There is practically no one who at least once in his life would not experience back pain in the lumbar region. This is how we pay for straight walking and our daily habits.
In addition to the damage that can affect the spine, its muscles, nerves and ligaments, it should be borne in mind that the back sometimes hurts in the lumbar region with internal diseases - diseases of the kidneys, gastrointestinal tractand female genitalia.
Low back pain symptoms can range from dull to sharp. The pain may go away on its own or become chronic (the symptom has been present for more than three months).
Dangerous! You should see a doctor immediately if:
- pain in the lumbar region appeared sharply after an obvious injury to the back;
- the temperature has risen sharply, there are vegetative disorders, loss of consciousness, sweating, difficulty breathing;
- involuntary emptying of the bowels and bladder occurs;
- there is numbness in the groin area;
- there was weakness of the lower extremities, their paresis or paralysis, impaired sensitivity;
- pains are given in the stomach and increase sharply when coughing or sneezing;
- symptoms appeared against the background of a sharp weight loss, prolonged use of steroids, immunodeficiency;
- in the family history there were cases of cancer, inflammatory or degenerative diseases of bone and cartilage tissue.
Why does the back hurt in the lumbar region?
Myofascial pain
Muscle tension or spasm can develop gradually or come on suddenly. With a high load, the damage affects not only the muscle fibers, but also the ligament apparatus and fascia.
Muscle pain in the lower back appears after:
- lifting heavy weights or overexerting yourself at work or playing sports;
- play sports from time to time. Muscles are especially vulnerable if you're inactive during the work week and then spend hours in the gym on weekends.
- a sharp increase in the weight of one's own body, behind which the muscles do not have time to grow;
- prolonged sitting or standing in an uncomfortable position;
- daily carrying of a bag in one hand or over the shoulder;
- postural disorders. The spine performs its best supportive and protective function when you are not slouched. The lower back muscles experience the least stress when you are seated with good support under your lower back and, when standing, distribute the weight evenly over both legs.
If the back hurts after a bruise, fracture, sprain, hypothermia, infectious disease or established helminthic invasion, myositis (inflammation) of the muscles of the lower back can be suspected. Severe pain is constantly present due to inflammation of muscle fibers, "nodules" are felt in the muscles - places of spasm. Inflammation can be acute or take a chronic form. With a long course of the disease, the pain is unstable, aggravated by prolonged lying or sitting, in the late afternoon or when the weather changes. Touching the muscles causes a feeling of pain and discomfort, the muscles of the lower back are in constant tension, inflammatory edema is formed, the temperature rises locally and at the level of the whole organism.
With muscle spasms, the roots of the spinal nerves are affected, so the attacks often look like a picture of sciatica or sciatica - there are intense, burning pains in the back of the thigh and lower leg, the limbs become numb, they lose their sensitivity. Pronounced muscle tone in myositis forces the patient to take a forced position, he walks and lies bent over, moves on bent legs.
How to treat muscle pain in the spine? Nonsteroidal anti-inflammatory drugs and painkillers are used to eliminate inflammation and pain. Medicines can be taken in the form of tablets, ointments, injections, transdermal patches with the gradual release of active substances. Irritating and warming ointments are also used, which reflexively increase blood flow to the muscles of the lower back. A larger volume of incoming blood contributes to the washing out of the products of inflammation and tissue breakdown.
The reduction of inflammatory edema is facilitated by injections of corticosteroids and vasoconstrictor drugs.
If the cause of myositis is an infection or poisoning of the body with worm toxins, antibiotics or anthelmintics are initially used. In this case, warming ointments or compresses cannot be used.
Spinal diseases involving nerve endings
In the lumbar region, the vertebrae are separated by elastic cartilaginous discs, which protect the spine from injury, but are themselves subject to wear and aging.
Normally, the disc is a pulpy, jelly-like nucleus surrounded by a denser layer of the annulus fibrosus. The elasticity of the core is due to its capacity to bind and retain water: when the load increases, it accumulates water, and the elasticity increases, when the pressure decreases, the core releases water andbecomes flatter.
Osteochondrosis in the vertebral region develops when the intervertebral discs are poorly nourished (their "drying out") or with an excessive local load. Most often, lower back pain is due to the fact that the lower poles of his intervertebral discs bear the greatest load when sitting, when lifting weights in front of them. At the same time, tears, displacements are formed in the discs, spinal ligaments are damaged, there is constant pain, pulsation.
Pain in the spine has several mechanisms of development:
- violation of microcirculation in the tissues surrounding the spine and, in particular, in the spinal canal, the formation of congestion and edema. Such conditions develop against the background of hypothermia, overheating, inflammatory processes.
- degenerative processes in the attachment ligaments of the spine. An increase in the mobility of the vertebrae leads to their slight displacement and non-physiological compression, which causes damage to the nerves, blood vessels and the formation of hernias.
- axial compression of the vertebrae when lifting weights or their damage during excessive rotation (turn).
- aseptic inflammation. The destruction of the nucleus leads to the release of sensitizing factors in the spinal canal. There is irritation of the nerve endings, which causes the muscles that impinge on the neighboring vertebrae to spasm - above and below the hernia. Gradually, the reaction covers the entire lumbar region and leads to the fact that any movement causes a feeling of pain.
A weakened disc can rupture, causing the core to bulge, protrude or prolapse, and possibly herniate. The appearance of a hernia puts pressure on the spinal cord and spinal nerve roots. In such conditions, a shooting pain in the lower back suddenly appears, which diverges along the strangulated nerve. The most well-known cases of compression of the sciatic nerve (sciatica), which is manifested by sharp pain along the back of the thigh and lower leg, numbness in the limb on the side of the hernia, muscle weakness, an involuntary folding of the legs.
