Low back pain

The lumbar spine is a complex structure of bones, joints, nerve endings, muscles and tendons that work together to provide stability, strength and flexibility to the body. The spine is relatively stable but is prone to injury and pain.

In the case of low back pain, it is important to locate the pain, diagnose it and only then take action.

Lumbar spine: what can go wrong

The sacrum holds the body upright and provides stability in movement. The muscles in this part of the spine are responsible for the proper movement of the hips when walking, as well as for supporting the spine. Nerve endings in the lumbar lobe transmit nerve impulses to the muscles of the pelvis, as well as the feet all the way to the stairs.

Most often, acute low back pain is caused by injuries to muscles, tendons and/or intervertebral discs. The body reacts to injury by initiating a recovery process, during which acute back pain can occur.

The nerve signals from most intervertebral discs, muscles and ligaments overlap considerably, so when pain occurs, it can be difficult for the brain to pinpoint the exact location of the pain medication. For example, when the fibrous ring on an intervertebral disc ruptures, there is pain accompanied by inflammation at the site . This pain may be accompanied by soreness of the muscle tissues immediately adjacent to that intervertebral disc. The affected muscles and tendons recover quickly, but the rupture of the fibrous ring cannot be repaired. In this case, the pain from both things feels like one thing and it is difficult to determine the cause.

Symptoms of low back pain

Back pain can be accompanied by a variety of symptoms. The pain can be mild and almost annoying, but it can also be sharp and debilitating. Back pain can occur suddenly and it can get progressively and gradually worse and worsen.

Depending on the root cause of the pain, the symptoms can be described in different ways. We will list the most common cases:

• Mild and dull pain in the back;
• Severe burning pain that travels from the waist to the hips and sometimes even to the feet. May be accompanied by numbness (in sciatica) ;
• Muscle spasms that cause pain in the lower back, pelvis and hips;
• Pain that gets worse when standing in one place for long periods of time;
• Difficult movements when walking or standing.

In addition, back pain has varying onset and duration.

• Acute pain. This type of pain is usually characterized by a sudden onset and can last from a few days to a few weeks. The pain is considered a normal reaction of the body to the injury. The pain gradually subsides during the healing process.
• Subacute low back pain. This pain lasts from 6 weeks to 4 months, usually due to muscle strain or joint pain. If this type of pain occurs, it is advisable to see a medical specialist. Medical examination is mandatory if the pain is severe, interferes with daily activities and disturbs a person’s sleep.
• Chronic low back pain. This is defined as low back pain that lasts for more than 3 months. It is severe pain that may not respond and disappear with initial treatment. Requires serious medical intervention and precise localization of the source of the pain.

Types of low back pain

Back pain is usually categorized into two types:

• Mechanical pain. This is also a more common type of pain. Mechanical (axial) pain occurs mainly in muscles and tendons or joints and bones that are related to the spine. This type of pain is localized to the lower back, sciatic nerve, and sometimes pain occurs in the legs. Usually the pain is affected by strain on the spine, which can be increased by moving, straightening, sitting, etc.
• Radicular (root) pain. This type of pain occurs when the roots of the spinal cord are affected or inflamed. Radical pain can travel down the sciatic nerve and down the leg. There is a sharp burning pain that may be accompanied by numbness and weakness in the limbs (sciatica). The pain usually occurs on only one side of the body.

There are other sources of lower back pain — pain can also result from infections, tumors, injuries, and more. Pain can be the result of arthritis, and it can also originate from another part of the body and irradiate the lower back.

Additionally, lower back pain can develop without any specific cause. In such cases, the main focus of treatment is the symptoms (not the cause) and the patient’s medical history.

Subacute and chronic low back pain requires examination by a specialist and is necessary to accurately diagnose the condition . In this way, an appropriate treatment and rehabilitation program for the patient can be prescribed. Treatment of low back pain reduces the likelihood of low back pain and helps prevent the onset of chronic pain.

Back pain — causes

The most common causes of mechanical pain are rooted in soft tissue damage. These can include damage to the intervertebral discs — tearing of the fibrous ring, pinched nerve roots and improper movement of the spinal joints. Caused in most cases by torn or strained muscles and/or ligaments.

