Lower back pain

There are many diseases that manifest as painful sensations in the lumbar region. They can indicate problems with the spine, joints, muscles, internal organs - kidneys, intestines, liver. This is a rather insidious symptom, and without visiting a doctor it is impossible to determine the real cause of pain in the lumbar region. Correct treatment is possible only after diagnosis in a medical institution.

Types of pain

During the initial examination, the doctor must ask the patient about the nature of the pain. By duration they can be:

• sharp- appear suddenly, paroxysmal, vary in intensity, last less than 1 month;
• subacute- they last 2-3 months, they are most often repeated: they become active for 2-5 days, then subside and return after some time;
• chronically- last more than 1 year, the course is usually repeated.

Doctors have determined that chronic pain in this area is most often associated with the occurrence of local muscle spasms, tightness that has 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:

• lumbodia- pain in the lumbar or lumbosacral region;
• sciatica- in the lower back, radiating to the leg;
• sacralgia- in the area of the sacrum;
• coccidinia- in the coccyx.

5 facts about lower back pain

• About 25% of all visits to clinics with complaints of back pain refer to sensations in the lumbar region.
• According to research, 84% of people have experienced pain in the lumbar region at least once in their life.
• 44–78% of patients (depending on age and region of residence) experience repeated attacks of lumbonia.
• Up to 37% of people periodically lose their ability to work due to low back pain.
• In 85% of patients who turn to a doctor for pain in the lumbar region, musculoskeletal disorders are observed that become the cause of the 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 disorders

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

1. Compression of the spinal root, peripheral nerve in the lumbar spine. It is caused by protrusion (degenerative changes) of the intervertebral discs. Less often, due to dysplasia (disorder in the process of formation) of the upper articular processes of the sacrum.
2. Diseases of the spine caused by tumors, joint damage, infections, compression fractures, allergic reactions, autoimmune inflammatory processes.
3. Disorders of the musculoskeletal system as a result of subluxation, stretching 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.

   Pain in the lower back in women may indicate dysfunction of the genital organs. Most often, the main sensations are concentrated in the lower abdomen and radiate to the sacrolumbar spine. They can appear during menstruation or after sexual intercourse.

   One of the possible causes of lower back pain in women are ovarian tumors, which are located on 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 strongly and acutely and indicate serious disturbances in the blood supply, stretching of the peritoneum and compression of the nerve plexuses in the pelvic area.

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

2. Disorders of the gastrointestinal tract.

   Most often, pain is felt in the lumbar region due to stomach and duodenal ulcers and acute pancreatitis. Patients complain that there is pain of a dangerous nature. Usually the lower back starts to hurt at the same time as the right/left hypochondrium, where the most intense sensations are concentrated. In a number of clinical cases, lumbar pain accompanies an attack of acute appendicitis, although they are not the main symptoms of this disease. Pain can also be caused by various inflammations of the intestinal mucosa (proctitis, sigmoiditis).

10 risk factors for lower back pain

1. Congenital pathologies of the lumbosacral spine.
2. Heavy physical work associated with stress on the lower back, frequent bending and vibration.
3. Acute and chronic stress that causes muscle spasms.
4. Sedentary lifestyle and prolonged stay in an unnatural position with load on the lumbar part.
5. Weak muscle corset, resulting in improper posture, slouching, scoliosis and kyphoscoliosis.
6. Metabolic disorders and excess body weight, which increases the load on the lower part of the spine.
7. Increased physical activity and playing sports increase 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 vitamin B deficiency.

Pain in the lower back 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. In osteochondrosis, the intervertebral discs, which play the role of cushioning between the vertebrae, become thinner. Nerve roots are compressed, muscles spasm and severe acute pain occurs. The intensity increases when bending, lifting heavy objects, or when the patient tries to sit up from a lying position or get up from a sitting position.

In advanced cases, a hernia is formed between the vertebrae, which only increases the pain. Osteochondrosis most often affects the lumbar spine, because it bears the maximum load when sitting and walking.

A severe complication of osteochondrosis is spondylosis. It is characterized by the almost complete destruction of the intervertebral discs and the formation of sharp bony protrusions - osteophytes. They damage nearby tissues, causing sharp, severe pain that spreads to one or both legs.

Signs of intervertebral hernia

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

Ankylosing spondylitis

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

Spondyloarthrosis

This disease affects the cartilaginous tissue that covers the intervertebral discs. With aging, it thins, destroys, and bony growths form in places where cartilage breaks. Due to the fact that the intervertebral discs rub against each other, the nerve roots are irritated - this process is accompanied by severe pain in the lower back. The muscles in the problem area of the back are constantly tense and cramping.

