Back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle strain combined with insufficient physical training. Rest for 2-3 days and perhaps mild painkillers might resolve the problem.

In rarer cases, the cause is more serious: slipped disc (otherwise known as a slipped disc), spondylolisthesis, fracture, or tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the legs, difficulty urinating, and so on.

Treatment of back pain begins with a detailed medical history (when the pain started, how long it lasts, where it affects, what makes it worse, etc. ), followed by a physical exam. Other parts of the body that may cause back pain similar to back pain, such as the kidneys and abdomen, should be examined.

If necessary, tests such as plain x-rays and MRIs will be ordered. Conservative treatment (rest, medications, physical therapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, injections are performed in the spinal column under local anesthesia.

Frequently asked questions about back pain

What does the middle (lumbar) spine consist of?

The spinal column in life is composed of:

1. bones (vertebrae);
2. intervertebral discs (between two adjacent vertebrae there is a disc, like a pillow);
3. joints (there are two joints at the back of each vertebra);
4. ligaments;
5. tendons;
6. muscles and finally;
7. nerves emerging from the spine (one on the right and one on the left at each level) that 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 previous question have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is stretching of the soft tissue, e. g. muscles, ligaments and tendons. So let's say the pain is "muscular".

The following paradox is also true: the image during an x-ray examination does not always correspond to the intensity of the pain. Thus, one patient may have terrible back pain due to a pulled muscle (showing nothing on a plain 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 (over 70%);
2. wear of the intervertebral discs (for example herniated disc);
3. joint damage;
4. spondylolisthesis;
5. fractures (following trauma, as well as automatically following osteoporosis or metastasis);
6. other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (e. g. ankylosing spondylitis), Scheuermann's disease;
7. causes external to the spine, for example nephrolithiasis (kidney stones), abdominal aortic aneurysm, cholecystitis.

The cause of the 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 (in addition to muscle strain) is disc herniation.

In old age, the wear and tear of the posterior elements of the spine (such as the joints) increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and fractures due to osteoporosis also begin to occur.

Can back pain be related to body weight?

Yes, the role of increased body weight in the onset of back pain is known empirically and confirmed scientifically. This may be due to the fact that an overweight person does not usually play sports and therefore has not "built" the adequate muscular system to protect the back from minor injuries. Overweight and obese people (with a body mass index greater than 25-30) are more likely to suffer from bouts of back pain.

I have back pain. Should I Stop Lifting Weights?

In the acute phase, i. e. when the pain is recent, heavy lifting should be avoided. That is, you can lift a package from the supermarket, but you cannot lift, for example, a heavy box. Once this phase has passed and the pain has disappeared, you can lift small weights, but you must learn to do it correctly, that is, bend your knees and not straighten them, as weight lifters do. Additionally, the more a person exercises their spinal muscles, the more stress their back can withstand.

In general, everyday life definitely involves weight lifting: the human body is designed to lift weights and to do heavy lifting, such as a parent lifting their child.

The situation is different for lifting weights in the gym: as a general rule, unless it is absolutely necessary (i. e. unless you are an athlete), those suffering from back problems are advised to avoid training with weights in the gym.

Can osteoporosis cause back pain?

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

What does chronic low back pain mean?

Back pain (lumbago) is classified as chronic if it persists for more than 3 months without interruption. The 3 month limit is not arbitrary: it has been observed that patients who suffer from back pain for more than 3 months have some 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 be resolved, for example a herniated disc may be "resolved" on an MRI;
3. the patient experiences the psychological impact of pain and manifests 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 persistent, prolonged stimulation of a neural pathway (i. e. the path from the site of pain to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.

Therefore, a low intensity stimulus can cause very intense pain or pain that does not match the type of stimulus, such as feeling on fire when no part of the body is heating up. Therefore, even if the anatomical cause of the pain is treated, the pain and psychological reaction may remain, as if imprinted in the brain. It is for this reason that for chronic back pain, drugs that act on the central nervous system, such as antidepressants, are prescribed (in addition to conventional painkillers).

When should you see a doctor for back pain?

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

What are the next steps?

The doctor examining you will take a complete medical history and examine you. Then, if necessary, tests such as plain x-rays, CT or MRI will be performed.

Should I undergo an x-ray if I have back pain?

NO. Approximately 70% of cases of back pain are caused by a simple muscle strain, and in these cases no visit is necessary.

What if an x-ray or MRI shows something?

This is very, very common: someone does a back exam and discovers an x-ray finding such as a herniated disc, osteophytes, etc. But that's what the word says: an x-ray finding. This means that the disk has been corrupted at some point in time. But the test doesn't tell us when this injury occurred, i. e. recently or long ago, so it doesn't show us that the back pain is currently caused by this particular herniated disc. Furthermore, many "degenerative changes" occur in all people, regardless of whether they experience pain or not. Therefore, when making a diagnosis, you cannot be guided only by the results of an x-ray examination.

