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 maybe mild painkillers can solve the problem.
In rare cases, the cause is more serious: a herniated disc (otherwise known as a herniated disc), spondylolisthesis, fracture or tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the leg, difficulty urinating and so on.
Back pain treatment begins with a detailed history (when the pain started, how long it lasts, where it affects, what makes it worse, etc. ), followed by a physical examination. Other areas of the body that can cause back pain similar to back pain, such as the kidneys and abdomen, should also be examined.
If necessary, tests such as plain X-rays as well as an MRI will be requested. Conservative treatment (rest, medication, physical therapy) is usually sufficient. In rare cases, special surgery is required. As an alternative, there are injections into the spine under local anesthesia.
Frequently asked questions about back pain
What does the middle (lumbar) spine consist of?
The lumbar spine consists of:
- bones (vertebrae);
- intervertebral discs (between two adjacent vertebrae there is a disc, like a pillow);
- joints (there are two joints at the back of each vertebra);
- ligaments;
- tendons;
- muscles and finally;
- nerves exiting 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 question above have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is straining of soft tissues, i. e. muscles, ligaments and tendons. Then we say that 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. So one patient may have excruciating back pain due to a muscle strain (with nothing showing 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:
- muscle tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (more than 70%);
- wear and tear of intervertebral discs (for example, disc herniation);
- joint damage;
- spondylolisthesis;
- fractures (as a result of trauma, as well as automatically as a result of osteoporosis or metastases);
- other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (eg ankylosing spondylitis), Scheuermann's disease;
- 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 strain) is a herniated disc.
In old age, wear and tear on the back 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 appear.
Could back pain be related to body weight?
Yes, the role of increased body weight in the occurrence of back pain is empirically known and scientifically confirmed. This may be due to the fact that an overweight person usually does not play sports and therefore has not "built" the appropriate muscular system to protect the back from minor injuries. People who are overweight and obese (with a body mass index greater than 25-30) more oftenexperience 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 pick up a package from the supermarket, but you are not allowed to pick up, for example, a heavy box. When this phase is over and the pain is gone, you can lift small weights, but you have to learn how to do it correctly, that is, bend your knees, not straighten them, like weightlifters do. In addition, the more a person exercises their spinal muscles, the more stress the back will be able to take.
In general, everyday life certainly involves lifting weights: the human body is designed to lift weights and to lift heavy, like a parent lifting their child.
Lifting weights in the gym is another matter: as a general rule, unless absolutely necessary (ie unless the person is an athlete), it is recommended that a person with back problems avoids weight training in the gym.
Can osteoporosis cause back pain?
Only in case of fracture. These types of fractures usually occur spontaneously (ie not caused by a fall) and the symptoms may not be as noisy as with "normal" fractures ie. pain may be minimal.
What does chronic lumbago mean?
Back pain (lumbago) is classified as chronic if it lasts longer than 3 months without interruption. The 3-month limit is not arbitrary: it has been observed that patients suffering from back pain for more than 3 months have certain characteristics that make treatment difficult:
- pain of a "strange" character, i. e. described as tingling, "electric current";
- the cause of the pain may appear to be resolved, for example, a herniated disc may "resolve" on an MRI;
- the patient experiences the psychological impact of 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 persistent and prolonged stimulation of a neural pathway (ie, the pathway from the site of pain to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.
Thus, a low-intensity stimulus may cause very intense pain or pain that does not match the type of stimulus, such as a burning sensation when there is no part of the body being heated. Therefore, even if the anatomical cause of the pain is treated, the pain and the psychological reaction may remain, as if imprinted in the brain. For this reason, drugs that affect the central nervous system, such as antidepressants (in addition to conventional painkillers), are prescribed for chronic back pain.
When should you see a doctor for back pain?
- when the pain does not go away with simple painkillers within a few days;
- when the pain occurs not only in the back, but also in the leg;
- when the leg goes numb or starts to become paralyzed;
- if the back pain persists at night, during sleep or even wakes the patient from sleep;
- if you have problems with urination, defecation and/or sexual function;
- when accompanied by fever;
- when it is caused by a fall or accident;
- when accompanied by weight loss;
- if there is a history of cancer, osteoporosis, long-term use of cortisone, intravenous drug use (eg heroin), or alcoholism.
What are the next steps?
The doctor who will examine you will take a complete medical history and examine you. Then, if necessary, tests such as plain X-rays, CT or MRI will be done.
Should I undergo an X-ray if I have back pain?
no. About 70% of back pain cases are caused by simple muscle strain and in these cases there is no need for an examination.
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 like a herniated disc, osteophytes, etc. But that's what the word says: an X-ray finding. This means that the disk was damaged at some point. But the examination does not tell us when this injury occurred, ie. recently or long ago, so it does not prove to us that the back pain is currently caused by this herniated disc. In addition, many "degenerative changes" occur in all people, regardless of whether they feel pain or not. Therefore, when establishing a diagnosis, one cannot be guided only by the results of an X-ray examination.
