Back pain in the lower back is a common occurrence that almost all of us encounter at one point. It is a symptom of many different diseases, and not necessarily associated with the spine, in some cases it is accompanied by internal organ pathologies. The intensity and nature of the pain syndrome varies widely and depends on the history of the disease's development. We will discuss the causes and types of pain in the lower back (back pain), the principles of diagnosis and treatment of these diseases in our article.
The main causes of back pain
The overwhelming number of visits to the doctor with such a complaint is associated with the pathology of the lumbar spine - with degenerative-dystrophic changes in the osteoarticular system of the back. However, the pain can be based on infectious-inflammatory and other diseases. Let's consider them in more detail.
Ankylosing spondylitis (spondylitis)
One of the systemic connective tissue diseases. It is characterized by non-infectious inflammation of spinal structures. The vertebrae gradually fuse, which limits the range of motion in the affected area - ankylosis forms. The paravertebral ligaments ossify. Gradually, the spine completely loses its ability to bend and becomes a single solid bone.
It debuts in youth, the first symptom is precisely a pain in the back, in the lumbar spine, which, as the pathology progresses, spreads to other parts of it. At first they only appear once in a while, but soon they become permanent, temporarily decreasing only after ingestion of the medicine.
Other characteristics of pain:
- accompanied by a feeling of stiffness in movement;
- more pronounced at rest, mainly painful in the second half of the night in the morning;
- its intensity decreases after active movements - physical exercises, as well as after taking NSAID drugs.
It is accompanied by damage to joints located far away from the spine - morning stiffness occurs in them, and with an exacerbation, there is severe pain, swelling, and hyperemia (redness) of the surrounding soft tissue.
hernia and osteochondrosis
Osteochondrosis is characterized by malnutrition and subsequent destruction of the cartilaginous tissue of the intervertebral discs, hernial protrusion of this towards the spinal canal, formation of marginal growths of bone tissue in the areas adjacent to the affected discs, as well as arthrosis of the spinal joints.
All these changes lead to the appearance of back pain - constant or sharp pains in the lumbar region, often radiating (radiating) to the buttocks, to the legs, accompanied by weakness of the limbs, their numbness. Locally at the site of the injury, it is possible to palpate (feel) the tense paravertebral muscles, and the patient now notices an increase in unpleasant sensations. Compression of the spasmodic muscle of the nerve roots is accompanied by burning, tingling, numbness, or a "crawling" sensation.
Intervertebral hernia is a complication of osteochondrosis, in which a fragment of the intervertebral disc protrudes or falls into the spinal canal. At an early stage it is asymptomatic, but as it progresses it leads to frequent and gradually increasing back pain, limited range of motion in the affected spine.
Unpleasant sensations are intensified with high physical exertion, static load on the lower back (during a long standing or sitting position), restricted movement, sometimes there is "lumbago" radiating to one or both of the buttocks and lower extremities. Severe hernias are accompanied by decreased sensation in the legs, which does not recover after rest, as well as dysfunction of the reproductive system and pelvic organs.
kyphosis and scoliosis
With the curvature of the spine, the back also hurts in the lower back. According to its anatomy, the spine is not a strictly straight structure, it has physiological curves: forward - cervical and lumbar lordosis, backward - thoracic and sacral kyphosis. Bends are necessary so that the load is evenly distributed across the vertebrae, they help to cushion the spine during movement.
In some congenital diseases curves are formed incorrectly, a change in their depth can be observed in a number of acquired pathologies. Lumbar lordosis is usually smoothed in the context of spondylitis and spondyloarthrosis (degenerative-dystrophic and inflammatory processes in the joints between the vertebrae). Also, kyphosis is formed as a result of injuries.
Lumbar scoliosis (lateral curvature) develops in response to compensatory thoracic spine curvature (the body seeks stability, more evenly to distribute the load). Visually, it manifests as an S-shaped back, asymmetry in the waist and shortening of the lower limb. Lumbar scoliosis is a very rare condition - the curvature mainly develops in the thoracolumbar spine.
Early stages of kyphosis and scoliosis are asymptomatic. As the disorders progress, the patient notices fatigue in the back muscles, especially at the end of the workday, there are periodic pains, which later become permanent. By nature, they are unpleasant, dull, pressing or painful pains, more pronounced in the context of stress, less - after rest.
Degenerative dystrophic disease, characterized by the destruction of articular cartilage in the vertebrae, the formation of bone growths on them - osteophytes. As a result, the spinal canal narrows to the point where, in some areas, it begins to compress the spinal cord. In recent years, spondyloarthrosis has become significantly younger - it develops in people who have reached the age of 30-35 years, but more often in mature and elderly people.
The signs are:
- chronic pain not intense or moderate intensity in the lower back, moving to the buttocks, hip joint region to the right or left, aggravated by exertion, as well as during prolonged walking or standing, decreasing after rest;
- palpation - muscle tension and pain at the injury site;
- decreased mobility of the spine;
- with spinal cord compression - numbness, lower extremity weakness, pelvic organ dysfunction.
It is characterized by the appearance of an unnatural protrusion of the intervertebral disc, maintaining the integrity of its fibrous ring. It is a consequence of the progression of osteochondrosis and other degenerative dystrophic diseases. Lack of timely patient care leads to the formation of a hernia.
Factors that cause the development of protrusion:
- spinal injury;
- increased load on the lower back as a result of an overweight person or their work associated with heavy physical work, weight lifting;
- multiple intervertebral disc microtrauma;
- weakness of the muscular system of the back;
- sedentary lifestyle;
The manifestations of this pathology are:
- feeling uncomfortable, tense, chronic pain in the affected region of the back;
- decreased range of motion in the area of protrusion;
- chills, numbness, discomfort in the lower extremities.
