Lower back pain

There are many diseases that manifest themselves as painful sensations in the lumbar region. They may indicate problems with the spine, joints, muscles, internal organs - kidneys, intestines, liver. This is a rather insidious symptom, and without a visit to a doctor it is impossible to determine the true cause of pain in the lumbar region. Correct treatment is possible only after diagnosis in a medical institution.

Types of pain

During the initial examination, the doctor must ask the patient about the nature of the pain. In duration they can be:

• sharp- occur suddenly, paroxysmally, differ in intensity, last less than 1 month;
• subacute- last 2-3 months, most often they are recurrent: they become active for 2-5 days, then subside and return again after some time;
• chronic- last more than 1 year, the course is most often recurrent.

Doctors have found that most often chronic pain in this area is associated with the formation of local muscle spasms, compactions that have certain pain points (the so-called myofascial syndrome). The process also involves the muscles that straighten the spine, the muscles of the buttocks, the pelvic ligaments and the sacroiliac joint.

The nature of the pain is sharp, aching, dull. By intensity - strong, medium, weak. Depending on the location of pain, the following types are distinguished:

• lumbodynia- pain in the lumbar or lumbosacral region;
• sciatica- in the lower back, radiating to the leg;
• sacralgia- in the area of the sacrum;
• coccydynia- in the tailbone.

5 facts about lower back pain

• About 25% of all visits to clinics with complaints of back pain are related to sensations in the lumbar region.
• According to research, 84% of people have experienced pain in the lumbar region at least once in their lives.
• 44–78% of patients (depending on age and region of residence) experience repeated attacks of lumbodynia.
• Up to 37% of people periodically lose their ability to work due to low back pain.
• In 85% of patients who consult a doctor about pain in the lumbar region, musculoskeletal disorders are identified, which become the cause of pain.
• According to statistics, about 90% of patients with acute pain in the lumbosacral region recover within 2 weeks.

Causes of lower back pain

Musculoskeletal disorders

In 2006, the European Federation of Neurological Societies officially adopted the following classification of causes of pain in the lower back. They are divided into 3 main groups:

1. Compression of the spinal root, peripheral nerve in the lumbar spine. It occurs due to protrusion (degenerative changes) of the intervertebral discs. Less commonly, due to dysplasia (disturbances in the formation process) of the upper articular processes of the sacrum.
2. Diseases of the spine that are caused by tumors, joint damage, infection, compression fractures, allergic reactions, autoimmune inflammatory processes.
3. Musculoskeletal disorders as a result of subluxation, sprain of spinal ligaments, muscle strain, dysfunction of intervertebral joints.

Pathologies of internal organs

1. Disorders of the genitourinary system.

   Diseases of the urinary system - urolithiasis, cystitis, pyelonephritis - often cause discomfort in the lumbar region.

   Lower back pain in women may indicate dysfunction of the genital organs. Most often, the main sensations are concentrated in the lower abdomen and radiate to the sacrolumbar spine. They may appear during menstruation or after sexual intercourse.

   One of the possible causes of lower back pain in women is ovarian tumors, which are located on the back of the uterus. Often, discomfort in the lower back becomes a symptom of uterine fibroids. As it grows, the pain can manifest itself strongly and acutely and indicate serious disturbances in the blood supply, stretching of the peritoneum, and compression of the nerve plexuses in the pelvic area.

   Another cause of lower back pain in women is pelvic organ prolapse. In this case, the sensations are of a pulling nature. During walking and physical work, their intensity increases.

2. Disorders of the gastrointestinal tract.

   Most often, pain is felt in the lumbar region due to gastric and duodenal ulcers and acute pancreatitis. Patients complain that there is pain of a girdling nature. Usually the lower back begins to ache simultaneously with the right/left hypochondrium, where the most intense sensations are concentrated. In a number of clinical cases, lumbar pain accompanies an attack of acute appendicitis, although they are not the main symptoms of this disease. Various inflammations of the intestinal mucosa (proctitis, sigmoiditis) can also cause pain.