When a muscle is sprained and a ligament is flexed

Stretching / tearing can occur suddenly or develop over time when performing repetitive movements.

Muscle strains and sprains occur when a muscle is stretched too far or breaks, damaging the muscle itself.

Torsions occur when the ligaments that play the role of connecting the bone/joint are overstretched and torn.

Whether it is a muscle strain or a ligament twist, the symptoms are the same in both cases and therefore the treatment prescribed is the same.

The causes of a sprain or strain can be:

• Lifting a heavy object or curvature of the spine when lifting/straightening the body;
• Sudden movements that put strain on the lower back, such as falling;
• Engaging in an inappropriate body posture over time (e.g. sitting in an office chair);
• Sports injuries, especially in sports, that involve twisting the body or using high force on impact.

If a sprain or strain doesn’t sound that serious, the pain it causes can be quite sharp and intense.

Causes of chronic low back pain

Pain is defined as chronic when it lasts for more than three months and the treatment process takes longer than expected. Chronic low back pain often involves problems with intervertebral discs, joints, and inflammation of nerve roots. The most common causes can be:

• Herniated disc in the lumbar region of the spine . When the fibrous ring ruptures on an intervertebral disc, part of the nucleus pulposus leaks and can inflame nerve endings in the immediate vicinity. The herniated part of the nucleus pulposus contains proteins that cause inflammation when they come in contact with the nerve root, accordingly, and the inflammation causes nerve root pain. The outer shell of the intervertebral disc is supplied with nerve fibers, which can cause a sudden onset of pain, sharp and intense.
• Wear and tear on the intervertebral discs. At birth, the intervertebral discs are filled with water and are at their strongest phase. Over time and with age, the discs gradually lose their hydration and wear out. For this reason, the discs are not always able to resist pressure, their stability decreases, and this leads to disc herniation. In addition, wear and tear of the intervertebral disc can also lead to spinal stenosis.
• Facet joint dysfunction. Each intervertebral disc has two facet joints that connect in the lumbar lobe of the spine. These joints have cartilage that stands between the bones and a corresponding ligament that connects the joint to the spine. The ligament is rich in nerve endings. Joint pain can be severe and acute when in direct contact with the nervous system.
• Sacroiliac dysfunction. The sacroiliac joint connects the pelvic bones and the sacral bone (respectively the spine), thus forming the lumbar girdle. This becomes a strain that comes from both the upper body and the lower body. When inflamed, the sacroiliac joint can cause soreness.
• Spinal stenosis. This is a condition in which pain is caused by narrowing of the spinal canal where the nerve roots are located.
• Spondylolisthesis. This condition occurs when a vertebra slides over a neighboring vertebra. There are 5 types of spondylolisthesis. The most common are secondary defects, fractures (between facet joints) or mechanical instability caused by joint wear and tear. Pain can also be caused by spinal instability or a pinched nerve.
• Osteoarthritis. This condition is the result of wear and tear on the intervertebral discs and veneered joints. It causes acute pain, inflammation, and a feeling of instability that can occur at one level or multiple levels in the spine. Osteoarthritis is associated with aging and progresses slowly and gradually. Also called spondylosis or degenerative joint disease.
• In the case of deformity. Spinal curvature can include scoliosis or kyphosis. A deformity can cause back pain if it causes disc or veneers to collapse.
• In trauma. Acute pain can occur when the spine is fractured or sprained. Back pain that occurs after an injury, such as a car accident or fall, requires medical and health care.
• Fracture. Spinal fractures can cause sudden pain. Fractures are caused by weaker bones — in osteoporosis, for example — and are most often seen in older people.

It is important to note that the presence of one or more of the above conditions does not necessarily mean that they cause pain. For example, osteoarthritis may not cause any pain or outward symptoms of the condition at all.

Less common causes of back pain

Although less common, low back pain can occur for the following reasons:

• Infection. The onset of infection is also called osteomyelitis. Infection of the spinal cord is rare but can cause severe pain. The infection can endanger a person’s life if left untreated. The infection can occur from surgical procedures, injections and can spread through the bloodstream. Patients with compromised immune systems are more susceptible to developing an infection in the spine.
• Tumor. Most tumors in the spine start from another part of the body and manifest as metastases to the spine. The most common tumors in the spine are due to breast, prostate, kidney, thyroid, or lung cancer. In cancer patients, symptoms associated with back pain should be considered as a possibility of metastases to the spine.
• Autoimmune disease. Back pain is a possible symptom associated with autoimmune conditions such as fibromyalgia, lupus, Crohn‘s disease, and others.

