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Back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common reason is muscle tension combined with insufficient physical training. Rest for 2-3 days and maybe some mild painkillers will do the trick.

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

Treatment of back pain begins with a detailed history (when the pain started, how long it lasted, where it affected, what made it worse, etc. ), followed by a physical examination. Other parts of the body that can cause back pain similar to back pain, such as the kidneys and abdomen, should also be examined.

If necessary, tests such as plain X-rays and MRIs will be required. Conservative treatment (rest, medication, physiotherapy) is usually sufficient. Rarely, special surgery is required. Alternatively, there are spinal injections under local anesthesia.

Lower back pain

Frequently asked questions about back pain

What is the middle (lumbar) spine?

The lumbar spine consists of:

  1. bones (vertebrae);
  2. intervertebral discs (there is a cushion-like disc between two adjacent vertebrae);
  3. joints (there are two joints behind each vertebra);
  4. gardens;
  5. tendons;
  6. muscles and finally;
  7. nerves from the spine (one on the right and one on the left at each level) provide nerve stimulation to the legs.

In a broader sense, the intervertebral disc is also a type of joint.

Which of the following spinal elements can cause back pain?

All the anatomical elements described in the question above have sensitive 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 X-ray image does not always correspond to the intensity of the pain. So one patient may have excruciating back pain from a muscle strain (with nothing showing up 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:

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

The cause of pain can vary from age to age.

Yes, the reasons change 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 back elements of the spine (such as the joints) increases, so the most common causes are osteoarthritis and narrow back (spondylolisthesis), and fractures from osteoporosis also begin to occur.

Can back pain be related to body weight?

Yes, the role of increased body weight in the occurrence of back pain is empirically known and scientifically confirmed. This may be due to the fact that an overweight person does not usually exercise and therefore does not "build" the proper muscle system to protect the back from minor injuries. Overweight and obese people (with a body mass index of more than 25-30) are more prone to back pain attacks.

I have back pain. Should I stop lifting weights?

In the acute stage, that is. If the pain is recent, heavy loads should be avoided. That is, you can lift a package from the supermarket, but you are not allowed to lift, for example, a heavy box. 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 like weightlifters and do not straighten them. In addition, the more a person exercises the spinal muscles, the more stress the back can withstand.

In general, everyday life undoubtedly involves lifting weights: the human body is designed to lift weights and carry heavy loads, for example, a parent lifting a child.

Lifting weights in the gym is another matter: as a general rule, a person with back problems is advised to avoid weight training in the gym unless absolutely necessary (ie, the person is not an athlete).

Can Osteoporosis Cause Back Pain?

Only when it's broken. Such fractures usually occur spontaneously (i. e. not caused by a fall) and the symptoms may not be as noisy as in "normal" fractures, ie. pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is classified as chronic if it lasts for more than 3 months without interruption. The 3-month limit is not arbitrary: patients suffering from back pain for more than 3 months have been observed to have certain characteristics that make treatment difficult:

  1. pain of a "strange" nature, ie. burning sensation, described as "electricity";
  2. the cause of the pain may appear to be resolved, for example, a herniated disc is "resolvable" on an MRI;
  3. the patient experiences the psychological impact of pain and exhibits symptoms such as anxiety and depression.

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

The prevailing theory of chronic pain is that continuous and long-term stimulation of a nerve pathway (that is, the path from the pain site to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.

Thus, a low-intensity stimulus can cause very severe pain or pain that does not correspond to the type of stimulus, for example, when no part of the body is heated, you feel like burning. Thus, even if the anatomical cause of the pain is treated, the pain and psychological response may remain imprinted in the brain. It is for this reason that drugs that affect the central nervous system, such as antidepressants (in addition to conventional painkillers), are prescribed for chronic back pain.

When should you see a doctor for back pain?

  • if the pain does not go away within a few days with simple pain relievers;
  • when the pain is not only in the back, but also in the leg;
  • when the leg becomes numb or starts to become paralyzed;
  • if the back pain continues at night, during sleep, or even wakes the patient up;
  • if you have problems with urination, bowel movements and/or sexual function;
  • 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 drug use (such as heroin), or alcoholism.

What are the next steps?

The doctor who will examine you will take a complete history and examine you. Then, if necessary, tests such as plain X-ray, CT or MRI will be performed.

Should I have an X-ray if I have back pain?

Nope. About 70% of back pain is caused by a simple muscle strain and in these cases no examination is needed.

What if an X-ray or MRI shows something?

It's very, very common: someone does a back exam and finds a herniated disc, osteophytes, etc. reveals an X-ray finding such asBut that's what the word says: an x-ray finding. This means that the disk has been damaged at some point. But the examination does not tell us when this injury occurred, ie. recently or a long time ago, so it doesn't tell us that the back pain is currently caused by this particular herniated disc. In addition, many "degenerative changes" occur in all people, regardless of whether they experience pain. Therefore, when making a diagnosis, you cannot rely only on the results of an X-ray examination.

