Low Back Pain

The posterior area of our body that we know as the lower back, or the lower back of the spine, is a very active area of our body, in which there is a great concentration of muscles, bones, nerves, and ligaments.
In this article, we will see some possible causes of lower back pain, its symptoms, and possible treatment.

This central area of our body, and presents a lot of activity, since it supports the weight of the upper body and makes movements such as twisting and twisting, movements that we do daily in our daily life even when we sleep.

In addition to this, also the muscles concentrated in the lumbar area are responsible for hip movements, such as flexing and turning when we perform movement activities such as walking or running.
For its part, the nerves present in this area are responsible for the sensations and the force of movement of the pelvis and legs.

Low back pain is generated from injuries to muscles, ligaments, joints or nerves in the area.
In some cases, it is particularly difficult to identify the cause of pain for a patient, since the high concentration of different muscles, nerves, and joints can cause a pain to be related to a cause other than the real one.
For example, a degenerated lumbar disc can be perceived in a manner very similar to a pulled muscle. However, while pain from a muscle pull can be of rapid relief and healing, a tear or degeneration in a lumbar disc can be a lasting pain.

Low back pain description

Low back pain can present some variables. It can be mild pain and simply have an annoying presence, or it can be a very high pain and really weaken the patient and their quality of life.
In addition, it may be a pain that starts suddenly for brief periods of time and then disappears, or it may be a pain that is recurring and increasing in intensity and gradually worsening.

The type of back pain can be defined or presented in three ways:

  • Acute pain: usually this type of pain corresponds to a normal response of the body due to damage or injury, and it decreases as time passes and the body heals. It usually lasts a few days or weeks at the most.
  • Subacute pain: Subacute pain usually corresponds to a response by the body to mechanical damage, such as distension in the muscles or pain in the joints. It usually lasts a long period of 6 weeks to 3 months.
    It is recommended to perform medical studies, especially if the pain limits the performance of daily activities such as sleep or work.
  • Chronic pain: chronic back and lower back pain are usually intense, for cycles longer than 3 months and that prevents most activities of daily life. It requires extensive medical studies to determine the cause and treat it.

We can also separate or categorize in two ways by the type of pain:

  • Root pain: radicular pain occurs when there is inflammation or damage to the root of a spinal nerve. It presents a sensation of acute, electrifying and burning pain. It may be related to numbness or weakness of the sciatic nerve and usually presents on only one side of the body.
  • Mechanical pain: is cataloged as the cause or type of pain most common in this area. It mainly affects the muscles, joints, ligaments or bones of the area.
    It is caused due to the load presented in the spine, or certain movements related to physical activities, like sprains, twists, among others.

There are also other classifications of lumbar pain, depending on different possible conditions or causes. It is even possible that back pain does not present a definitive cause that develops it, in some cases.

When this pain is subacute and chronic, it must be treated in a medical way to be able to know the cause and carry out a treatment that allows the patient not to be greatly affected to carry out the activities of his daily life, since These kinds of pain can be very harmful.

Low back pain: Causes

The causes of back pain can be many and varied. Low back pain is commonly caused due to soft tissue injuries in the area, injuries such as damage to the spinal joints due to improper movements, compression of the vertebral discs or nerve roots, among others.

The tear or pull of a muscle, or ligament, are the most common causes of pain in the lower back.

Muscle or ligament sprain

In the case of a low back sprain, it can occur at any time due to a bad movement, or it may appear gradually and grow due to repetitive movements.

Distension occurs when the muscle is stretched too far, exceeding what it can support, while the sprain occurs when the ligaments are damaged due to excessive stretching of the bone joints.
Whether it is the muscle or the ligament that is damaged, in this case, there is no practical difference in terms of pain symptoms and treatment.

The most common causes for this type of injury are due to sudden movements or unusual force that loads the area, for example, lifting heavy objects. They can also occur as a result of poor permanent posture or sports injuries due to blows, impacts or forced movements.

Although these lesions mostly do not present a high level of seriousness or risk and are recoverable, the acute pain present can be quite high and general discomfort in daily life.

Causes of chronic low back pain

When pain lasts more than 3 months or exceeds the normal average recovery time of the body, it is considered chronic pain.
When the same is in the lower back, it is usually caused due to a problem in the vertebral discs, joint problems or irritation of the nerves in the area.

