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Back pain (lumbago)

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

In rare cases, the cause is more serious: a herniated disc (otherwise known as a herniated disc), spondylolisthesis, fracture or tumor. Back pain is considered dangerous if accompanied by pain, numbness, weakness in the legs, difficulty urinating, etc.

Treatment for back pain begins with a detailed history (when did the pain start, how long does it last, where does it affect, 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 checked, such as the kidneys and abdomen.

If necessary, tests such as plain x-rays and MRIs will be requested. Conservative treatment (rest, medications, physical therapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, there is an injection into the spine under local anesthesia.

Lower back pain

Common questions about back pain

What does the central (lumbar) spine consist of?

The lumbar spine consists of:

  1. bones (vertebrae);
  2. intervertebral disc (between two adjacent vertebrae there is a disc, like a pillow);
  3. joints (there are two joints at the back of each vertebra);
  4. ligaments;
  5. tendons;
  6. muscles and finally;
  7. nerves emerging from 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 question above have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is soft tissue tension, 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 severe back pain due to muscle strain (without showing anything on a plain X-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What can cause back pain?

Causes of back pain are:

  1. muscle tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (more than 70%);
  2. worn intervertebral disc (for example, herniated disc);
  3. joint damage;
  4. spondylolisthesis;
  5. fracture (as a result of trauma, as well as automatically due to osteoporosis or metastasis);
  6. other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (eg, ankylosing spondylitis), Scheuermann's disease;
  7. causes outside the spine, for example, nephrolithiasis (kidney stones), abdominal aortic aneurysm, cholecystitis.

The cause of pain may vary with age.

Yes, the reason changes 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 posterior elements of the spine (such as joints) increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and osteoporosis-related fractures also begin to occur.

Can back pain be related to weight?

Yes, the role of weight gain in the incidence of back pain is empirically known and scientifically confirmed. This may be due to the fact that overweight people usually do not play sports and therefore do not "build" the appropriate muscle system to protect the back from minor injuries. People who are overweight and obese (with a body mass index of more than 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 packages from the supermarket, but you are not allowed to lift, for example, heavy boxes. 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 and not straighten them, like weightlifters do. Also, the more a person exercises their spinal muscles, the more stress their back can bear.

In general, everyday life certainly involves lifting weights: the human body is designed to lift weights and do heavy lifting, like parents lifting their children.

Lifting weights in the gym is a different matter: as a general rule, unless it is 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 in case of fracture. This type of fracture usually occurs automatically (i. e. not due to a fall) and the symptoms may not be as noisy as a "normal" fracture, i. e. pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is classified as chronic if it continues 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 a "strange" character, i. e. described as burning sensation, "electric current";
  2. the cause of the pain may appear to have resolved, for example, a herniated disc may be "resolved" on an MRI;
  3. patients experience psychological effects of pain and show symptoms such as anxiety and depression.

What is the scientific explanation for this strange type of back pain?

A common theory of chronic pain is that continuous and prolonged stimulation of a nerve pathway (ie, the pathway from the site of pain to the brain) causes "sensitization, " so that the stimulation causes an exaggerated or peculiar response.

Therefore, low-intensity stimulation can cause pain or intense pain that is not appropriate for the type of stimulation, such as feeling like you're on fire when no part of the body is heating up. Therefore, even if the anatomical cause of the pain is treated, the pain and the psychological response may remain, as if imprinted on the brain. For this reason, for chronic back pain, drugs that affect the central nervous system, such as antidepressants, are prescribed (in addition to conventional painkillers).

When should you see a doctor for back pain?

  • when the pain does not go away with simple pain relievers in a few days;
  • when the pain occurs not only in the back, but also in the legs;
  • when the legs become numb or start to become paralyzed;
  • if the back pain continues at night, during sleep or even waking the sufferer from sleep;
  • if you have problems with urination, bowel movements and/or sexual function;
  • when accompanied by fever;
  • when it is triggered by a fall or accident;
  • when accompanied by weight loss;
  • if there is a history of cancer, osteoporosis, long-term cortisone use, intravenous drug use (eg, heroin), or alcohol addiction.

What is the next step?

The doctor who will examine you will take a complete medical history and examine you. Then, if necessary, tests such as regular x-rays, CT or MRI will be carried out.

Do I need an X-ray if I have back pain?

Nope. About 70% of back pain cases are caused by simple muscle tension, and in these cases there is no need for an examination.

What if an X-ray or MRI shows something?