For the same reason, treatment of spinal problems (or even an indication for surgery) should never be suggested simply by looking at an MRI image. It is advisable to first take the history and clinical examination and then correlate the MRI results with the patient's symptoms.

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

There is no single answer to this question. Each test has indications and each test has disadvantages:

  1. conventional radiographyIt is a very quick and simple test that costs very little. But it only shows the bones. This means that a fracture, scoliosis or kyphosis or spondylolisthesis is clearly visible, but the intervertebral discs and nerves are not.
  2. CT scanit takes only a few minutes and has a moderate cost, but at the same time it has a high radiation dose. It describes all elements of the spine relatively well. This is relatively inconvenient when imaging nerves and discs.
  3. MRIIt takes a long time, for example 20 minutes, and is an inconvenient examination for people suffering from claustrophobia. The costs are high, but there is no radiation. This is the most detailed exam we have and maps all the structures of the spine, especially the nerves. It lacks a bit in curls, especially the smaller ones. In any case, after examining you, the doctor will choose and recommend a suitable test.

How is back pain usually treated?

  • in most cases, rest at home and some simple measures help, for example, "hot and cold" and back protection (belt);
  • You can use certain drugs to relieve pain, such as analgesics, non-steroidal anti-inflammatory drugs, etc. ;
  • A visit to a physical therapist often helps, especially if it is done in a certain way and for specific indications;
  • alternative forms of treatment such as acupuncture, yoga and Pilates can provide significant benefits to individual patients;
  • Spinal injections may 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 2-3 days and only in emergency cases. Studies have shown that staying in bed for more than 2-3 days worsens back pain rather than curing it. In general, it is recommended to walk as much as possible.

If a person is unable to get out of bed due to excruciating pain despite conservative treatment, this usually indicates a serious problem and should consult a doctor.

Should you use heat or cold to relieve back pain?

Both methods are tried and tested and help depending on the situation. The mechanism of action is different:

  • heat (warmth) causes muscle relaxation, i. e. it relaxes muscles that are tight with pain and increases blood circulation. You can use a heated cloth on a radiator or take a warm bath (not hot).
  • cold inhibits pain fibers from transmitting pain (e. g. , athletes apply cooling when 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 medications can you take for back pain?

Medications that can be used to treat back pain include:

  1. Analgesic, mainly of the anilide group, alone or in combination with codeine or a muscle relaxant. It is the simplest and safest drug and treatment should always start with it.
  2. Non-steroidal anti-inflammatory drugs (there are several classes). They are stronger pain relievers, but when taken chronically, they have many side effects, such as gastritis, gastrointestinal bleeding, high blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticosteroid- a powerful and effective pain reliever, but with many side effects when used chronically and without clearly proven benefits for back pain.
  4. Opioids, that is. morphine-type drugs. It is usually given intravenously or intramuscularly in a hospital, but some oral medications are also available.
  5. Antiepileptic drugs or antidepressants, mainly for chronic pain but also for some acute conditions.

It is important!

All the above medicines should be taken on the recommendation of the doctor who has examined you before. It is reckless and potentially dangerous to self-medicate without first checking by listening to friends, getting ideas from the Internet, or talking to your doctor on the phone.

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

The role of the physiotherapist in the treatment of back pain is very important. The most suitable is an initial program lasting a few days, and then the patient can learn to perform the necessary exercises on his own. Severe pain is first treated so that the patient can walk (i. e. not in bed), and when the pain subsides, exercises are started to strengthen the muscles and restore the spine. The program may include:

  1. emergency 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 that "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 range of motion;
  6. mechanical diagnosis and therapy McKenzie;
  7. retraining, that is. correct standing, sitting, lifting weights, etc.

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

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

It is best for a patient 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 to discuss the progress of the treatment. The ultimate responsibility for the patient's progress rests with the physician.

Should I wear a talisman (belt) for back pain?

A simple soft pad can be used for several days. It does not provide complete immobilization (the rigid braces we use for fractures do), but it limits excessive and sudden movements, thus reminding the back patient of proper posture, especially at work.

Long-term chronic use has the opposite effect, such as atrophy of the spinal muscles and causes increased pain. Finally, it should be noted that the amulet can be useful when used for 1-2 weeks. It is best used in conjunction with a spinal muscle strengthening program to eliminate the need for protection.

How likely is it that I will need surgery for my back pain?

It's a small chance. Only 5-10 out of 100 patients who see a doctor for back pain will ultimately require surgery, and that's after all other treatments (conservative treatments) have been exhausted.

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

  • 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 conditions, such as heart disease.
  • Strengthen the muscles that support the lower back (abdominal and back muscles). A consultation with your physical therapist or physical therapist is important.
  • Quit smoking or at least reduce the amount of smoking.
  • Maintain proper body weight, get rid of excess weight.
  • Help your spine: 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.