Common causes of chronic low back pain:

  • Degenerative disc disease: When we are born, the intervertebral discs are filled with water inside and in optimal conditions. As time goes by and the person gets elder, the discs lose their hydration and wear out. This can lead to the fact that due to the lack of resistance, tears can occur or weaken the disc wall, which can cause a herniated disc. This can also contribute to suffering from the stenosis.
  • Lumbar disc herniation: A lumbar disc has a gelatinous center. In a herniated lumbar disc, this gelatinous center crosses the outer layer and can irritate and cause inflammation in the nerve roots of the area, which in turn causes intense pain.
  • Osteoarthritis: Osteoarthritis is the condition due to the wear of the vertebral discs and joints in the area. It results in pain, inflammation and possible variable stenosis, which can occur at one level of the spine or in several. It is a slowly progressive disease that is associated with aging.
  • Spinal stenosis: Spinal stenosis is the pain caused due to the narrowing of the spinal canal where the nerve roots and endings are located. It presents great pain and can be classified into multiple levels.
  • Spondylolisthesis: This condition occurs when a vertebra slides on an adjacent one, causing great pain. It can occur in up to 5 variants, although the most common are those caused due to an accident or fracture, or a degenerative disease.
  • Compression fracture: This disease is caused due to a fracture produced in the cylindrical vertebra, in which the bone sinks on it, causing great sudden pain. This condition is more common in older people with fragile bones or due to osteoporosis.
  • Dysfunction of the sacroiliac joint: The sacroiliac joint is the one that joins the sacrum, located in the lower part of the spine, with both sides of the pelvis. This joint is strong and is responsible for absorbing the shock and tension of both the upper body as well as the lower part.
    The pain in this joint is caused due to inflammation or too much/little movement of it.
  • Trauma: The damages caused after a trauma, such as a car accident or a strong fall, can present problems that in turn lead to chronic conditions due to possible fractures, fissures or dislocations in the lumbar area.
  • Deformity: Some of the ailments are caused due to the curvature of the spine, such as scoliosis or kyphosis. In turn, the deformity may lead to pain related to the rupture of the vertebral discomfort or joint pain.

Low back pain: Symptoms

Due to injury or trauma, back pain may start as a sharp or temporary pain. However, later that pain can be transformed into chronic or recurrent pain.
For this reason, it is important to investigate the symptoms and the possible cause of the pain, in order to obtain adequate treatment.

To correctly identify the symptoms of pain, can be of great help when choosing an adequate treatment and proportional to the cause of the problem.

Some of the common symptoms of lower back problems are the following:

  • Dull pain: Called axial pain, is the one that remains in the lower back is described as a dull, instead of burning or sharp pain. In addition, it is often accompanied by spasms of different levels, from mild to high, and produce discomfort in the hip or pelvic area that sometimes prevent or limit mobility.
  • The pain of position: Sometimes, a certain pain can be felt by staying in a certain position. Depending on the cause of it, sometimes it may diminish or even disappear when changing position, for example when leaning forward, or when lying on your back.
    The cause of the pain can be identified according to the positions where we do not feel it.
  • Pain to get up: Many of the people who suffer back pain assure that it is worse in the morning hours when they are just beginning the daily activities or getting up. Then it decreases and eases with the movement.
    This may be due to factors such as staying in the same position for extended periods of time while in the sleep stage and blood flow that decreases at this stage. In addition, the quality of the elements for rest, such as mattresses and pillows, can influence it.
  • The pain of quietness due to sitting: When we sit down, the discs of the vertebrae are pressed, which causes the back pain to get worse after sitting for prolonged periods of time. Performing movement activities such as walking or stretching can make the discomfort better, but sitting down will make it come back again.
  • Pain in the lower extremities (sciatica pain): Occasionally, back pain can present a sharp, intense pain or sensation of tingling in the lower extremities, such as the legs or feet. It is commonly called sciatica pain because it is just caused by irritation of the sciatic nerve. It is usually felt only on one side of the body.

Of course, depending on the person, the way to experience pain and intensity may vary. There are many psychological, physical and even economic factors that can sometimes influence the way in which different individuals experience the same condition.

Depending on the cause of back pain, sometimes this can occur in different ways in terms of time. For example, some pains develop as time passes, especially when some movements or actions are performed repetitively that gradually damage a certain lumbar area.