Here we list only the most common rare causes of low back pain, stating that we are not exhaustive and the list can be very long. Prescribing the right treatment for low back pain relief usually depends on accurately diagnosing the source of the pain and determining the root cause of the patient’s symptoms.

Low back pain-symptoms

Back pain can be very acute and severe with an injury or trauma, but can become chronic and long-lasting. The right approach to pain relief early on can go a long way toward reducing symptoms and preventing complications.

Common symptoms of low back pain

Proper identification and description of symptoms helps to more accurately diagnose and initiate effective treatment for low back pain.

Low back pain is usually characterized by a combination of the following symptoms:

• Dull/muffled pain. This pain may be accompanied by mild or more severe muscle spasms, limited mobility, hip and pelvic pain.ре и тазом.
• Pain that radiates from the pelvis down the leg and foot. This pain may be accompanied by burning, numbness, or stiffness. The pain travels down the sciatic nerve down the legs. This pain is associated with t. N. sciatica. Sciatica is caused by irritation of the sciatic nerve and usually symptoms are present on only one side of the bodyо.
• Pain that gets worse with stagnation in one place. Sitting puts pressure on the intervertebral discs, which can lead to increased back pain. Frequent movement can relieve the pain, but then helps bring back the symptoms.
• Pain that is soothed by changing body postures. Depending on the underlying cause of the pain, certain body postures may be more comfortable and pain relieving. For example, with spinal stenosis, normal walking can be difficult and painful, but tilting the body forward or leaning on a shopping cart can relieve pain. Depending on how symptoms vary with body position, it may help to determine the source of the pain.
• Pain that increases upon waking and subsides with movement. After waking and sleeping, the symptoms disappear. In this case, the pain is due to stiffness caused by long periods of rest and decreased blood flow during sleep. The quality of the mattress and pillows he sleeps on can also have an impact.

Here we list only the most common symptoms. There are other factors that can affect pain, including a person’s mental and emotional health, exposure to stress, and activity level.

How do the symptoms of back pain occur?

Depending on the cause of your lower back pain, the symptoms may vary. They can be:

• Pain that develops slowly over time. Symptoms are caused by repetitive movements or tense body positions. Usually the pain manifests itself slowly and gradually. It may develop after certain activities or at the end of a long and tiring day. Over time, it becomes a constant pain.
• Immediate pain from injury. Sudden movements or injuries can cause damage to the spine and the muscles around it, causing immediate and sharp pain.ю боль.
• Delayed symptoms after an injury. Sometimes symptoms develop later or worsen hours or days after an accident or injury. Delayed pain is usually seen as a side effect of the natural healing process that occurs in the muscles.

Symptoms of low back pain depending on location

The largest vertebrae in the body are located in the lumbar lobe of the spine. Their function is to keep the upper body in an upright and stable position. These vertebrae are very susceptible to wear and tear and injury, and specific pain symptoms can occur accordingly:

• L3-L4. The nerve roots of the L3 and L4 vertebrae can cause pain, numbness or stiffness in the front of the thigh. Pain may also irradiate to the front of the knee.
• L4-L5. L4 and L5 low back pain usually occurs in the buttocks and hips.х и бедрах.
• L5-S1. When the base of the spine connects to the sacroiliac bone, there are several joints that provide support and flexibility at the joint. The lumbosacral joint allows the hips to rotate from side to side, and the sacroiliac joint (which has limited mobility) is responsible for absorbing the tension created by the upper body.

Pain occurring in the segment from L5 to S1 usually signals problems with these joints. In addition, pain can occur when a nerve root in this area is pinched. Problems in this segment often lead to sciatica.

Different nerve endings can be irritated depending on which part of the spine is injured.

Symptoms that require immediate medical attention

In some cases, lower back pain indicates a serious condition that requires immediate medical attention. We will list the symptoms you may want to visit as soon as possible:

• Loss of control when defecating;
• Weight loss that is not related to diet or exercise;
• Chills;
• Severe abdominal pain.

