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Lower back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle strain combined with inadequate physical training. Rest for two to three days and perhaps mild painkillers can solve the problem.

In rarer cases, the cause is more serious: a herniated disc (also called a herniated disc), spondylolisthesis, a fracture, or a tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the leg, difficulty urinating, etc.

Treatment for back pain begins with a detailed medical history (when the pain started, how long it lasts, where it occurs, what aggravates it, etc. ), followed by a physical examination. Other parts of the body that can cause back pain-like pain should be examined, such as the kidneys and abdomen.

If necessary, tests such as x-rays and MRIs will be requested. Conservative treatment (rest, medication, physiotherapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, there are injections into the spine under local anesthesia.

Lower back pain

Frequently asked questions about back pain

What does the middle (lumbar) spine consist of?

The spine at the waist consists of:

  1. bones (vertebrae);
  2. Intervertebral discs (between two adjacent vertebrae there is an intervertebral disc, similar to a pillow);
  3. Joints (there are two joints at the back of each vertebra);
  4. ribbons;
  5. tendons;
  6. muscles and finally;
  7. Nerves that originate from the spine (one on the right and one on the left at each level) and provide nerve stimulation to the legs.

In a broader sense, the intervertebral disc is also a type of joint.

Which of the following elements of the spine can cause back pain?

All of the anatomical elements described in the question above have sensory nerve endings, so damage to any of these elements can cause pain. The most common cause of back pain is overuse of the soft tissue, i. e. H. Muscles, ligaments and tendons. Then we say that the pain is "muscular. "

The following paradox also applies: the image in an X-ray examination does not always correspond to the intensity of the pain. For example, one patient may have terrible back pain due to a muscle strain (without showing anything on a simple X-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What can cause back pain?

The cause of back pain is:

  1. Muscle tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (more than 70%);
  2. wear and tear on the intervertebral discs (e. g. herniated disc);
  3. joint damage;
  4. spondylolisthesis;
  5. Fractures (as a result of trauma and automatically as a result of osteoporosis or metastases);
  6. other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (e. g. Bechterew's disease), Scheuermann's disease;
  7. Causes outside the spine, for example nephrolithiasis (kidney stone), abdominal aortic aneurysm, cholecystitis.

The cause of pain can vary from age to age.

Yes, the reasons change with age because the structure of the spine changes. In young people, the intervertebral disc is usually affected: the most common cause (besides muscle strains) is a herniated disc.

As we age, wear and tear on the posterior elements of the spine (e. g. joints) increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and fractures due to osteoporosis also occur.

Can back pain be related to body weight?

Yes, the role of increased body weight in the development of back pain is empirically known and scientifically confirmed. This may be because an overweight person does not normally exercise and therefore has not "built" the appropriate muscles to protect the back from minor injuries. People who are overweight and obese (with a body mass index of more than 25–30) suffer more often from back pain.

I have backache. Should I stop weightlifting?

In the acute phase, i. e. H. If the pain has recently started, heavy lifting should be avoided. This means you can lift a package from the supermarket, but you are not allowed to lift a heavy box, for example. When this phase is over and the pain goes away, you can lift small weights, but you need to learn how to do it correctly, that is, bending your knees and not straightening them, as weightlifters do. Additionally, the more a person trains their spinal muscles, the more stress their back can endure.

Everyday life does involve lifting weights: the human body is designed to lift weights and lift heavy loads, such as a parent lifting their child.

The situation is different with weightlifting in the gym: In general, people with back problems are advised to avoid strength training in the gym unless absolutely necessary (i. e. unless the person is an athlete).

Can osteoporosis cause back pain?

Only in case of a fracture. These types of fractures usually occur automatically (i. e. not caused by a fall) and the symptoms may not be as loud as "normal" fractures, i. e. pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is considered chronic if it lasts continuously for more than 3 months. The 3-month limit is not arbitrary: it has been observed that patients who suffer from back pain for more than 3 months have certain characteristics that make treatment difficult:

  1. Pain of a "strange" character, i. e. described as a burning sensation, "electric current";
  2. The cause of the pain may appear to have been resolved; for example, a herniated disc may be "fixed" on an MRI.
  3. The patient experiences the psychological effects of the pain and exhibits symptoms such as anxiety and depression.