In other cases, there are pains that appear after an injury or accident and do not necessarily appear immediately afterward, since there may be a delayed healing process in the muscles of the affected area.

Sometimes lower back pain can bring some serious ailments, and we should consult a medical professional as soon as possible. These cases refer to:

  • Loss of bowel and bladder control
  • Weight loss without recent changes in diet or physical activity
  • Fever and chills
  • Severe pain in the abdomen
  • Sleeping problems
  • States of anxiety

Low back pain: Diagnosis and treatments

If we present problems or difficulties in our daily life due to low back pain, it is necessary that we contact a medical professional or go to a clinical center where they can make a diagnosis.

To be able to carry out an accurate diagnosis by a professional, you can have the exact cause of the pain identified, in order to obtain a specific and appropriate treatment.

General History Diagnosis

A professional could obtain a general idea of the patient’s condition from the following information:

  • Clinical history: If the patient has presented previous related problems, if he has had operations or accidents that may have caused this problem later, among other data.
  • Current symptoms: Is the pain more intense during the day or at night? Is it more intense in the mornings? Does it interfere with daily activities such as work? , description of pain: dull, sharp, strong, hot, throbbing, other symptoms such as weakness or numbness together with pain.
  • Patient’s lifestyle: If it is a person who performs a physical activity or regular exercise, or if their work requires physical effort or is a sedentary job.
  • Sleeping habits: Sleep hours, posture at rest time, mattress/pillow quality.
  • Posture: If the patient has a normal or stooped posture. Postures in your daily life.
  • Injuries: If the patient has had any recent injury or trauma, or if he has had an accident in the past that may be related.

Concerning the answers to these questions is very important to be able to guide the professional in being able to establish an idea of the patient’s routine and its history, in order to identify possible causes for the condition from their daily life.

Physical Diagnosis

A medical professional can perform certain exams or physical tests with the patient to be able to establish more accurately the affected area, the intensity or the possible cause.

Usually, the physical exams that will be performed are some of the following:

  • Mobility test: The patient may be asked to slightly perform certain movements to the point of pain, in order to examine which movements or postures intensify or relieve pain.
  • Palpation: The doctor can feel the painful areas with the hand, in order to establish, according to the patient’s indications, the exact areas of pain or tension, the areas of sensitivity and possible joint abnormalities.
  • Leg lift: The patient is asked to lie on his back and can lift one leg as high and straight as possible. If the back pain intensifies, it is possible that it is due to a herniated disc.
  • Reflex test: Sometimes tests of the reflexes of the patients are carried out in order to establish whether they are weakened or diminished. If this is so, it is possible that there is damage to some nerve root located in the lower back that affects the reflexes of the legs and muscle strength.
  • Neurological examination: The doctor can perform certain physical tests to see the patient’s reaction to certain situations such as a puncture or contact senses in the lower extremities and hip. It also involves the realization of hip movements, legs, and upper extremities.

With these exams and reviews, added to the previous general historical diagnostic test, a medical professional will be able to identify the possible cause of the problem and the exact area where it develops realizing without further tests.

Imaging Tests

In certain cases, the doctor may request imaging tests that are done to the patient to determine their condition or the affected area. These are the cases in which the person presents very severe pain or does not recover after two or three months of non-surgical treatment.

Some of these imaging tests are the following:

  • X-rays: X-rays are used to examine the structure of the spinal cord. With them, you can find problems such as arthritis, fractures, fissures, bone spurs, and even tumors.
  • Magnetic Resonance: An MRI allows to obtain a detailed image of the structure of the spine without using the level of radiation required for x-rays. With it, abnormalities can be detected in the soft tissues of the spine, as well as in the muscles, ligaments and intervertebral discs. It also allows locating anomalies in the structure or excessive growth in some areas.
  • Computed tomography: Performing a CT scan allows doctors to obtain an image of a cross section of the spine and obtain a reproduction of it in 3D digital format, which helps to see the structure of the spine more easily. precise. Sometimes, along with the tomography, a myelogram can be performed, in which dye is injected around the nerve roots in a way that highlights the structure of the spine in the computerized view.
  • Injection studies: These studies are performed by fluoroscopy-directed injections of local anaesthesia and steroid medications. They are used to confirm the source of pain accurately and are also used for rehabilitation and diagnosis.