Signs of spondyloarthrosis

• The pain becomes more intense after exercise and disappears after rest.
• The pain occurs after standing or walking for a long time.
• At the same time as the lumbar 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. Usually painful sensations arise from an inflamed kidney. It is difficult for the patient to find a position in which he feels better. After the attack, the urine becomes reddish in color and the volume decreases.

Inflammation in the superficial tissues and fibers

The cause of the pain may be a carbuncle or an ulcer. These are purulent dense formations on the skin with a diameter of more than 1 cm. They are easy to spot by their purple color. Painful sensations are sharp, intense, pulsating.

Paranephritis, inflammation of the perinephric tissue caused by infection, is also painful. Sensations become stronger during inhalation and movement. The patient tries to lie down with his legs tucked in - in that position the pain is less pronounced. The skin on 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 increased pain of a pulling, shooting nature. It is combined with signs of intoxication and fever.

Spinal tuberculosis is caused by infection with Koch's bacillus. The first signs of the disease may appear many years after infection. It all starts with a deep pain that occurs after exercise. The infection affects the vertebrae, hindering the patient's movements and a characteristic gait is formed.

Other diseases

Lumbar pain can be a symptom of numerous pathologies, including quite exotic ones. These include, for example, foot-and-mouth disease, Ebola, hemorrhagic fevers and Japanese mosquito-borne encephalitis.

• Cardiovascular diseases - aneurysm of the abdominal aorta, Loeffler's endocarditis.
• Myositis is inflammation and pain in the muscles in the lower back, which can be caused by infectious diseases such as flu, sore throat, and even common ARVI.
• Benign and malignant neoplasms of the spine and spinal cord.
• Renal pathologies - glomerulonephritis, renal vein thrombosis, pyelonephritis, cyst.
• Lower back pain in men occurs with prostate cancer.

Why does my lower back hurt when I cough?

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

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

Diagnostics

As mentioned above, pain in the sacrolumbar region can be a symptom of many diseases. Therefore, in order to identify the objective causes, you should consult a doctor at the first signs. You can make an appointment with an orthopedist, neurologist or surgeon. In the future, you may need to consult a rheumatologist, urologist or gastroenterologist.

• Initial review.The doctor assesses tissue sensitivity, muscle function and reflexes in the affected area.
• Radiography.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 infection and inflammatory processes.
• Functional diagnostics.It includes methods for assessing nerve conduction and muscle performance - electroneurography, electromyography.
• CT and MRI.It enables a detailed examination of the state of bone, muscle, nerve and vascular structures.
• Ultrasoundit is carried out if pathology of the pelvic organs, prostate or kidneys is suspected.

It is important to rule out (or confirm the presence of) a tumor, distinguish between spinal root compression and musculoskeletal pain syndrome. 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 about strict bed rest. On the contrary, patients are advised to return to normal activities as soon as possible to prevent the onset of chronic pain syndrome. Strict immobilization is recommended for 1-3 days in severe cases, i. e. severe pain. For acute lower back pain, you can use a fixation belt. However, long-term lumbar fixation is not recommended unless there is trauma or spondylolisthesis. You must gradually include special exercises to strengthen the spine and muscles.

Treatment of lower back pain

Most often, a combination of medical and non-medical means is required to solve the problem.

Medicines

The basis of drug therapy is non-steroidal anti-inflammatory drugs (NSAIDs). They affect the peripheral mechanisms of pain and are prescribed for the worsening of pain syndromes. In most clinical cases, treatment is carried out in courses - no longer than 12 weeks.

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

Non-drug

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 improved tissue nutrition.

According to doctors, physical therapy, exercises to strengthen the muscles of the lumbar region, traction therapy and transcutaneous electrical stimulation have little effect. Most often, these procedures are prescribed in the absence of a pronounced effect from taking drugs for 4-6 weeks. There is no scientific evidence on the effectiveness of massage, physiotherapy or wearing various belts.

What to do for prevention

• In the morning, do exercises with simple stretching exercises for the spine and muscles.
• Eat rationally, excluding fatty, fried, smoked, salty, spicy and alcohol.
• Watch your own weight.
• Drink at least 1. 5 liters of liquid (preferably water) a day.
• Once every 6 months, take a classic massage course.
• Avoid staying in one position for long periods of 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 strain, although the problem may actually be kidney inflammation. Such treatment only worsens the situation - a person concentrates on a non-existent disease and causes serious pathology. That is why it is important to seek qualified help and identify the real cause of the pain. It is strictly not recommended to self-prescribe drugs.