10 Risk Factors for Low Back Pain

1. Congenital pathologies of the lumbosacral spine.
2. Heavy physical labor associated with stress on the lower back, frequent bending, and vibrations.
3. Acute and chronic stress that causes muscle spasms.
4. A sedentary lifestyle and prolonged stay in an unnatural position with a load on the lumbar region.
5. A weak muscle corset, which results in incorrect posture, stooping, scoliosis, and kyphoscoliosis.
6. Metabolic disorders and excess body weight, which increases the load on the lower part of the spine.
7. Increased physical activity and sports participation increase the risk of injury.
8. Age above 50 years - due to the development of degenerative processes in the spine.
9. Frequent stress, depression.
10. Poor nutrition with a lack of B vitamins.

Lower back pain as a symptom of various diseases

Osteochondrosis of the lumbar spine

One of the most common diseases, the symptom of which is pain in the lumbar region. With osteochondrosis, the intervertebral discs, which play a shock-absorbing role between the vertebrae, become thinner. The nerve roots are compressed, muscles spasm, and severe acute pain occurs. Its intensity increases when bending over, lifting heavy objects, or when the patient tries to sit up from a lying position or stand up from a sitting position.

In advanced cases, a hernia forms between the vertebrae, which only increases the pain. Osteochondrosis most often affects the lumbar spine, since it bears the maximum load when sitting and walking.

A severe complication of osteochondrosis is spondylosis. It is characterized by almost complete destruction of the intervertebral discs and the formation of sharp bone protrusions - osteophytes. They injure nearby tissues, causing sharp, severe pain that radiates to one or both legs.

Signs of intervertebral hernia

• The patient can rise from a sitting position only with support from a chair/table or knee.
• Any load on the lower back causes an attack of acute pain.
• The patient lies down on his stomach, only placing a pillow under him.
• A person can only pick up an object from the floor by crouching slowly.

Ankylosing spondylitis

The disease occurs as a consequence of inflammatory processes in the spine. It is most often diagnosed in men aged 20-35 years. The patient feels stiffness in the lower back and discomfort in the sacrum in the morning and at rest. Gradually during the day this feeling passes, the person "paces. "Many people do not pay attention to this alarming symptom; meanwhile, ankylosing spondylitis leads to gradual fusion of the vertebrae, decreased spinal mobility and disability. Therefore, you need to see a doctor at the first signs of illness - morning stiffness in the spine.

Spondyloarthrosis

This disease affects the cartilage tissue that covers the intervertebral discs. With age, it becomes thinner, destroyed, and bone growths form in places where cartilage breaks. Due to the fact that the intervertebral discs rub against each other, the nerve roots are irritated - this process is accompanied by severe lower back pain. The muscles in the problem area of the back are constantly tense and spasming.

Signs of spondyloarthrosis

• The pain becomes more intense after exercise and goes away after rest.
• Pain appears after prolonged standing or walking.
• Simultaneously with lumbar pain, the patient feels discomfort in one of the hips and hip joint.

Urolithiasis disease

The pain in this pathology is paroxysmal and very intense. Typically, painful sensations arise from the inflamed kidney. It is difficult for the patient to find a position in which he feels better. After attacks, the urine becomes reddish in color and its volume decreases.

Inflammation in superficial tissues and fiber

The cause of pain may be a carbuncle or boil. These are purulent dense formations on the skin with a diameter of more than 1 cm. They are easy to notice by their purple color. The painful sensations are sharp, intense, pulsating.

Paranephritis, an inflammation of the perinephric tissue caused by infection, is also painful. The sensations become stronger with inhalation and movement. The patient tries to lie down with his legs tucked in - in this position the pain is less pronounced. The skin in the affected area swells and turns red.

Inflammation of the spine, spinal cord

Osteomyelitis is an inflammatory process in the bone marrow that affects all bone tissue. The acute form is characterized by increasing pain of a tugging, bursting nature. It is combined with signs of intoxication and fever.

Tuberculosis of the spinal column occurs due to infection with Koch's bacillus. The first signs of the disease may appear many years after infection. It all starts with deep pain that appears after exercise. The infection affects the vertebrae, hindering the patient’s movements, and a characteristic gait is formed.

Other diseases

Lumbar pain can be a symptom of numerous pathologies, including quite exotic ones. These include, for example, foot and mouth disease, Ebola fever, hemorrhagic fevers, and Japanese mosquito encephalitis.