Occasionally, doctors already have the knowledge of the cause of low back pain, however, they do not know for sure where it is being generated, so it is possible that they ask for these methods of image tests in order to locate the source in a specific way.

They are also used for patients who must undergo surgery, so professionals can plan the performance of it in advance.

Self-Care Treatments

Depending on the patient’s situation, some methods or treatments can be taken to reduce back pain. There are treatments that can be performed from home and performed by the same person, in conjunction with certain medication prescribed by a doctor.

Self-care from home can be effective for mild or acute low back pain, or in the reduction of chronic disease. They usually involve methods that are easily performed by the patient, as well as accessible medication.

Some of the methods are:

  • Periods of rest: In many cases, lumbar pain can be improved with periods of rest and avoiding strenuous activities. Rest periods should not be very long, they are recommended only for a few days since otherwise a period of excessive inactivity can make the situation worse.
  • Over-the-counter medications: Over-the-counter medications are easily accessible to any type of user anywhere in the world. Among these medicines, those that serve to alleviate pain are for example aspirin, ibuprofen, naproxen or paracetamol.
    Some of these medications work by reducing inflammation in muscles or nerves present in the lumbar area, while other medications such as those containing acetaminophen work by interfering with nerve signals of pain that are sent to the brain.
  • Modification of activity: Depending on what the pain reawakens or diminishes, it is possible to temporarily adapt our lifestyle for the reduction of these tasks or the modification of them, in order to carry out a more efficient treatment. For example, if the pain becomes greater when sitting for long periods of time, rest intervals can be established with brief periods to stretch the legs and walk, or in case it intensifies when standing, it is possible to try to avoid activities that require stay in that position.
  • Cold/heat treatment: The application of heat in an area is used to increase the blood flow and provide oxygen to the muscles of the area, while the application of cold reduces swelling/inflammation of the area.
    We can use both methods to try to alleviate the area before and after the development of physical or daily activity. Apply heat to the muscles to relax the muscles of the area and allow greater mobility and flexibility before movements, and then apply cold to reduce inflammation in the area and reduce irritation in the area.
    It must be protected against direct contact with the skin in both application methods.

Non-Surgical Treatments

The goal of the following treatments is based on pain reduction, however, they may or may not cure it. Generally, a doctor will recommend one of the following treatments along with proper medication.

  • Pain medication: Narcotic pain medications, such as analgesics or opioids, are used for the specific purpose of reducing the sensation of pain in acute pain situations after an accident or operation. These act by blocking the nerve signals of pain that are sent to the central nervous system to reduce the painful sensation caused by the condition. It is difficult to use this type of medication in case of chronic pain since the body can generate resistance or even addiction.
  • Muscle relaxants: Medicines of this type act by relieving muscle tension, increasing the mobility of muscles and reducing spasms. This type of relaxants are not usually indicated for chronic conditions.
  • Orthopedic braces: Some people find that there are certain types of orthopedic braces that can relieve pain during the day by correcting the posture of the spine on a daily basis. This, in combination with rehabilitation therapies, can improve considerably and speed up the treatment. Some patients usually use this method after spinal or hip operations.
  • Injections of steroids: These injections are made by means of fluoroscopy, which is a type of live radiography, which makes it possible to indicate with greater accuracy the area where the needle must be injected correctly. A type of steroid is applied in the area surrounding the spinal cord, allowing rapid temporary relief by reducing inflammation in the compressed nerve area.

These non-surgical medical treatments are performed in parallel with an alternative treatment, in order to reduce pain in the short term and progress in physical therapy.

As alternative treatments, we refer to methods different from the traditional doctor, however, they are not less effective.

Some people find the following treatments helpful in relieving pain:

  • Massage therapy: Massage applied to the lower back can be very helpful in relieving muscle spasms in the affected area. Massages also contribute to increased blood flow, which speeds healing by providing more oxygen and nutrients to the muscle area.
  • Chiropractic: A specialist or certified chiropractor can make adjustments manually in our column, by using physical techniques in combination with certain types of massage. You can find chiropractic very effective to improve mobility, reduce stiffness and pain.
  • Meditation: Meditation can be done in addition to a form of physical therapy. With it, you can reduce the level of stress, anxiety and even reduce the sensation of pain for the suffering of it in everyday life. You can also face rest problems, caused by the suffering of chronic lumbar diseases.
  • Acupuncture: Acupuncture is a method that is based on ancient Chinese medicine, and aims to stimulate certain areas of the body by inserting very thin needles in these areas of the body and correct what is called “qi”, or force vital of the body. With an adequate qi, it is established that it is possible to reduce the pain and discomfort of a physical condition. It has been shown in several people that the use of this technique has been useful.