This is very common: someone performs a back examination and finds x-ray findings such as herniated discs, osteophytes, etc. But that's what the word says: the discovery of x-rays. This means that the disk was corrupted 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 this time is caused by this particular disc herniation. Also, many "degenerative changes" occur in all people, whether they are in pain or not. Therefore, when making a diagnosis, one should not be guided only by the results of an x-ray examination.

For this same reason, treatment (or indications for surgery) for spinal problems cannot be suggested simply by looking at MRI images. It is advisable to first conduct a history and clinical examination and then relate the MRI findings to the patient's symptoms.

What is the more specific test for back pain: plain x-ray, CT scan, 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 the bones. This means that fractures, scoliosis or kyphosis, or spondylolisthesis are clearly visible, but the intervertebral discs and nerves are not visible.
  2. CT scantakes a few minutes and has an average cost, but at the same time has a high dose of radiation. It depicts all the elements of the spine quite well. This is somewhat disadvantageous when imaging nerves and discs.
  3. MRIIt takes a long time, for example 20 minutes, and is a troublesome examination for people with claustrophobia. The cost is high, but there is no radiation. This is the most detailed examination we have and maps all the spinal structures, especially the nerves. It is relatively less in tangles, especially the small ones. In any case, the doctor, after examining you, will choose and recommend the 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);
  • To relieve pain, you can use certain drugs, such as analgesics, non-steroidal anti-inflammatory drugs, etc. ;
  • A visit to a physiotherapist often helps, especially if it is done in a certain way and for a certain indication;
  • alternative forms of treatment such as acupuncture, yoga and Pilates can provide significant benefits to individual patients;
  • Spinal injections can also sometimes 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 case of emergency. Studies have shown that staying in bed for more than 2-3 days worsens rather than cures back pain. It is usually recommended to walk as much as possible.

If a person cannot get out of bed despite conservative treatment because of unbearable pain, this usually indicates a serious problem and should see a doctor.

Should you use heat or cold to relieve back pain?

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

  • heat (warmth) causes muscle relaxation, i. e. relaxes muscles contracted by pain and improves blood circulation. You can use a cloth heated on a radiator or take a warm (not hot) bath.
  • cold prevents pain fibers from conducting pain (for example, athletes use coolant while playing football). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). An easy alternative: a bag of vegetables from the freezer.

What medicine can you take for back pain?

Medications that can be used to treat back pain include:

  1. Mainly analgesics from the anilide group, alone or in combination with codeine or muscle relaxants. This is the easiest and safest drug, and treatment should always start with it.
  2. Nonsteroidal anti-inflammatory drugs (there are several classes). A stronger painkiller, but when taken chronically it has many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticosteroids- a powerful and effective pain reliever, but with a large number of side effects when used chronically and without clearly proven benefits for back pain.
  4. Opioids, i. e. morphine-type drugs. It is usually given intravenously or intramuscularly in a hospital, but some oral medications are also available.
  5. Antiepileptic or antidepressant drugs, 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 over the phone without checking first.

How can a physical therapist help me with my back pain?

The role of the physical therapist is very important in the treatment of back pain. The most suitable is an initial program that lasts a few days, and then the patient can learn to do the necessary exercises on his own. Severe pain is initially treated so that the patient can walk (ie not bedridden), and as the pain subsides, exercises begin to strengthen the muscles and restore the spine. This 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. exercises for trunk stabilization and proprioception, which "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. exercises to develop a range of motion;
  6. McKenzie mechanical diagnosis and therapy;
  7. retraining, i. e. learn how to stand, sit, lift weights, etc. correctly.

If you have back pain, do you need to see a physical therapist or doctor first?

Physiotherapy is one method of treating back pain. Other methods are medications, care, walking and finally spinal injections and surgery. Therefore, there must be a central person who will choose the method used and evaluate the patient's progress.

It is best for patients 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 treatment progress. The ultimate responsibility for the patient's progress rests with the physician.

Do I need to wear a talisman (belt) for back pain?

A soft pad can easily be used for several days. It does not provide complete immobilization (a rigid guard, as we use for broken bones, does), but it limits excessive and sudden movements and thus reminds the back patient of the correct posture, especially at work.

Long-term chronic use has the opposite effect as spinal muscle atrophy, which leads 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 muscle strengthening program to ultimately eliminate the need for protection.

How likely am I to need surgery for my back pain?

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

What can I do during my period when I have no pain to prevent back pain?

  • Exercise regularly in consultation with 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.
  • Strengthens the muscles that support the waist area (abdominal and back muscles). Consultation with your physiotherapist or physiotherapist is essential.
  • Quit smoking or at least reduce the amount of smoking.
  • Maintain a proper weight, reduce excess weight.
  • 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.

Which 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.