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

What is a more specific test for back pain: plain x-ray, CT scan, or MRI?

There is no single answer to this question. Each test has indications and each test has disadvantages:

1. conventional radiographyit is a very quick and simple test that costs very little. But it only shows the bones. This means that a fracture, scoliosis or kyphosis or spondylolisthesis is clearly visible, but the intervertebral discs and nerves are not visible.
2. CT scanit lasts a few minutes and has an average cost, but at the same time it has a high dose of radiation. It represents all the elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and discs.
3. magnetic resonance imagingIt takes a long time, for example 20 minutes, and is an uncomfortable exam for those who suffer from claustrophobia. The cost is high, but there is no radiation. This is the most detailed exam we have and maps all the structures of the spine, especially the nerves. It is somewhat free of defects, especially the small ones. In any case, the doctor, after examining you, will select and recommend a suitable test.

How is back pain usually treated?

• in most cases rest and some simple home care measures such as "hot and cold" and lumbar protection (belt);
• Some drugs can be used to relieve pain, such as analgesics, non-steroidal anti-inflammatories, etc. ;
• Often a visit to the physiotherapist helps, especially if done in a certain way and for specific indications;
• alternative forms of treatment such as acupuncture, yoga and pilates can provide significant benefits to individual patients;
• Spinal injections may also sometimes be used.
• In relatively rare cases, the above (conservative) treatment is ineffective and surgery is required.

Does rest mean I have to stay in bed?

Only for 2-3 days and only in case of emergency. Studies have shown that staying in bed for more than 2-3 days aggravates rather than cures back pain. It is generally recommended to walk as much as possible.

If a person cannot get out of bed despite conservative treatment due to unbearable pain, this usually indicates a serious problem and should be seen by a doctor.

Should you use heat or cold to relieve back pain?

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

• heat (heat) causes muscle relaxation, i. e. it relaxes muscles contracted by pain and increases blood circulation. You can use a cloth heated on a radiator or take a warm (not hot) bath.
• cold prevents pain fibers from transmitting pain (for example, athletes apply coolant while playing football). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). An easy alternative: a bag of veggies from the freezer.

What medications can you take for back pain?

Medications that may be used to treat back pain include:

1. Primarily 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 start with it.
2. Nonsteroidal anti-inflammatory drugs (there are several classes). More powerful painkillers, but when taken chronically they have many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
3. Glucocorticosteroids- a powerful and effective painkiller, but with a large number of side effects when used chronically and with no clearly demonstrated benefits for back pain.
4. Opioids, e. g. morphine-type drugs. Usually given intravenously or intramuscularly in a hospital, but some oral medications are also available.
5. Antiepileptic drugs or antidepressants, mainly for chronic pain, but also for some acute conditions.

Important!

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

How can a physical therapist help me with back pain?

The role of the physiotherapist is very important in the treatment of back pain. The most appropriate solution is an initial program lasting several days, after which the patient can learn to perform the necessary exercises on his own. Severe pain is initially treated so that the patient can walk (i. e. is not bedridden), and when the pain decreases, 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. exercises for trunk stabilization and proprioception, which "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. McKenzie mechanical diagnosis and therapy;
7. retraining, i. e. learning to stand, sit, lift weights, etc. correctly.

If you suffer from back pain, should you first consult a physical therapist or doctor?

Physiotherapy is one of the methods to treat back pain. Other methods are medications, treatments, walking and finally injections and spinal surgeries. Therefore, there must be a central person who will select the methods used and evaluate the patient's progress.

It is best for a patient with back pain to consult a doctor first to rule out rare and serious causes of back pain. The doctor then refers the patient to a physiotherapist, with whom the patient should maintain contact to discuss the progress of the treatment. The final responsibility for the patient's progress rests with the doctor.

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

A simple soft swab can be used for a few days. It does not guarantee complete immobilization (rigid protections, such as those we use for fractures, do), but it limits excessive and sudden movements and thus reminds the patient of correct back posture, especially during work.

Long-term chronic use has the opposite effect of atrophy of the spinal muscles, leading to increased pain. In conclusion, it should be noted that when used for 1-2 weeks, the amulet can be useful. It is best used in conjunction with a spinal muscle strengthening program to permanently 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 this is after all other remedies (conservative treatments) have been exhausted.

What can I do during times when I don't have pain to prevent back pain?

• 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 what exercises are appropriate for other health problems, such as heart disease.
• Strengthen the muscles that support the waist area (abdominal and back muscles). Consultation with your physical therapist or physiotherapist is essential.
• Quit smoking or at least reduce the amount you smoke.
• Maintain adequate body weight, lose excess weight.
• Help your spine: learn how to lift weights, how to stand, what mattress to sleep on and how to sleep, how to sit at a desk, etc.

Which doctor should you see for back pain?

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