Low back pain is often referred to as lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute low back pain, which is usually associated with hypothermia and exertion. Low back pain occurs in many people and is usually the cause of temporary disability. Sports injuries or sprains can often be the cause of low back pain, but sometimes the factor that causes the pain is unknown. Low back pain is characterized by pain without radiating to the legs. Low back pain (lumbago) can appear acutely and progress gradually throughout the day. There is often stiffness in the morning and gradually the stiffness turns into a pain syndrome. Curvature of the spine (antalgic scoliosis) is also possible as a result of muscle spasm. The pain itself may be due to a muscle spasm, which in turn is linked to other causes. This can be overuse or sprain, sports injuries, herniated disc, spondyloarthrosis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the cause-and-effect relationship of the appearance of discomfort with exertion, hypothermia, but often the pain appears for no apparent reason. Sometimes back pain can appear even after sneezing, bending over, or putting on shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.
Unlike lumbago, the term lumbodynia does not mean acute pain, but subacute or chronic pain. As a general rule, pain with low back pain appears gradually over several days. Pain can also occur in the morning hours and can decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable body position). It is also characteristic of lumbodynia that pain is relieved by lying down in a certain position. Lumbodynia patients 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 (forward bending or, to a lesser extent, bending to the side or extension). Due to pain syndrome, the patient often has to change position when it is necessary to sit or stand. Unlike lumbago, muscle spasm is less pronounced and, as a rule, does not cover the entire lower back, and there are often signs of a predominance of 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 painit can be caused by diseases of the abdominal cavity, small pelvis and thorax. Such pains are called reflected pains. Diseases of the abdomen (eg, Appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), infections of the pelvic organs, ovaries; all these diseases can manifestBack pain. . . Even a normal pregnancy can lead to lower back pain due to sprains in the pelvic area, muscle spasms due to stress, and irritation of the nerves.
OftenBack painis associated with the following diseases:
- Nerve root compression, which causes sciatica symptoms and is most often caused by a herniated disc. As a general rule, when the nerve root is compressed, the pain is acute, has irradiation and altered sensitivity in the zone of innervation of the nerve root. A herniated disc occurs primarily as a result of disc degeneration. There is a bulging 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 the age of 30 years or more. 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, causing 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 low back pain that radiates to both legs. Low back pain can appear as a result of standing or walking.
- Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs as a result of compression of the elements of the cauda equina (terminal part 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 emergency surgery.
- Pain syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and discomfort at certain points (trigger points), a decrease in the volume of muscle movement in painful areas. The pain syndrome is reduced by relaxing the muscles located in the painful areas. With fibromyalgia, pain and ache are common throughout the body. Fibromyalgia is not characterized by muscle stiffness and 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 often metastases from cancer, can be a source of lower back discomfort.
- Inflammation of the nerves and, consequently, manifestations of pain (in the chest or lower back) can be caused by damage to the nerves themselves (for example, with shingles).
- Given the variety of causes of symptoms, such as acute or subacute low back pain, it is very important to fully evaluate the patient and perform all necessary diagnostic procedures.
Symptoms
Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, lumboishalgia.
- The pain can radiate to the front, side or back of the leg (lumbar iscalgia), or it can be localized only in the lumbar region (lumbago, lumbodynia).
- The sensation of pain in the lower back may intensify after exertion.
- Sometimes the pain may be worse at night or when sitting for a long time, such as during a long car ride.
- Perhaps the presence of numbness and weakness in the part of the leg, which is located in the zone of innervation of the compressed nerve.
For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:
- A recent history of injuries, such as a fall from a height, a traffic accident, or similar incidents.
- The presence of minor injuries in patients older than 50 years (for example, fall from a low height as a result of sliding and landing on the buttocks).
- History of long-term steroid use (for example, these are patients with bronchial asthma or rheumatological diseases).
- Any patient with osteoporosis (mostly elderly women).
- Any patient older than 70 years: at this age, there is a high risk of cancer, infections and diseases of the abdominal organs, which can lead to low back pain.
- History of oncology
- The presence of infectious diseases in the recent past.
- Temperature above 100 F (37. 7 C)
- Drug use: Drug use increases the risk of infectious diseases.
- Low back pain worsens at rest: as a rule, this nature of pain is associated with oncology or infections, and such pain can also be with ankylosing spondylitis (ankylosing spondylitis).
- Significant weight loss (for no apparent reason).
- The presence of any acute nerve dysfunction is a sign of urgent medical attention. For example, this is a violation of gait, foot dysfunction, as a rule, are symptoms of an acute nerve injury or compression. In certain circumstances, these symptoms may require an emergency neurosurgical operation.
- Bowel or bladder dysfunction (urinary incontinence and retention) can be a sign of a medical emergency.
- Failure of 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.
Diagnostics
Medical history is important for making an accurate diagnosis, as various conditions can cause low back pain. The moment of onset of pain, the relationship with physical exertion, the presence of other symptoms such as cough, increased temperature, dysfunction of the bladder or intestines, presence of seizures, etc. A physical examination is performed: identification of pain points, presence of muscle spasm, a study of the neurological status is performed. 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, urine blood tests).
If the somatic genesis of low back pain is excluded, instrumental research methods such as radiography, computed tomography or magnetic resonance imaging can be prescribed.
Radiography is the initial examination method and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.
CT allows to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).
Magnetic resonance imaging is the most informative research method that makes it possible to diagnose morphological changes in various tissues.
Densitometry is necessary when osteoporosis is suspected (usually in women older than 50 years)
EMG (ENMG) is used to determine the violation of conduction along nerve fibers.
Laboratory tests (blood tests, urinalysis, blood chemistry) are prescribed mainly to exclude inflammatory processes in the body.
Pain treatment
Once the diagnosis and confirmation of vertebral genesis with lumbago and lumbodynia is established, a certain treatment for low back pain is prescribed.
In acute pain, it is necessary to rest for one to two days. Bed rest can reduce muscle tension and muscle spasms. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome subsides within a few days without the use of medications, just due to rest.
Medicine. For pain syndrome, drugs from the group of NSAIDs are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also carries certain risks. Since all the drugs of this group have many side effects, the taking of drugs of this group should be of short duration and under the mandatory supervision of a doctor.
Muscle relaxants can be used to relieve spasms. But the use of these drugs is effective only in the presence of a spasm.
Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of pronounced side effects, the use of steroids must be selective and short-lived.
Manual therapy. This technique can be very effective in the presence of muscle blockages or subluxation of the facet joints. Mobilizing the motor segments can reduce both muscle spasm and lower back pain.
Physiotherapy. There are many modern physiotherapy procedures that can reduce pain and inflammation, improve microcirculation (eg, electrophoresis, cryotherapy, laser therapy, etc. ).
Exercise therapy. Exercise is not recommended for acute low back pain. Connection of exercise therapy is possible after reducing 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. Exercises should be selected only with an exercise therapy doctor, since independent exercises can often lead to increased manifestations of pain. Systematic 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.