• Cardiovascular diseases - abdominal aortic aneurysm, Loeffler's endocarditis.
• Myositis is inflammation and muscle pain in the lower back, which can be caused by infectious diseases such as influenza, sore throat, and even common ARVI.
• Benign and malignant neoplasms of the spine and spinal cord.
• Renal pathologies - glomerulonephritis, renal vein thrombosis, pyelonephritis, cyst.
• Lower back pain in men occurs with prostate cancer.

Why does my lower back hurt when I cough?

Coughing provokes muscle tension in the affected area, resulting in pain. Often, patients first learn about a developing disease when they notice pain when coughing. Most often, such sensations are a sign of:

• intervertebral hernia,
• osteochondrosis,
• neuralgia,
• facet arthropathy,
• kidney diseases.

Diagnostics

As noted above, pain in the sacrolumbar region can be a symptom of many diseases. Therefore, to identify objective causes, you should consult a doctor at the first signs. You can make an appointment with an orthopedic doctor, neurologist, or surgeon. In the future, you may need to consult a rheumatologist, urologist, or gastroenterologist.

• Initial examination.The doctor evaluates tissue sensitivity, muscle function, and reflexes in the affected area.
• Radiography.The examination shows changes in the structure of bones, cartilage, and joints.
• Blood and urine tests.With their help, you can determine the presence of infection and inflammatory processes.
• Functional diagnostics.It includes methods for assessing nerve conduction and muscle performance - electroneurography, electromyography.
• CT and MRI.Allows a detailed examination of the condition of bone, muscle, nervous, and vascular structures.
• Ultrasoundcarried out if pathology of the pelvic organs, prostate, or kidneys is suspected.

It is important to exclude (or confirm the presence of) a tumor, to differentiate between compression of the spinal roots and pain syndrome of a musculoskeletal nature. Based on the diagnostic data, the doctor will determine the true cause of the pain and prescribe an effective treatment program.

Is bed rest necessary?

None of the recommendations for the treatment of lower back pain in diseases of the musculoskeletal system contain instructions on strict bed rest. On the contrary, patients are advised to return to normal activity as early as possible in order to prevent the formation of chronic pain syndrome. Strict immobilization is advisable for 1–3 days in severe cases, that is, with severe pain. For acute pain in the lower back, you can use a fixation belt. However, long-term lumbar fixation is not recommended unless there is trauma or spondylolisthesis. Gradually you need to include special exercises to strengthen the spine and muscles.

Treatment of lower back pain

Most often, a combination of medicinal and non-medicinal agents is required to solve the problem.

Medication

The basis of drug therapy is non-steroidal anti-inflammatory drugs (NSAIDs). They affect the peripheral mechanisms of pain formation and are prescribed for exacerbation of pain syndrome. In most clinical cases, treatment is carried out in courses - no more than 12 weeks.

In most cases, patients are prescribed B vitamins to improve nerve conduction, decongestants and sedatives. In the chronic course of the disease, it is possible to take antidepressants. For severe muscle spasms and pain - muscle relaxants, weak opioids.

Non-drug

Additionally, the patient may be prescribed manual therapy, acupuncture (acupuncture). The procedures are aimed at activating metabolism and blood circulation in the affected area. This allows for improved tissue nutrition.

According to doctors, physical therapy, exercises to strengthen the muscles of the lumbar region, traction therapy, and transcutaneous electrical neurostimulation have little effect. Most often, these procedures are prescribed in the absence of a pronounced effect from taking the drugs for 4-6 weeks. There is no scientific evidence of the effectiveness of massage, physiotherapy, or wearing various belts.

What to do for prevention

• In the morning, do exercises with simple stretching exercises for the spine and muscles.
• Eat rationally, excluding fatty, fried, smoked, salty, spicy, and alcohol.
• Watch your own weight.
• Drink at least 1. 5 liters of fluid (preferably water) daily.
• Once every 6 months, take a course of classical massage.
• Avoid staying in one position for a long time.

Conclusion

Painful sensations in the lumbar region can be a symptom not only of pathologies of the musculoskeletal system, but also of internal organs. Many patients self-diagnose and treat, for example, a muscle strain, although in fact the problem may be kidney inflammation. Such treatment only aggravates the situation - a person concentrates on a non-existent disease and triggers a serious pathology. That is why it is important to seek qualified help and identify the true cause of the pain. Self-prescription of medications is strictly not recommended.