Surgery for Low Back Pain

Usually, you can consider operating a case of low back pain when the same cannot be relieved after a period of between 6 to 12 weeks under a regime of medical and physical treatment.

It is usually the patient’s decision to undergo surgery and there are very few cases in which an immediate surgical procedure is performed for this condition.

There are several factors to take into account before an intervention of this kind. It is analyzed if the patient’s lifestyle can be affected by the healing and rest process that must be performed after the surgery. The factor of hospitalization necessary for the patient is also analyzed, depending on the type of surgery to be performed and its corresponding healing process.

In the same way, the mental state of the person is analyzed, since it is proven that a positive attitude on the part of the patient can make the healing process after an operation easier to cope with, less painful and less extensive.

It is not recommended to operate when a patient does not really have a very high pain or an inability to continue with a lifestyle within normal parameters. It is also not recommended to operate when the exact cause of the problem can not be diagnosed, so in this case, the patient will be subjected to more frequent and exhaustive controls until the cause is found.
Back problems operations are not an option if the cause of the condition is not found through imaging studies.

Decompression surgeries

A decompression surgery is performed in order to eliminate everything that can cause pressure on a nerve root of the spine, which may be caused by a portion of a herniated disc or a bone spur.

There are two procedures for this:

  1. It can be done by means of a microdiscectomy, a minimally invasive procedure for the patient suffering from a lumbar hernia that causes pain in the leg due to the sciatic nerve.
  2. The other procedure is called laminectomy and consists of removing a part of the bone or soft tissue layer that is found by compressing a nerve or several nerve roots. It is performed mostly in those patients who suffer from spinal stenosis due to changes in the facet joints, discs or bone spurs.

Currently, decompression surgery can be carried out through a minimally invasive procedure, with small incisions and rapid post-operative recovery.

Lumbar Spinal Fusion

Surgical Fusion procedures are performed in order to remove soft tissues between two or more vertebral bones and replace them with bone or metal.

In this way, said procedure allows growth in the union of the bones with the passage of time, which later allows a greater stabilization of the spinal segments. This process implies a slow recovery which could take between 6 and 12 months in total.

In the lumbar area, this process can be carried out on the front as well as on the back, on the side or even in combination. Thanks to the technological advances present today, the recovery after this procedure is easier and faster, allowing the return to daily activities and work in a shorter period than before.

Some of the conditions that are treated by this procedure include the following: fractures, instability, degenerative disc disease, stenosis, spondylolisthesis, deformity, among others.

Alternative surgical options

Nowadays the advancement of technology allows certain alternative methods to treat certain ailments. Some of them related to low back operations are the following:

  • Artificial lumbar disc: An alternative option to fusion surgery for patients with degenerative disc disease, is disc replacement. This intervention has a faster recovery period and better results than fusion surgery, although long-term results are still being analyzed in terms of patients’ quality of life.
  • Interlaminar device: This is a device that presents an alternative to the fusion procedure for patients with lumbar stenosis or mild degenerative spondylolisthesis. With this method, a small device is introduced as a support and results similar to that of the fusion operation are obtained, although with shorter recovery times and a smaller and faster surgery. As in the previous case, long-term results are still being collected.

There are also many other advances that are presented for this type of column operations. Some of them bring with them the use of stem cells, nanotechnology, and robotics.

Recovery

The post-operative process may be presented to some patients in a better way than to others. It depends on the condition of your condition prior to surgery, your lifestyle, and habits, your physical condition, surgical intervention, among other related factors.

After an operation of this style, professionals will recommend certain habits and rehabilitation treatments such as physiotherapy, in conjunction with some muscle relaxants or analgesics. This is done in order to improve the recovery process and strengthen the area. In some cases, it is also recommended to use certain special devices to help in rehabilitation, such as back braces, special beds or support pillows.

Recovery patients are also recommended to take a rest period from their daily activities and work from a minimum of several weeks to even a couple of months, in order to rest properly.

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