What is the scientific explanation for this strange type of back pain?

The prevailing theory of chronic pain is that sustained and prolonged stimulation of a neural pathway (i. e. , the path from the site of pain to the brain) causes "sensitization" so that the stimulus produces an exaggerated or strange response.

A stimulus of low intensity can cause very severe pain or pain that does not correspond to the type of stimulus, e. g. B. the feeling of being on fire even though no part of the body is heating up. Even if the anatomical cause of the pain is treated, the pain and psychological response can remain as if they were imprinted in the brain. For this reason, for chronic back pain, medications that act on the central nervous system, such as antidepressants, are prescribed (in addition to traditional painkillers).

When should you see a doctor if you have back pain?

  • if the pain does not go away within a few days with simple painkillers;
  • if pain occurs not only in the back but also in the leg;
  • if the leg becomes numb or begins to paralyze;
  • if back pain persists at night or during sleep or even wakes the affected person from sleep;
  • if you have problems with urination, bowel movements and/or sexual function;
  • if accompanied by fever;
  • if it is triggered by a fall or accident;
  • if it is accompanied by weight loss;
  • if you have a history of cancer, osteoporosis, long-term cortisone use, intravenous drug use (e. g. heroin) or alcoholism.

What are the next steps?

The treating doctor will take a complete medical history and examine you. If necessary, examinations such as X-rays, CT or MRI are then carried out.

Do I have to undergo an X-ray if I have back pain?

No. About 70% of back pain cases are caused by a simple muscle strain, and in these cases no investigation is necessary.

What if an X-ray or MRI scan shows something?

This is very, very common: someone does a back exam and discovers an X-ray finding like a herniated disc, osteophytes, etc. But that's what the word says: an X-ray finding. This means that the hard drive became corrupted at some point. However, the investigation does not tell us when this injury occurred, i. e. H. So it happened recently or a long time ago, so it doesn't prove to us that the back pain is currently caused by this particular herniated disc. In addition, many "degenerative changes" occur in all people, regardless of whether they have pain or not. Therefore, when making a diagnosis, one cannot rely solely on the results of an X-ray examination.

For the same reason, treatment (or even an indication for surgery) for spinal problems should never be suggested solely by looking at an MRI image. It makes sense to first perform a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

Which is a more specific test for back pain: X-ray, CT or MRI?

There is no single answer to this question. Every test has clues and every test has disadvantages:

  1. conventional radiographyis a very quick and easy test that costs very little. But it only shows bones. This means that a fracture, scoliosis or kyphosis, or spondylolisthesis are clearly visible, but the discs and nerves are not.
  2. CT scanIt only takes a few minutes and has an average cost, but at the same time it involves a high dose of radiation. It shows all the elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and intervertebral discs.
  3. MRIThe examination takes a long time, for example 20 minutes, and is a cumbersome examination for people with claustrophobia. The cost is high, but there is no radiation. This is the most detailed exam we have and maps all structures of the spine, especially the nerves. Some creases are missing, especially small ones. In any case, after the examination, the doctor will select and recommend an appropriate test.

How is back pain usually treated?

  • In most cases, rest and some simple measures at home help, for example "heat and cold" and lumbar protection (belt);
  • To relieve pain, you can take certain medications, such as: B. Analgesics, non-steroidal anti-inflammatory drugs, etc. ;
  • A visit to a physiotherapist often helps, especially if it is carried out in a specific way and for specific indications;
  • alternative forms of treatment such as acupuncture, yoga and Pilates can provide significant benefits for individual patients;
  • Spinal injections may also sometimes be used.
  • In relatively rare cases, the above (conservative) treatment is ineffective and surgical intervention is required.

Does rest mean I have to stay in bed?

Only for 2-3 days and only in an emergency. Studies have shown that staying in bed for more than 2-3 days tends to worsen rather than cure back pain. It is generally recommended to walk as much as possible.

If a person is unable to get out of bed despite conservative treatment due to unbearable pain, this usually indicates a serious problem and should be sought out by a doctor.

Should you use heat or cold to relieve back pain?

