexology, gymnastics;
- When the acute phase decays, it can be treated with mud, rehmannia glutinosa, and warm-up.
Treatments for radiculopathy pain include:
- Provide bed rest, lumbar traction (dry or underwater);
- Use of neocaine blockers, NSAIDs or weak opioids at the site of infringement;
- Physical therapy - microcurrent stimulation, analgesic electrophoresis.
Indications for surgery are persistent acute pain, as well as impaired visceral function, quadriplegia, and isolation of intraspinal hernias.
degenerative inflammatory disease
Spondyloarthropathies (inflammation of the facet joints of the vertebrae) occur as the discs degenerate and decrease in height and volume. Lower back pain is caused by overstretching the joint capsule and increasing pressure on the surfaces of the intervertebral joints. The pain causes the patient's lower back to bend more, which increases the load on the intervertebral joints. Discomfort in the lower back, in particular, can be exacerbated by wearing high heels, walking for long periods of time, getting off an elephant, and veering backwards, for example, when looking at things overhead.
In patients with this diagnosis, lower back stiffness is noted in the morning and pain increases during the day or after exercise. It is diffuse and difficult to demarcate: discomfort is defined in the buttock muscles, groin area, lower abdomen and male scrotum. This spondyloarthropathy is different from radiculopathy when you can pinpoint the source of the pain.
What can be done to relieve pain? It is usually helpful to take a supine position with the legs flexed at the hip and knee.
Their medications are non-steroidal anti-inflammatory drugs and non-narcotic analgesics of choice.
Muscle relaxants are also added, as they relieve muscle tension and improve spinal mobility.
Psychotherapy has a positive effect because chronic pain can push patients into a state of depression.
Unlike osteochondrosis, spondylosis affects more the annulus fibrosus and anterior longitudinal ligament of the intervertebral disc. With this disease, calcification of connective tissue structures occurs with the formation of outgrowths -- osteophytes -- along the edges of the vertebrae. These formations disrupt microcirculation near the nerve roots, leading to pain in the lower back and limited mobility in this sector.
Vertebral osteophytes are pathological growths that damage nerves and blood vessels.
Treatment is usually conservative, with anti-inflammatory drugs, analgesics, and vitamins. Electrophoresis with novocaine, lidase, manual therapy, physiotherapy (amplippulse, laser installation, shock wave therapy to destroy compaction elements and increase spinal mobility) can produce good results.
notes! In advanced stages, the osteophytes do not regress. Although they are small in size, the goal of treatment is to eliminate inflammation, pain, and improve metabolism. If the back is not very painful, then nothing will be done to the growth. If the osteophyte causes persistent pain or is large, it can be removed during surgery.
neoplastic disease
Low back pain can be caused by a tumor compressing the spinal cord both from the outside (formed extramedullary) and from the inside (intramedullary, originating in the cerebrospinal fluid itself).
Cells of various tissues can grow pathologically:
- Fat - the formation of lipomas;
- nerve root - neuroma;
- Spinal blood vessels - hemangioma;
- Auxiliary tissue - glioma;
- Bone tissue - osteosarcoma;
- Cartilage - chondrosarcoma.
The neoplastic process, especially malignant, is characterized by a pain syndrome similar to sciatica (it can be unilateral and bilateral), general deterioration of the patient's condition and exhaustion.
If the lesion affects the lumbar region I-IV, there is a burning sensation on the front and sides of the upper thigh, and the region is not completely paralyzed.
For lesions in the IV lumbar-II sacral region, numbness in the accessory genital region and impaired motor and sensory innervation of the gluteal muscles, posterior thigh, calf, fecal and urinary incontinence were noted.
Tumors in the V-III sacral region can cause significant impairment of pelvic organ function. The patient suffers from impotence or menstrual disorders, constipation or fecal and urinary incontinence.
Tumor treatment is specific, pain relievers, anticancer drugs are prescription drugs.
As you can see, low back pain is often caused by musculoskeletal disorders. They can be diagnosed from clinical symptoms and research data, and their main task is to correctly identify the nature of the disease, not to confuse it with oncological causes, visceral disease or trauma. If you experience low back pain, we recommend that you always seek the advice of a neurologist or orthopaedic surgeon.