Low back pain is often referred to as lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute low back pain, usually associated with hypothermia and exertion. Lumbago occurs in many people and is often the cause of temporary disability. Often sports injuries or sprains can cause lumbago, but sometimes the factor that triggers the onset of pain remains unknown. The lumbago is characterized by pain without radiating to the legs. Lumbar pain (lumbago) can occur acutely and gradually develop during the day. Stiffness often occurs in the morning and gradually stiffness becomes a pain syndrome. Curvature of the spine (antalgic scoliosis) is also possible due to muscle cramps. The cause of the pain itself may be muscle cramps, which in turn is related to other causes. This can be overload or sprain, sports injuries, disc herniation, spondyloarthrosis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the causal relationship between the onset of malaise and exertion, hypothermia, but often the pain occurs for no apparent reason. Sometimes back pain can occur after sneezing, bending down, or wearing shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.
Unlike lumbogo, the term lumbodynia does not mean acute pain but subacute or chronic pain. The pain associated with lumbodynia usually occurs gradually over several days. Pain can also occur in the morning and decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable posture). It is also characteristic of lumbodynia that the pain subsides when lying in a certain body position. Patients with lumbodynia have difficulty performing routine activities such as washing or putting on shoes due to muscle cramps. Due to the disease, the volume of movement of the trunk decreases (leaning forward, or to a lesser extent sideways or elongation). Because of the pain syndrome, the patient often has to change position when sitting or standing. Unlike lumbago, muscle cramps are less pronounced and usually do not cover the entire lower back, and there are often signs of a 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 discs. Sometimesback paincan be caused by diseases of the abdomen, pelvis and chest. Such pains are called reflected pains. Abdominal diseases (eg appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), pelvic organs, ovarian infections - all of these can occurback pain. . . Even a normal pregnancy can cause low back pain due to sprains in the pelvic area, muscle cramps due to stress, and nerve irritation.
Oftenback painis associated with the following diseases:
- Compression of the nerve root, which causes the symptoms of sciatica and is most commonly caused by a disc herniation. Usually, when the nerve root is compressed, the pain is associated with acute irradiation and impaired sensitivity in the nerve root innervation zone. Disc herniation develops primarily due to disc degeneration. The gelatinous portion of the disc bulges from the central cavity and puts pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at age 30 and older. But the presence of a hernia does not always affect the nervous system.
- Spondylosis - degenerative changes in the vertebrae themselves, bone growths (osteophytes) that can affect the nearby nerves, causing pain.
- Spinal stenosis can occur due to degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience radiant low back pain on both legs. Low back pain can occur as a result of standing or walking.
- Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome is caused by the compression of elements of the cauda equina (the 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 pain at certain points (trigger points), a decrease in the volume of muscle movement in the painful areas. Pain syndrome is reduced by relaxing the muscles in the painful areas. In fibromyalgia, aches and pains are common throughout the body. Fibromyalgia is not characterized by tension and muscle pain.
- Bone infections of the spine (osteomyelitis) rarely cause 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 worse especially in the morning.
- Tumors, most often cancerous metastases, can be sources of lower back discomfort.
- Nerve inflammation and, accordingly, manifestations of pain (in the chest or lumbar region) can be caused by damage to the nerves themselves (such as shingles).
- Given the wide 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 may radiate to the front, side, or back of the foot (lumbar ischalgia) or may be localized only in the lumbar region (lumbago, lumbodynia).
- The feeling of pain in the lower back may intensify after exertion.
- Sometimes the pain may get worse at night or during prolonged sitting, such as during a long drive.
- Perhaps the presence of numbness and weakness in the part of the foot that is in the innervation zone of the compressed nerve.
In order to diagnose and treat in time, a number of criteria (symptoms) deserve special attention:
- A recent history of injuries, such as a fall from a height, a car accident, or similar events.
- Presence of minor injuries in patients over 50 years of age (e. g. , falling from a height due to slipping and landing on the buttocks).
- History of long-term use of steroids (e. g. , patients with bronchial asthma or rheumatological diseases).
- All patients with osteoporosis (especially elderly women).
- All patients over the age of 70: at this age, there is a high risk of cancer, infections and diseases of the abdominal organs that can cause low back pain.
- History of oncology
- Recent presence of infectious diseases
- Temperatures above 100 F (37, 7 C)
- Drug use: Drug use increases the risk of infectious diseases.
- Low back pain worsens at rest: this pain is usually associated with oncology or infections, and can be associated with ankylosing spondylitis (ankylosing spondylitis).
- Significant weight loss (for no apparent reason).
- The presence of any acute dysfunction of the nerve is an indication of urgent medical attention. For example, this gait violation, foot dysfunction, is usually a symptom of acute nerve injury or compression. Under certain circumstances, such symptoms may require urgent neurosurgery.
- Intestinal or bladder dysfunction (both incontinence and urinary retention) can be a sign of a medical emergency.
- Medical treatment may also be required in case of failure of the recommended treatment or increased pain.
The presence of any of the above factors (symptoms) is an indication that medical attention should be sought within 24 hours.
Diagnostics
A medical history is important to make an accurate diagnosis because different conditions can cause low back pain. Date of onset of pain, relationship to physical exertion, other symptoms such as cough, fever, presence of bladder or intestinal dysfunction, seizures, etc. Physical examination is performed: identification of pain points, presence of muscle cramps, study of neurological condition. If abdominal or pelvic organ disease is suspected, an examination should be performed (abdominal ultrasound, pelvic and pelvic ultrasound, urine blood test).
If somatic genesis of lower back pain is ruled out, instrumental research methods such as radiography, CT, or MRI may be prescribed.
X-ray is the initial method of examination and allows the identification of indirect signs of changes in bone tissue and changes in intervertebral discs.
CT allows the presence of various changes to be visualized, both in bone tissue and in soft stones (especially with contrast).
MRI is the most informative research method that allows the diagnosis of morphological changes in different tissues.
Densitometry is required if osteoporosis is suspected (usually in women over 50 years of age)
The EMG (ENMG) is used to determine the violation of driving along nerve fibers.
Laboratory tests (blood tests, urine tests, blood biochemistry) are prescribed primarily to rule out inflammatory processes in the body.
Pain treatment
After the diagnosis and confirmation of the vertebral genesis of lumbago and lumbodynia, certain treatments are prescribed to treat lower back pain.
In case of acute pain, 1-2 days of rest is required. Bed rest can reduce muscle tension and muscle cramps. In most cases, when the pain syndrome results from a muscle spasm, the pain syndrome decreases within a few days without the use of medications, just because of rest.
Medicine. In the case of pain syndrome, drugs belonging to the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also carries some risks. Given that all drugs in this group have many side effects, the use of drugs in this group should be short-lived and under mandatory medical supervision.
Muscle relaxants can be used to relieve cramps. But the use of these drugs is effective only in the presence of convulsions.
Steroids can be used to treat pain, especially if there are signs of sciatica. But due to the presence of pronounced side effects, steroid use should be selective and short-lived.
Manual therapy. This technique can be very effective for subluxation of muscle blocks or faceted joints. Mobilizing motor segments can reduce muscle cramps and low back pain.
Physiotherapy. There are many modern physiotherapy procedures that can simultaneously reduce pain and inflammation, improve microcirculation (e. g. , electrophoresis, cryotherapy, laser therapy, etc. ).
Practice therapy. In the case of acute low back pain, exercise is not recommended. Combining training therapy is possible after reducing the pain syndrome. In the presence of chronic pain, exercise can be very effective in strengthening the ligament and improving the biomechanics of the spine. Exercises should only be selected with a gym therapist, as often independent exercises can lead to increased 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.