Both methods have been tried and tested and can help depending on the situation. The mechanism of action is different:

  • hot (warmth) causes muscle relaxation, i. e. H. relaxes muscles that are tense due to pain and increases blood circulation. You can use a towel heated on the heater or take a warm (not hot) bath.
  • Cold prevents pain fibers from transmitting pain (e. g. athletes apply coolants when playing football). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). A simple alternative: a bag of vegetables from the freezer.

What medications can you take for back pain?

Medicines that can be used to treat back pain include:

  1. Mainly an analgesic from the anilide group, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest medicine and treatment should always begin with it.
  2. Nonsteroidal anti-inflammatory drugs (there are several classes). Stronger painkillers, but when taken chronically, many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticosteroid- a strong and effective painkiller, but with a variety of side effects when used chronically and with no clearly proven benefit for back pain.
  4. Opioids, i. e. H. Morphine-type drugs. Typically given intravenously or intramuscularly in the hospital, some oral medications are also available.
  5. Antiepileptics or antidepressants, especially for chronic pain, but also for some acute illnesses.

Important!

All of the above medications should be taken on the recommendation of a doctor who has previously examined you. It is reckless and potentially dangerous to take medication on your own by listening to friends, getting ideas from the Internet, or talking on the phone without first consulting your doctor.

How can a physical therapist help me with my back pain?

The role of a physical therapist is very important in treating back pain. An introductory program lasting several days is best, in which the patient can then learn to carry out the necessary exercises independently. Severe pain is initially treated so that the patient can walk (i. e. is not bedridden). When the pain subsides, exercises to strengthen the muscles and restore the spine begin. The program may include:

  1. immediate relief measures such as electrotherapy (e. g. TENS), ultrasound, diathermy, massage;
  2. Aerobic exercise such as walking, swimming or hydrotherapy and in some cases even cycling;
  3. Core stabilization and proprioception exercises that "teach" the muscles to better support the spine;
  4. Strengthening exercises such as abdominal and back exercises (not at the beginning of the program);
  5. exercises to develop range of motion;
  6. mechanical diagnosis and therapy McKenzie;
  7. retraining, i. e. H. Learning how to properly stand, sit, lift weights, etc.

If you have back pain, should you first see a physical therapist or a doctor?

Physiotherapy is one of the methods used to treat back pain. Other methods include medication, care, walks and finally injections and spinal surgery. Therefore, there must be a central person who selects the methods used and evaluates the patient's progress.

For patients with back pain, it is best to first see a doctor to rule out rare and serious causes of back pain. The doctor then refers the patient to a physiotherapist, with whom the patient should keep in touch to discuss the course of treatment. The ultimate responsibility for the patient's progress lies with the doctor.

Should I wear a talisman (belt) for back pain?

A simple soft pad can be used for a few days. It does not provide complete immobilization (rigid guards like those we use for fractures do), but it limits excessive and sudden movements, thus reminding the back patient of proper posture, especially at work.

Long-term chronic use has the opposite effect: the spinal muscles atrophy, leading to increased pain. In conclusion, it should be noted that the amulet can be useful when used for 1-2 weeks. It is best used in conjunction with a spinal muscle strengthening program to ultimately eliminate the need for protection.

How likely is it that I will need surgery for my back pain?

It's a small chance. Out of 100 patients who see a doctor for back pain, only 5-10 ultimately need surgery, and that is after all other remedies (conservative treatment options) have been exhausted.

What can I do during pain-free times to prevent back pain?

  • Do exercise regularly in consultation with your doctor. Walking and swimming are two excellent exercises that strengthen the spine. Before you start exercising, ask your doctor about exercises that might help with other health problems, such as: B. heart disease, are okay.
  • Strengthen the muscles that support the waist area (abdominal and back muscles). It is essential to consult with your physical therapist or physiotherapist.
  • Quit smoking or at least reduce the amount of smoking.
  • Maintain proper body weight and lose excess weight.
  • Help your spine: Learn to lift weights, stand, what mattress and how to sleep, how to sit at a desk, etc.

Which doctor should you go to if you have back pain?

You may want to see a doctor who specializes in spine, such as a neurosurgeon or orthopedic surgeon.