Lumbar pain

lumbar pain

Pain in the lumbar region is familiar to every person, few of those who have not experienced it. Sometimes sitting for a long time to cause back pain. According to statistics, 60-90% of people experience pain in the lumbar region. Lower back pain is second only to acute respiratory illness and is a common cause of temporary disability.

In 80% of the pain in the lumbar region is associated with pathology of the spine, the remaining 20% are associated with concomitant diseases of the internal organs. Low back pain can be an innocent functional disorder that disappears without a trace, or it can indicate serious problems with the spine or internal organs. Therefore, it is important to consult a doctor in time, diagnose the problem and avoid serious complications.

Causes of pain in the lumbar region

The causes of pain in the lumbar region are manifold. They can be primary, associated with the pathology of the spinal column and secondary, associated with diseases of the internal organs. Together with the reasons, it is necessary to take into account the predisposing factors that can provoke or intensify the pain syndrome. These factors include:

  • Features of professional activity (heavy physical activity, for example, loaders, construction workers or athletes who lift weights, etc. ).
  • Prolonged sitting, especially daily.
  • Sedentary lifestyle.
  • Overweight.
  • Unbalanced nutrition (lack of calcium, phosphorus, protein, vitamins in the body).
  • Bad habits - the use of alcoholic beverages and alcohol.

By reducing or eliminating the above-described factors affecting the body, this is already a huge step towards improving the overall health and condition of the spine, and as a result, the elimination or reduction of back pain.

Having dealt with the predisposing factors, let's go directly to the causes of pain in the lumbar region.

The primary causative factors of back pain are associated with degenerative-dystrophic processes in the spine, these include:

  1. Osteochondrosis - degenerative-dystrophic changes in the intervertebral discs and cartilage, which leads to deformation of the discs and the occurrence of a hernia.
  2. Spondylosis is a degenerative process in which the formation of bone growths on the vertebrae occurs (i. e. , the growth of bone tissue), as a compensatory response to excessive stress. The overgrowth of bone tissue leads to spasm of the muscles around the spine, restricts its mobility, possibly injury to the radicular nerves in the lumbosacral and the spinal cord membranes.
  3. Spondyloarthrosis is a progressive degeneration of the articular surface of the lumbosacral vertebrae with the involvement of ligaments, muscles, an articular capsule in the pathological process and the growth of marginal osteophytes. This process leads to deformation of the intervertebral discs, the joint space decreases, the mobility of the spine is limited, there is pain and muscle tension around the spine. Spinal roots may be compressed over time.
  4. Spondylolisthesis is characterized by the displacement of the vertebrae relative to each other, as a result of which the lumen of the spinal canal changes, the spinal roots are injured.
  5. Herniated discs.

Secondary causal factors arising from concomitant pathology in the body include:

  1. Metabolic disorders, lack of micro- and macroelements in the body, as a result of which the bone skeleton changes (for example, osteomalacia, osteoporosis, hemochromatosis, alkaptonuria).
  2. Curvature of the spinal column (lordosis, kyphosis, scoliosis).
  3. Malignant neoplasm located near the spinal column or its metastasis to the spine. Metastases to the vertebrae or epidurals. Lymphogranulomatosis, lymphoma, or multiple myeloma.
  4. Infectious diseases: Epiduritis (spinal epidural abscess). Spondylitis (spinal osteomyelitis). Sweat's disease (tuberculous spondylitis). Purulent discitis.
  5. Spinal column injuries (eg, vertebral fractures).
  6. Autoimmune diseases: Rheumatoid arthritis. Reiter's syndrome (simultaneous damage to the joints, urinary system and conjunctiva of the eyes). Ankylosing spondylitis (ankylosing spondylitis).
  7. Back pain of a psychogenic nature (mental disorders), as well as after a stroke.
  8. Diseases of the gastrointestinal tract (eg, intestinal obstruction, appendicitis).
  9. Specific and nonspecific diseases of the pelvic organs (renal colic, ovarian inflammation, venereal diseases).
  10. Low back pain during physiological processes in women (during menstruation and pregnancy).

How does lumbar pain manifest?

How does lumbar pain manifest, you ask? Differently. Low back pain can be, depending on the degree of its severity:

  • Sharp, shooting character, strong enough, sudden (lumbago).
  • Chronic, lasting more than three months. Such pain is often dull, aching in nature (lumbodynia or lumboishalgia).

In addition, pain in the lumbar region can take on a recurrent course and from time to time make itself felt.