For the same reason, treatment (or even indication for surgery) of a spinal problem should never be suggested simply by looking at an MR image. It is appropriate to take an anamnesis and clinical examination first, and then relate the MR findings to the patient's symptoms.
Which is the more specific test for back pain: plain X-ray, CT or MRI?
There is no single answer to this question. Each test has indications and each test has disadvantages:
- conventional radiographyis a very quick and simple test that costs very little. But it only shows the bones. This means that the fracture, scoliosis or kyphosis, i. e. spondylolisthesis is clearly visible, but the intervertebral discs and nerves are not visible.
- CT scannerit takes very few minutes and has an average price, but at the same time it has a high dose of radiation. It shows all the elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and discs.
- MRIIt takes a long time, for example 20 minutes, and is an inconvenient examination for people who suffer from claustrophobia. The price is high, but there is no radiation. This is the most detailed scan we have and maps all the structures of the spine, especially the nerves. It is somewhat lacking in creases, especially the small ones. In any case, the doctor will select and recommend the appropriate test after the examination.
How is back pain usually treated?
- in most cases rest and some simple measures at home help, for example, "hot-cold" and lumbar protection (belt);
- For pain relief, you can use certain medicines, such as analgesics, non-steroidal anti-inflammatory drugs, etc. ;
- A visit to a physiotherapist often helps, especially if it is done in a certain way and for certain indications;
- alternative forms of treatment such as acupuncture, yoga and pilates can provide significant benefit to individual patients;
- Sometimes injections into the spine can also 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 2-3 days and only in urgent cases. Studies have shown that staying in bed for more than 2-3 days worsens rather than cures back pain. Walking as much as possible is generally recommended.
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 hot or cold for back pain relief?
Both methods have been tested and work, depending on the situation. The mechanism of action is different:
- hot (heat) causes muscle relaxation, i. e. relaxes muscles tight with pain and increases blood circulation. You can use a cloth heated on a radiator or take a warm bath (not hot).
- cold prevents pain fibers from conducting 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). A simple alternative: a bag of vegetables from the freezer.
What medicines can you take for back pain?
Medicines that can be used to treat back pain include:
- Mainly an anilide analgesic, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest remedy and treatment should always be started with it.
- Nonsteroidal anti-inflammatory drugs (there are several classes). Stronger pain relievers, but when taken chronically, have many side effects, such as gastritis, gastrointestinal bleeding, high blood pressure, kidney damage, bleeding, etc.
- Glucocorticosteroid- a powerful and effective pain reliever, but with a large number of side effects when used chronically and without clearly proven benefits for back pain.
- Opioids, i. e. morphine-type drugs. It is usually given intravenously or intramuscularly in a hospital, but some oral medications are also available.
- Antiepileptics or antidepressants, mainly for chronic pain, but also for some acute conditions.
Important!
All the mentioned medicines should be taken according to the recommendation of the doctor who previously examined you. It is careless and potentially dangerous to take medication on your own by listening to friends, getting ideas from the Internet, or talking to your doctor on the phone without first checking.
How can a physiotherapist help me with back pain?
The role of the physiotherapist is very important in the treatment of back pain. The most suitable is an initial program lasting a few 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. not bedridden), and once the pain subsides, exercises to strengthen the muscles and restore the spine begin. The program may include:
- immediate relief measures such as electrotherapy (eg TENS), ultrasound, diathermy, massage;
- aerobic exercise, such as walking, swimming or hydrotherapy, and in some cases even cycling;
- trunk stabilization and proprioception exercises, which "teach" the muscles to better support the spine;
- strengthening exercises, such as abdominal and back exercises (not at the beginning of the program);
- exercises to develop range of motion;
- mechanical diagnostics and McKenzie therapy;
- retraining, i. e. learn how to stand, sit, lift weights, etc.
If you have back pain, should you see a physical therapist or doctor first?
Physiotherapy is one of the methods for treating back pain. Other methods are medication, care, walking and finally injections and spinal surgery. Therefore, there must be a central person to select the methods used and assess the patient's progress.
It is best for a patient with back pain to see a doctor first to rule out rare and serious causes of back pain. The doctor then refers the patient to a physical therapist, with whom the patient should maintain contact to discuss the progress of the treatment. The ultimate responsibility for the patient's progress rests with the physician.
Should I wear a talisman (belt) for back pain?
A simple soft pad can be used for several days. It does not provide complete immobilization (hard protectors, as we use for fractures), but it limits excessive and sudden movements and thus reminds the patient's back of proper posture, especially at work.
Long-term chronic use has the opposite effect as the spinal muscles atrophy, 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 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 consult a doctor for back pain, only 5-10 will eventually require surgery, and that is after all other remedies (conservative treatments) have been exhausted.
What can I do during pain-free periods 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 okay for other health problems, such as heart disease.
- Strengthen the muscles that support the waist area (abdominal and back muscles). A consultation with your physiotherapist or physical therapist is essential.
- Quit smoking or at least reduce the amount you smoke.
- Maintain a proper 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.