People with back pain who have been involved in an accident (such as a car accident) are advised to see a doctor. If low back pain interferes with daily activities or disrupts normal sleep, medical attention should also be sought.

Chronic low back pain is usually associated with other symptoms. Most people with chronic low back pain complain of symptoms such as difficulty falling asleep, insomnia, anxiety, irritability and depression.

Low back pain — diagnosis

A correct diagnosis that determines the cause of low back pain and does more than just report symptoms is important in prescribing a treatment program for the patient.

In order to make an accurate diagnosis, the patient must be given a detailed description of the symptoms as well as their medical history. From this information, the specialist gets a general idea of what the pain may be like.

Patient history

Prior to the exam, the patient should provide information about their pain symptoms and their medical history to date. The doctor’s questions usually include:

• Information about current symptoms. Does the pain worsen or decrease at certain parts of the day, such as in the morning after waking up or in the evening after work. How widespread is the pain and are there other symptoms such as weakness or numbness? What does the pain feel like — is it sharp and intense, dull and weak, or hot/burning?
• Activity level. Is there a more active or sedentary lifestyle? Do you work at a desk? How often do you exercise?
• Activity level. Is there a more active or sedentary lifestyle? Do you work at a desk? How often do you exercise?
• Body posture. What body position soothes pain? Do you feel better upright or lying down?
• Injuries. Have you been injured soon? Do you have an old injury that may affect your current condition?

The answers to these questions give the doctor a better understanding of the patient’s daily life and help him or her diagnose the problem from which the pain is coming.

Physical examination

The goal of the review is to eliminate and reduce possible sources of pain. Physical examination for low back pain includes the following steps:

• Palpation. Using this method of examination, using light pressure with the hands on the surface of the body, the waist is checked to see if there are muscle cramps, tightness or other abnormalities.
• Neurologic examination. It includes checking hip, knee, and leg movement and folding behavior (forward and backward motion), as well as ankle motion. It may also include checking the senses for light bumping or knocking. или стука.
• Range of body movement. Check when assuming certain positions to find out in which position the pain is worse and whether there are movements in which the pain limits the person and causes discomfort.
• Reflex test. The patient’s reflexes should be tested to determine if they have weakened and muscle strength has decreased. If so, the nerve endings may not be responding normally.
• Leg Raise Test. The patient is in a supine position and must lift the leg as high as possible. If this test causes back pain, the patient may be suffering from a herniated disc.

The doctor is usually able to diagnose the source of the problem based on the history and physical examination. Further tests can help confirm the diagnosis.

Additional diagnostic tests

Additional tests are performed to gather detailed information about the source of low back pain. They become necessary if the patient does not feel relief after treatment and if the pain is chronic and lasts for more than a few months.

Research typically includes:

• Radiograph. X-rays help you see the current condition of your spine. X-rays show spinal distortions, fractures, breaks and more.
• CT scan and myelogram. A CT scan allows you to see a cross-sectional view of the spine. A CT scan creates a three-dimensional image based on the x-ray images taken. This enhanced image allows doctors to look at the spine from different angles. Sometimes a myelogram is also done — this study gives greater clarity to the image of the bone marrow.
• MRI. Nuclear magnetic resonance provides a detailed image of the spine without exposing the patient to x-rays.

Sometimes doctors quickly identify the cause of low back pain, but cannot pinpoint its exact location. The above tests help to properly assess and prescribe treatment.

Treatment of low back pain — initial stage

There are many different treatments for low back pain. Before a treatment program is prescribed, it should be fully tailored to the patient’s individual symptoms and needs, as well as their medical history. A treatment program may include pain medication, therapy, and homework.

Depending on the patient’s diagnosis, some treatment programs may be more effective than others.