The occurrence of back pain is associated with pinching of the nerve roots, spasm, swelling and irritation of the muscles, ligaments, vertebrae and intervertebral discs of the lumbosacral region.

Lower back pain can be:

  • Mechanical, which usually occurs or increases in the afternoon, after physical exertion, and decreases or disappears after rest. The occurrence of such pain is due to degenerative-dystrophic or functional disorders of the structures of the back. It is noted in middle-aged people or the elderly.
  • Inflammatory - arises or intensifies in the morning, decreases when performing physical activity and when taking non-steroidal anti-inflammatory drugs, morning stiffness is characteristic. This pain is caused by inflammatory spondylopathies. The onset of the disease is noted at a young age.

Depending on which structures are damaged, the following types of pain in the lumbar region are distinguished:

  1. Local (local) pain in the lumbar region. It occurs as a result of damage and irritation of the structures of the lumbar region (joints, musculoskeletal system, ligaments). This pain is clearly localized, constant in nature, usually not severe. It may vary depending on the position of the body.
  2. Reflex (reflected) pain in the lumbar region. Pain that radiates to the lumbar spine due to diseases of the internal organs (organs of the small pelvis and abdominal cavity). This pain can radiate to the buttocks and thighs. Such pain is deep, pulling and aching, does not go away at rest. Pain that occurs due to damage to the sacrum. It can radiate to the groin area and the area of the buttocks, thighs, up to the feet. The pain is prolonged, dull, diffuse.
  3. Radicular pain in the lumbar region. It occurs due to irritation of the roots of the spinal nerves. Radicular pain in intensity is stronger than reflex pain and radiates from the spine to the periphery. Such pain is located in the area of innervation of the spinal root and can radiate to the lower extremities to the toes. Coughing, sneezing, or other exertion increases radicular pain.
  4. Muscle pain (fibromyalgia) is pain caused by a protective muscle spasm. It occurs most often and occurs in many diseases of the spine. Prolonged, chronic muscle tension causes aching, sometimes cramping pain.

Dull and aching pain in the lumbar region

Dull and aching pain in the lumbar region can be a manifestation of a wide variety of diseases of the spine and internal organs (osteochondrosis, intervertebral hernias, infections, tumors, etc. ). Pains of this nature appear, as a rule, gradually. But depending on the severity of the pathological process, dull and aching pain can progress and transform into acute. More often, dull and aching pain in the lumbar region occurs in women during menstruation, during pregnancy and with infections of the genitourinary system (for example, pyelonephritis). To correctly determine the causative factor of dull pain in the lumbar region, you need to seek help from a specialist who will conduct differential diagnostics and prescribe optimal therapy.

Acute back pain in the lumbar region

Acute pain in the lumbar region occurs suddenly, rather excruciating and brings severe discomfort, significantly limits motor activity. It can occur as a result of sudden movements - turns of the body, bends, lifting weights, a sharp rise from a sitting position. Acute pain in the lumbar region may indicate serious diseases of the spine or internal organs. Acute lower back pain can be caused by:

  • spinal injury (such as a fracture)
  • sharp stretching of the back muscles,
  • displacement of intervertebral discs,
  • intervertebral hernia of the lumbar spine,
  • arthrosis of the intervertebral joints (facet syndrome),
  • arthrosis of the hip joints (coxarthrosis),
  • epiduritis,
  • infections of the genitourinary system.

In the case of acute pain in the lumbar region, it is necessary to rest in bed (take the most comfortable position in which the pain is least noticeable) and call a doctor. It is better not to self-medicate, becausethis can lead to serious complications, including disability.

Diagnostics of the back pain in the lumbar region

Diagnosis of pain in the lumbar region is carried out by a neurologist, vertebrologist and is based on the following activities.

  1. Collecting anamnesis (medical history) by a doctor. The causal and predisposing factors (possible injuries, concomitant diseases, features of professional activity, etc. ) are clarified.
  2. Examination (including palpation), which assesses the general condition, orthopedic and neurological status (assess the mobility of the lower back, sensitivity in the lumbar region, etc. ).
  3. Additional examination methods: X-ray of the lumbosacral spine, computed tomography of the spine (the condition of the vertebrae, intervertebral discs, soft tissues, blood vessels, etc. is assessed), magnetic resonance imaging of the spine; pathways of the spinal cord - a contrast agent is injected into the spinal canal, an X-ray is taken and thus its patency is determined, which can be impaired due to tumors, hernias, stenoses), bone scintigraphy (radionuclide study), is prescribed in case of uninformativeness of previous methods of X-ray examination. It can be used to identify tumors, arthritis, etc. general clinical studies (general blood and urine analysis, biochemical blood test)
  4. Consultation of narrow specialists (if necessary): surgeon, orthopedist, urologist or nephrologist, gynecologist, infectious disease specialist, proctologist, cardiologist, gastroenterologist, oncologist.

