Lower back pain

There are many diseases that manifest themselves as painful sensations in the lumbar region. They can indicate problems in the spine, joints, muscles, internal organs - kidneys, intestines, liver. This is a rather insidious symptom and without a visit to the 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 first examination, the doctor must ask the patient about the nature of the pain. In duration, they can be:

• sharp- occur suddenly, paroxysmically, of different intensity, last less than a month;
• subacute- last 2 to 3 months, most often they are recurrent: they become active for 2 to 5 days, then subside and return after a certain time;
• chronic- last more than 1 year, the course is most often recurring.

Doctors have found that most often chronic pain in this area is associated with the formation of local muscle spasms, compactions that present certain painful 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 the pain, the following types are distinguished:

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

5 facts about lower back pain

• Approximately 25% of all clinic visits for complaints of back pain are related to sensations in the lumbar region.
• According to a study, 84% of people have experienced pain in the lower back region at least once in their life.
• 44 to 78% of patients (depending on age and region of residence) suffer from repeated attacks of lumbodynia.
• Up to 37% of people periodically lose their ability to work due to lower back pain.
• In 85% of patients who consult a doctor for 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 problems

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

1. Compression of the spinal root, peripheral nerve of the lumbar spine. This occurs due to protrusion (degenerative changes) of the intervertebral discs. Less commonly, due to dysplasia (disruptions in the formation process) of the upper articular processes of the sacrum.
2. Spinal diseases caused by tumors, joint damage, infections, compression fractures, allergic reactions, autoimmune inflammatory processes.
3. Musculoskeletal disorders resulting from 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 genital dysfunction. Most often, the main sensations are concentrated in the lower abdomen and radiate towards the sacrolumbar spine. They can appear during menstruation or after sexual intercourse.

   One possible cause of lower back pain in women is ovarian tumors, located at 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 sharply and sharply and indicate serious blood supply disorders, stretching of the peritoneum and compression of the nerve plexuses in the pelvic region.

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

2. Gastrointestinal tract disorders.

   Most often, pain is felt in the lumbar region due to gastric and duodenal ulcers and acute pancreatitis. Patients complain of belt-like pain. Usually, the lower back begins to hurt at the same time as the right/left hypochondrium, where the most intense sensations are concentrated. In a number of clinical cases, lower back 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 work associated with strain on the lower back, frequent bending and vibration.
3. Acute and chronic stress that causes muscle spasms.
4. A sedentary lifestyle and prolonged stay in an unnatural position with load on the lumbar region.
5. A weak muscular corset, which leads to poor posture, curvature, scoliosis and kyphoscoliosis.
6. Metabolic disorders and excess body weight, which increases the load on the lower spine.
7. Increased physical activity and sports participation increases the risk of injury.
8. Age over 50 years - due to the development of degenerative processes in the spine.
9. Frequent stress, depression.
10. Poor diet 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 whose symptom is pain in the lumbar region. With osteochondrosis, the intervertebral discs, which act as a shock absorber between the vertebrae, become thinner. The nerve roots are compressed, muscle spasms and severe acute pain occur. Its intensity increases when the patient bends, lifts heavy objects, or when the patient tries to sit down or get 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.

Spondylosis is a serious complication of osteochondrosis. It is characterized by almost complete destruction of intervertebral discs and the formation of sharp bony protrusions - osteophytes. They injure nearby tissues, causing sharp, intense pain that radiates to one or both legs.

Signs of intervertebral hernia

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

Ankylosing spondylitis

The disease occurs as a result of inflammatory processes in the spine. It is most often diagnosed in men aged 20 to 35. The patient feels stiffness in the lower back and discomfort in the sacrum in the morning and at rest. Little by little, during the day, this feeling disappears, the person "paces" back and forth. Many people do not pay attention to this alarming symptom, while ankylosing spondylitis leads to gradual fusion of the vertebrae, decreased mobility of the spine and disability. Therefore, you should consult a doctor at the first signs of illness - morning stiffness of the spine.

Spondyloarthrosis

This disease affects the cartilaginous tissue that covers the intervertebral discs. With age, it becomes thinner, destroyed, and bony growths form in places where the cartilage breaks. Due to the friction of the intervertebral discs 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 spasm.

Signs of spondyloarthrosis

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

Urolithiasis disease

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

Inflammation of superficial tissues and fibers

The cause of the pain may be a carbuncle or boil. These are dense purulent formations on the skin with a diameter of more than 1 cm, 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 inspiration and movement. The patient tries to lie down with his legs bent - 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 pulling and bursting nature. It is accompanied by signs of intoxication and fever.

Tuberculosis of the spine is caused by infection with Koch's bacillus. The first signs of the disease can appear several years after infection. It all starts with a deep pain that appears after exercise. The infection affects the vertebrae, hampering the patient's movements and a characteristic gait is formed.

Other diseases

Lower back pain can be a symptom of many pathologies, even 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 endocarditis.
• Myositis is inflammation and muscle pain in the lower back, which can be caused by infectious diseases such as influenza, sore throats and even common ARVI.
• Benign and malignant tumors of the spine and spinal cord.
• Renal pathologies - glomerulonephritis, renal vein thrombosis, pyelonephritis, cyst.
• Lower back pain in men occurs in cases of prostate cancer.

Why does my lower back hurt when I cough?

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

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

Diagnostic

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.
• X-ray.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 infections and inflammatory processes.
• Functional diagnosis.It includes methods for assessing nerve conduction and muscle performance - electroneurography, electromyography.
• CT and MRI.Allows a detailed examination of the condition of bone, muscular, 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 a 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 activities as soon as possible in order to prevent the formation of chronic pain syndrome. Strict immobilization is recommended for 1 to 3 days in severe cases, i. e. in case of severe pain. In case of 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 needed to resolve the problem.

Medicine

The basis of drug treatment is nonsteroidal 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 ongoing - no more than 12 weeks.

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

Non-medicated

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 better tissue nutrition.

According to doctors, physiotherapy, exercises aimed at strengthening the muscles of the lumbar region, traction therapy and transcutaneous electrical nerve stimulation have little effect. Most often, these procedures are prescribed in the absence of a pronounced effect from taking medications 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 spine and muscle stretches.
• Eat rationally, excluding fatty, fried, smoked, salty, spicy and alcoholic foods.
• Watch your own weight.
• Drink at least 1. 5 liters of fluid (preferably water) per day.
• Once every 6 months, follow a classic massage treatment.
• Avoid staying in the same 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, muscle tension, even though in reality the problem may be inflammation of the kidneys. Such treatment only aggravates the situation: a person focuses on a non-existent disease and triggers 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 discouraged.