Treatment of back pain at home

Home remedies can have a beneficial effect on both mild pain and severe and acute pain. Self-care is performed solely by the patient and may include:

• Short periods of rest. Back pain usually goes away when a person relaxes for a moment and dies away from daily activities. However, a long break of several days is not recommended because immobilization can impede the healing process.
• Activity modification. An option for pain relief is to adopt a healthy body posture that does not put undue strain on the waist. After standing at a desk for more than an hour, it is advisable to take short breaks every 20 minutes in which you can get up from the chair and take a few steps. Avoiding postures that put stress on the spine helps relieve pain faster.
• Applying ice or heat to the sore spot. Warming up with a hot bath, filling the area with a hot water bottle, and more. methods help in relaxing the muscles and improving blood circulation. Increased blood flow helps in supplying essential oxygen and nutrients to the affected area. If the inflamed area is sore and red, you can place an ice pack in it to reduce swelling. You can also alternate between cooling and heating the area, as this helps to move blood and restore the body’s natural flexibility and movement.
• Medications that do not require a prescription. Anti-inflammatory medicines to help relieve pain.

The personal care at home that we described above does not require medical attention, but should be used with caution. If a person is not sure whether to adopt a particular method or start taking painkillers, it is better to consult a doctor first.

Exercises to relieve lower back pain

Exercise is usually a mandatory part of a patient’s therapy and rehabilitation. Exercises for low back pain include:

• Stretching. Stretching exercises and muscle movement in the waist, hips and legs are extremely important. The lower back muscles support the upper body. The more nimble they are, the better the movement of the spine without the risk of narrowing or stiffness. In the beginning, it is recommended to start with fewer exercises, 20-30 seconds and rest if the stretching causes pain.
• Body Strengthening Exercises. Training the abdominal and pelvic muscles around the spine helps to significantly relieve back pain. There are two types of muscle strengthening programs:
  • The Mackenzie Method helps move the spine by building muscle mass. This reduces pain caused by a herniated disc or pinched nerve.
  • Dynamic muscle stabilization in the lumbar spine — supports the patient’s natural spinal posture, providing comfort and pain relief.
• Low Impact Aerobics. Low impact exercises help blood circulation and healing in the sore area after an injury without causing additional irritation to the waist area. Low impact aerobics includes fitness exercises as well as water therapy. For lower back pain, aerobics can help reduce the frequency of periods of severe pain.

The brunette bends her leg while escorting her

Any exercise that improves your heart rate over a long period of time is good for your body. Regular physical activity is important for maintaining flexibility and mobility of a healthy spine. When you are stagnant in one place and there is no movement, the chances of stiffness and discomfort in the lower back increase.

Low back pain — non-surgical treatment

Non-surgical treatment aims to reduce the sensation of pain, but it may not address the underlying source of pain. A doctor usually prescribes treatment in conjunction with a therapy program or exercises at home.

Treatment may include:

• Taking myorelaxants. These drugs act on the central nervous system as a depressant and help increase the mobility of tense and stiff muscles. It relieves pain from muscle spasms. However, myorelaxants cannot help with chronic low back pain.
• Drugs that contain a narcotic substance. Opiates or painkillers with a narcotic component alter the sensation of pain by weakening the signals that the affected area sends to the brain. These medications are taken when there is severe acute pain, such as after surgery. These drugs are rarely prescribed for long-term low back pain because they have many side effects and are addictive.
• Lumbar Corset. A corset can help with proper spinal posture and provide comfort. When combined with appropriate therapy, a corset can help not only relieve pain but also speed up the healing process.
• Epidural injections with steroids. These injections involve a steroid that is injected directly at the source of pain. They can only temporarily relieve pain by reducing inflammation around the nerve roots.

Non-surgical treatments are always used in combination with other methods. For example, steroid injections temporarily relieve pain so that the patient can continue physical therapy.

Alternative therapies

Alternative therapies may support the medical therapy prescribed by your doctor. They can be:

• Chiropractic care — chiropractic care is increasingly helping to restore proper spinal posture. This in turn improves a person’s mobility and reduces stiffness, pain and discomfort. Chiropractic care involves moving the spine with massage movements of varying strengths and speeds.
• Acupuncture — stimulates certain points in the body to improve the body’s vitality. Acupuncture therapy is believed to reduce pain and discomfort in the muscles of the body. During the treatment, thin needles are placed on the skin for about an hourрно на час.
• Back massage — can greatly relieve muscle spasms that cause back pain. Massage also increases blood flow to the back and thus speeds up the healing process by delivering oxygen and nutrients to injured musclesцам.
• Meditation — can help reduce feelings of pain. Meditation can help reduce anxiety, depression, and sleep problems.