Treatment of back pain in the lumbar region

Treatment of pain in the lumbar region depends on the cause of its occurrence, on the severity of the process and, as a rule, conservative (surgical treatment is possible).

  1. Elimination of the cause that caused back pain (treatment of concomitant diseases, osteochondrosis, hernias, etc. ).
  2. Bed rest, the bed must be firm (usually a shield is placed under the mattress).
  3. A balanced diet with a sufficient amount of vitamins, protein, micro- and macronutrients (especially calcium and phosphorus).
  4. Symptomatic therapy: non-steroidal anti-inflammatory drugs effectively eliminate inflammation and pain, it is possible to use analgesics, the use of muscle relaxants that reduce muscle spasm and tension, prescribe B vitamins (improve metabolic processes in the cell) and vitamin C (strengthen blood vessels and increase immunity), use localappointments (ointments, gels or compresses). Compresses with pain relievers and warming drugs, antiviral drugs and immunomodulators.
  5. The use of drugs that reduce degenerative - dystrophic processes in the bone and cartilage tissue.
  6. Perhaps the appointment of therapeutic blockades - the introduction of painkillers in the place where the pain is most pronounced, the so-called trigger points (most often an epidural blockade is performed with the introduction of an analgesic into the epidural space of the spine). A blockade is possible with the combined use of pain relievers and a corticosteroid drug.
  7. Physiotherapy treatment: electrophoresis using calcium, etc. Phonophoresis (use of ultrasound) - improves and accelerates the healing process, has anti-inflammatory and analgesic effects, reduces swelling. Muscle electrical stimulation (relaxes muscles, improves the lymph and blood circulation of the muscles around the spine), amplipulse therapy (has an analgesic and vascular-trophic effect), paraffin therapy (restores and improves neuromuscular conduction, metabolic processes, improves lymph and blood circulation), reflexology (acupuncture, electroacupuncture, laser therapy), balneotherapy (the use of sulfide, radon, sodium baths, etc. ), mud therapy (the use of mud applications of low temperatures).
  8. Therapeutic gymnastics begins with minimal exertion and under the strict supervision of a physician. It is carried out after the removal of acute pain.
  9. Therapeutic massage (strengthens the back muscles and helps to stabilize the spine), performed exclusively by a specialist, after an acute period.
  10. It is recommended to wear corsets, half-corsets, bandages, elastic belts, reclinators. With their help, the treatment and prevention of back pain is carried out. they restrict range of motion, relieve pain and muscle spasm.
  11. With the ineffectiveness of conservative methods and the progression of the process, accompanied by dysfunction of internal organs, increased compression of the spinal cord and / or its roots, the issue of surgical treatment is considered (for example, removal of an intervertebral hernia).
  12. In folk medicine, for the treatment of back pain, the following are used: horseradish compresses, ointments based on iodine, lemon, birch oil are rubbed in, rubbing with black radish and honey is carried out.

The complex of therapeutic measures is selected individually by the doctor for each case, depending on the cause of pain in the lumbar region, clinical symptoms, the severity of the process, concomitant diseases and age.

Prevention of lower back pain

Prevention of pain in the lumbar region consists in carrying out simple measures.

  1. Identification and treatment of concomitant pathology that can lead to back pain (various infections, tumors).
  2. A balanced diet with a sufficient content of micro- and macroelements (especially calcium and phosphorus), protein, vitamins.
  3. Avoid heavy physical exertion, heavy lifting. Distribute the load evenly over the body. Do not make sudden movements if possible.
  4. Lead an active lifestyle (go in for sports - swimming, walking, remedial gymnastics).
  5. Carry out a therapeutic massage.
  6. If professional activity is associated with a long stay in a sitting position, then you need to take a break every hour (walk, do a little exercise).
  7. Comfortable bed with an orthopedic mattress.
  8. For the prevention of pain in the lumbar region, it is recommended to wear bandages, corsets, posture correctors, an elastic belt (especially when performing heavy physical exertion, bandages, belts are also recommended for pregnant women).
  9. Keep track of your weight, becausebeing overweight increases stress on the spine.
  10. Eliminate bad habits - smoking alcohol.
  11. Every year, undergo a preventive examination of the whole body.