Low back pain is often called lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute low back pain, usually associated with hypothermia and physical exertion. Lumbago occurs in many people and is often the cause of temporary disability. Sports injuries or sprains can often be the cause of lumbago, but sometimes the trigger for the pain remains unknown. Lumbago is characterized by pain without radiating to the legs. Low back pain (lumbago) may appear acutely and gradually progress throughout the day. There is often stiffness in the morning and gradually the stiffness turns into pain syndrome. Spine curvature (antalgic scoliosis) is also possible as a result of muscle spasm. The pain itself can be caused by muscle spasm, which in turn is related to other causes. This can be strain or sprain, sports injuries, herniated disc, spondyloarthrosis (spondylosis), kidney disease (kidney stones or infections). Sometimes, the patient accurately determines the cause and effect relationship of the appearance of malaise 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 your shoes. This can be facilitated by deforming spinal conditions such as scoliosis.
Unlike lumbago, the term lumbodynia does not mean acute pain, but subacute or chronic pain. As a rule, pain with lumbodynia appears gradually over several days. Pain can also occur in the early morning hours and may 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 the pain is relieved by lying down in a certain position. Patients with lumbodynia 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, lateral bending or extension). Due to the 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 prevalence 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 chest. These 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 of these diseases can manifest.back pain. . . Even a normal pregnancy can cause lower back pain due to sprains in the pelvic region, muscle spasm due to stress and nerve irritation.
Oftenback painis associated with the following diseases:
- Nerve root compression, which causes symptoms of sciatica and is most often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is acute, has irradiation and impaired sensitivity in the nerve root innervation zone. A herniated disc mainly occurs 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 intervertebral discs begin at age 30 or older. But the very presence of a hernia does not always have an effect on nerve structures.
- Spondylosis - degenerative changes occur in the vertebrae themselves, bone growth (osteophytes), which can affect nearby nerves, which leads to pain.
- Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lower back may experience lower back pain radiating to both legs. Lower back pain can arise as a result of standing or walking.
- Equine tail 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 bowel and bladder pain and dysfunction (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. In fibromyalgia, pain and discomfort 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 cancer metastases, can be a source of discomfort in the lower back.
- Inflammation of the nerves and, consequently, the manifestations of pain (in the chest or in the lower back) can be caused by damage to the nerves themselves (for example, in the shingles)
- Given the variety of symptom causes, such as acute or subacute low back pain, it is very important to fully assess the patient and perform all necessary diagnostic procedures.
Symptoms
Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, low back pain.
- The pain may radiate down the front, side, or back of the leg (lumbar ischalgia), or it may be localized only in the lower back (lumbago, lumbodynia).
- The sensation of pain in the lower back may intensify after exertion.
- Sometimes the pain can get 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 area of innervation of the compressed nerve.
For timely diagnosis and treatment, a series of criteria (symptoms) deserve special attention:
- A recent history of injury, such as a fall from a height, a traffic accident, or similar incidents.
- The presence of mild injuries in patients over 50 years of age (eg, falling from a low height as a result of slipping and landing on the buttocks).
- History of long-term steroid use (eg, these are patients with bronchial asthma or rheumatologic diseases).
- Any patient with osteoporosis (especially elderly women).
- Any patient over 70 years of age: At this age, there is a high risk of cancer, infections and diseases of the abdominal organs, which can cause lower back pain.
- history of oncology
- The presence of infectious diseases in the recent past
- Temperature above 100F (37, 7 C)
- Drug use: Drug use increases the risk of infectious diseases.
- Low back pain is worse at rest: this nature of pain is usually associated with oncology or infections, and this 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 walking, foot dysfunction, as a rule, are symptoms of acute nerve damage or compression. Under certain circumstances, these symptoms may require emergency neurosurgical operation.
- Intestinal or bladder dysfunction (incontinence and urinary retention) may be a sign of a medical emergency.
- Failure to follow recommended treatment or increased pain may also require seeking medical attention.
The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.
Diagnosis
A medical history is important to make an accurate diagnosis, as many conditions can cause lower back pain. The moment when the pain starts, the relationship with physical exertion, the presence of other symptoms such as cough, temperature increase, bladder or bowel dysfunction, presence of seizures, etc. A physical examination is performed: identification of pain points, presence of muscle spasm, a study of neurological status is performed. If diseases of the abdominal cavity or pelvic organs are suspected, an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, blood tests in the urine).
If the somatic genesis of low back pain is excluded, instrumental research methods such as radiography, computed tomography, or magnetic resonance imaging may be prescribed.
X-ray 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 visualizing the presence of various changes, both in bone tissue and soft stones (especially with contrast).
Magnetic resonance imaging is the most informative research method that allows the diagnosis of morphological changes in various tissues.
Densitometry is necessary when osteoporosis is suspected (usually in women over 50 years old)
EMG (ENMG) is used to determine conduction violation along nerve fibers.
Laboratory tests are prescribed (blood tests, urine tests, blood biochemistry) primarily to rule out inflammatory processes in the body.
pain treatment
After diagnosis and confirmation of vertebral genesis with lumbago and lumbodynia, a specific treatment for low back pain is prescribed.
In acute pain, rest is needed for 1–2 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 decreases in a few days without the use of medication, just due to rest.
Medicine. For pain syndrome, drugs from the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also carries certain risks. Since all medications in this group have many side effects, the use of medications in this group should be short-lived and under the mandatory supervision of a physician.
Muscle relaxants can be used to relieve spasm. 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, steroid use should be selective and short-lived.
Manual therapy. This technique can be very effective in the presence of muscle blockages or joint subluxation. Mobilizing the motor segments can reduce muscle spasm and low back pain.
Physiotherapy. There are many modern physical therapy procedures that can reduce pain and inflammation, improve microcirculation (eg electrophoresis, cryotherapy, laser therapy, etc. ).
Exercise therapy. Exercise is not recommended for acute lower back pain. Connection of exercise therapy is possible after pain syndrome reduction. In the presence of chronic pain, exercise can be very effective in strengthening the muscular corset and improving spinal biomechanics. Exercises should only be selected with a physical therapist doctor, as independent exercises can often lead to increased pain manifestations. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can preserve spinal functionality and significantly reduce the risk of pain syndromes.