The methods listed here do not exhaust the list of alternative treatments. This may also include some more or less invasive methods through surgery.

Back pain: operative methods of treatment

Surgical treatments for back pain are used in more severe cases where there is chronic pain and non-surgical treatments have failed after a course of treatment of 6 to 12 weeks. Surgical treatments are optional and are almost always undertaken at the patient’s request.

Factors to consider before waist surgery:

• Function for normal activities. If the patient can perform daily activities with controlled levels of pain and if the pain does not interfere with sleep, surgical intervention is not recommended. Surgical intervention is recommended if the patient is unable to maintain their normal daily activities.
• Recovery process after surgery. Before surgery, consideration should be given to what the recovery process will be like as a period of time and whether it will affect the patient more favorably or unfavorably than nonsurgical treatment.
• Type of surgery. Some surgical procedures are much more invasive than others and require a longer recovery period as well as a period of hospitalization. With medical advances and improvements in surgical procedures, it is now possible to perform a very large number of manipulations on an outpatient basis and have a shorter recovery period.
• Mental Health Research shows that a patient’s good emotional state helps speed recovery after surgery. Understanding how a patient may react after surgery can greatly aid the recovery process.

Spinal neurosurgery is generally not recommended for patients with mild to moderate low back pain or pain that resolves in less than 6-12 weeks. In addition, surgery is not used in patients in whom the source of localized pain is not localized.

Operative decompression procedures

Decompression procedures help to remove the pinched nerve root in the spine. There are two types of decompression procedures for low back pain:

• Microdiscectomy — A minimally invasive procedure for patients with herniated discs in the lumbar spine that cause leg pain (sciatica);
• A laminectomy is an invasive procedure that removes part of the top layer of bone or soft tissue that is pinching a nerve. It is usually performed in patients with acute leg pain or spinal stenosis.

Surgical decompression techniques can be performed using minimally invasive methods — with relatively small incisions and causing minimal patient discomfort. They usually do not require a lengthy recovery process and the patient quickly returns to their normal daily activities.

Operative techniques for vertebral fusion in the lumbar spine

Surgical methods for fusing two adjacent vertebrae involve removing the soft tissue between two or more intervertebral discs, replacing the artificial part. This procedure allows the bones to grow over time — usually 6 to 12 months — eventually fusing into one long bone. This stabilizes movement in the spine.

In the lumbar spine, fusion can occur in several different ways. Modern techniques help simplify the procedure and heal the patient faster.

This procedure is applicable to patients with a spinal fracture, deformity, disc wear, or spinal stenosis. For low back pain caused by sacroiliac joint dysfunction, this procedure can also help. For infections and tumors, the procedure is also an option.

Other operating procedures

There are other less common treatments for low back pain:

• Placing an artificial disc in the lumbar region. In some patients, disc replacement is an appropriate option because inserting an artificial part in place of an intervertebral disc affected by a herniated disc helps maintain the natural height of the spine. The procedure may evolve and benefit more sick patients.
• Implantation of a motion device. These devices are an alternative to spinal fusion. The goal of this approach is to improve outcomes with a faster recovery process and less invasive surgery.

These are just some of the latest surgical treatments for low back pain that are still under development and have yet to be perfected.

Postoperative process after surgery

The recovery period after surgery for low back pain depends on a number of factors, including the patient’s overall condition prior to surgery, its complexity, and the surgeon’s skill and experience.

For example:

• Performing a microdiscectomy for a herniated disc in the lumbar region is considered minimally invasive. The patient is usually hospitalized for one day and the overall recovery period lasts up to a week.
• The procedure to fuse two vertebrae includes a one-day hospitalization and a full recovery process over the next 3-12 months.

Physical therapy is usually prescribed to restore strength, range of motion, and stimulate postoperative recovery. Patients are prescribed more painkillers and myorelaxants, and some patients use a corset and supportive pillows to make the process easier.

After surgery, patients should take a short period of rest while the spine recovers from the procedure. It is usually necessary to interrupt the work regimen, usually a few weeks to a few months, to avoid overloading the spinal structures.

The cost of treatment and diagnosis of low back pain in German clinics from 350 Euros.

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