Pain in the lumbar spine is aggravated when sitting and standing, when turning, tilting. Often there is a protective muscle reaction - a painful contraction of the muscles (roll formation) on both sides of the spine, which isolates the department from unnecessary movements. Osteochondrosis then leads to the appearance of sciatica (inflammation of the roots of the spinal nerves).
Radicular syndrome is dangerous when the nerves of the lower back, responsible for the innervation of the internal organs (horns of the cauda equina), are pinched. At the same time, the stomach hurts, the function of the bladder and intestines is disturbed, there are problems with potency in men and gynecological diseases in women.
Many patients, due to the fact that the lower back hurts badly, take pain-relieving postures - they deviate the body to the left, if the right side hurts, lie on the right side. If the hernia is on the left. Also characteristic is the appearance of severe pain when pressing on a hernia in the intervertebral space (ringing symptom).
How to treat if your back hurts with osteochondrosis:
- during an attack of pain, you can take an anesthetic pose - lie on your back and place a roller under your knees. It is also recommended to sleep on a hard surface;
- among analgesics, NSAIDs can be taken orally or in injections on both sides of the spine in the lumbar hotel;
- using local irritants as distraction therapy - mustard dressings, iodine net, pepper patch and ointments;
- eliminate miotic spasms through manual therapy, acupuncture, vacuum massage, reflexology, gymnastics;
- during the attenuation of the acute period, treatment with mud, ozocerite, warming up can be used.
Treatment for pain in radicular syndrome includes:
- provide bed rest, lumbar traction (dry or underwater);
- use of novocaine blockades at the site of offense, use of NSAIDs or weak opiates;
- physiotherapy - microcurrent stimulation, electrophoresis with painkillers.
Indications for surgery are constant sharp pain, as well as impaired function of internal organs, development of paralysis of the limbs, sequestration of a hernia in the spinal canal.
Degenerative inflammatory lesions
Spondylarthrosis (inflammation of the articular facets of the vertebrae) occurs with degeneration, a decrease in the height and volume of the intervertebral discs. Pain in the lower back appears due to overstretching of the capsule and increasing pressure on the surface of the intervertebral joints. The pain causes the patient to bend more in the lower back, increasing the overload of the intervertebral joints. Discomfort in the lower back is especially aggravated by wearing shoes with heels, prolonged walking, descending elephants, positions when the body deviates backwards, for example when looking at something abovethe head.
In patients with this diagnosis, stiffness in the lower back is noted in the morning, pain increases during the day or after exercise. It has a diffuse character and it is difficult to clearly show its limits: the discomfort is determined at the level of the gluteal muscles, the inguinal region, the lower abdomen and the scrotum in men. This spondylarthrosis is distinguished from radicular syndrome, where the origin of the pain can be identified.
What to do to relieve the pain? It is usually useful to take a lying position, bending the legs at the hip and knee joints.
Their medications are to be preferred non-steroidal anti-inflammatory drugs and non-narcotic analgesics.
Muscle relaxants are also added as they relieve muscle tension and improve spinal mobility.
Psychotherapy has a positive effect, because chronic pain introduces the patient into a depressive state.
Spondylosis, unlike osteochondrosis, affects more of the fibrous ring of the intervertebral disc and the anterior longitudinal ligaments. With this disease, calcification of connective tissue structures occurs with the formation of growths along the edge of the vertebrae - osteophytes. These formations cause a violation of microcirculation near the nerve roots and lead to the fact that the back hurts in the lower back, and the mobility of this department is also limited.
Vertebral osteophytes are pathological growths that damage nerves and blood vessels.
Treatment is usually conservative, with the use of anti-inflammatories, analgesics, vitamins. A good effect is given by electrophoresis with novocaine, lidase, manual therapy, physiotherapy (amplipulse, laser installation, shock wave therapy to destroy compacted elements and increase the mobility of the spine).
To note! In the advanced stage, the osteophytes do not disappear. Although their size is small, the treatment is aimed at eliminating inflammation, pain and improving metabolism. If the back does not hurt badly, nothing is done with the growths. If the osteophytes cause persistent pain or are large, they can be removed during surgery.
Tumor-like diseases
Low back pain can arise from compression of the spinal cord by a tumor from the outside (extramedullary formations) and from the inside (intramedullary, originating from the cerebrospinal substance itself).
Cells of various tissues can grow pathologically:
- fatty - a lipoma is formed;
- nerve roots - neuroma;
- spinal cord vessels - hemangioma;
- auxiliary tissue - glioma;
- bone tissue - osteosarcoma;
- cartilage - chondrosarcoma.
The tumor process, especially malignant, is characterized by a pain syndrome resembling sciatica (it can be unilateral and bilateral), a general deterioration in the patient's condition and exhaustion.
If the pathology affects the area of the I-IV lumbar vertebrae, then there is a burning pain in the front and sides of the upper thigh, incomplete paralysis of this area.
With a lesion in the region of the IV - II sacral lumbar segments, numbness of the paragenital region, impaired motor and sensory innervation of the gluteal muscles, posterior incontinence of the thigh, calf, fecal and urinary are noted.
A pronounced disturbance in the functioning of the pelvic organs occurs with a neoplasm in the region of the V-III sacral vertebrae. The patient suffers from sexual impotence or menstrual disorders, constipation or fecal and urinary incontinence.
The treatment of tumors is specific, painkillers and anti-cancer drugs are prescription drugs.
As you can see, low back pain is usually caused by musculoskeletal pathologies. They can be diagnosed by clinical signs and research data, the main task of which is to correctly determine the nature of the disease and not to confuse it with oncological causes, diseases of internal organs or trauma. If you experience lower back pain, we recommend that you always seek the advice of a neurologist or orthopedist.