Arthritis of the spinal joints is a very rare problem, but its appearance significantly affects human health. It is an inflammatory process of an infectious or non-infectious nature, which is accompanied by pain in the affected joints. It can be chronic in nature, be dull, painful, or be acute, acute, strong, acquiring the character of lumbago in the lumbar region, arising after overwork or hypothermia. There is a pronounced stiffness in the back after a long rest in one position.
Severe bacterial disease characterized by purulent necrotic inflammation of bone tissue. Initially, it is acute in nature - a paroxysmal, acute, explosive pain appears, which, in the absence of treatment, takes a chronic course - its intensity decreases, its character changes to painful, dull, constant. These sensations are more pronounced when moving, but at rest they also persist, not completely disappearing. There are also manifestations of general body intoxication - subfebrile condition (a slight increase in body temperature), weakness, fatigue, headache, sweating.
Also accompanied by back pain: when the head of the pancreas is affected, it hurts in the right hypochondrium, the body - in the epigastrium (in the upper abdomen in the middle), the tail - in the left hypochondrium. If the inflammatory process affects the entire gland completely, the pain is characterized as herpes, radiating to the lower back, groin, perineum. It occurs after eating or physical activity, is pulling, cutting, stabbing, sometimes it continues in the form of severe attacks.
It is a complication of protrusion or herniated disc. These pathological formations compress the spinal nerve roots, causing a violation of their function: numbness, weakness, tingling, faint discomfort along the nerve. The pain is noticed at rest, and when a person walks, it intensifies when trying to straighten the back and lessens when leaning forward.
It arises as a result of the degeneration of the facet joints (formed between the joint processes), which, in turn, develops in the context of the pathology of the intervertebral discs. The defeat of the discs leads to an increase in the load on the joints - inflammation is initiated in them, and then - and spondyloarthrosis - degeneration. This pathology affects 4 out of 5 patients aged 80 years and over.
Pain occurs locally in the area of affected joints, increases with body bends or during rotation in the lower back, as well as during prolonged standing and when changing the body position from sitting to lying down and vice versa. Can give groin, buttock, lower limb on the side of the lesion, cramps. It is characterized by morning stiffness lasting up to an hour, increasing the intensity of discomfort at the end of the day.
Location of pain in the lower back
From the location of the pain, one can indirectly judge its possible cause. But it is important to understand that this is just an assumption and is not a substitute for consulting a doctor.
Pain above lower back but below shoulder blades
Can be based on:
- diseases of the lower thoracic and/or lumbar spine of a degenerative-dystrophic, traumatic or other nature;
- muscle pathology (tension, muscle fiber spasm);
- benign and malignant neoplasms (tumors);
- digestive tract diseases (pancreatitis).
Pain in the lower back
You can talk about these diseases:
- osteochondrosis of the lumbosacral spine;
- diseases of the gallbladder, intestines;
- pathology of the genitourinary system (pyelonephritis, urolithiasis, inflammation of the ureters).
In women, this symptom may be accompanied by a complicated pregnancy (eg, proceeding with the threat of termination), premenstrual syndrome, and menstruation itself.
Low back pain resulting from damage to internal organs is called reflected. They are secondary in nature and are accompanied by other symptoms:
- abdominal discomfort;
- nausea, vomiting;
- violation of stools (increased frequency, constipation);
- increased frequency or difficulty in urinating, pain in the process;
- an increase in body temperature.
If there are no other symptoms and the pain occurs after staying in one position for a long time, lifting weights, or walking for a long time, it is likely associated with problems in the musculoskeletal system, and you should first undergo an examination to rule out this particular cause.
left back pain
A sudden onset of sharp pain on the left side, radiating to the left shoulder blade, the left half of the neck, may be a manifestation of myocardial infarction, requiring urgent treatment. Also, sudden sharp pain ("dagger") in this area from a sharp stab is a sign of perforation of the stomach ulcer. This is a dangerous, even life-threatening condition that you need to be aware of in order to start treating it as soon as possible.
In other cases, this symptom is a sign of a pathological process in the musculoskeletal system:
- posture disorders;
- radiculitis, radiculopathy.
Most of the time it is painful, occurs with a sedentary lifestyle, after physical efforts in the lower back (long walk, sitting), it goes away or does not go away after resting.
right back pain
Cramps or dull, nagging pain can be a sign of kidney or reproductive disease.
The gradual increase in the intensity of sensations, pain when touching the affected area means the presence of an inflammatory process of an infectious or non-infectious nature.
Sharp, sharp, as if struck by a dagger, pain that occurs suddenly - a symptom of perforation of a stomach or duodenal ulcer, internal bleeding, ruptured appendix.
Pulling sensations originating in the spine and spreading to the right side are a sign of muscle sprains, radiculopathies, or other diseases of the musculoskeletal system.
Back pain when coughing
The main reasons for this are as follows:
- facet syndrome (if you relax the muscles on the injured side, reduce the load on the damaged joints by leaning towards you, the intensity of discomfort decreases);
- herniated disc in the lumbar spine (usually accompanied by decreased sensation in the lower extremities or dysfunction of Organs pelvic organs);
- spinal canal stenosis (narrowing) (accompanied by intermittent claudication, impaired sensation, and movement in the legs);
- kidney disease.
Types of severe back pain radiating to the legs
In describing what back pain is talking about, we want to emphasize this sensation that radiates to the legs. It usually occurs when the nerve roots are damaged - when they are violated by a spasmodic muscle or damaged by osteophytes, however, depending on the characteristics of the nature of the discomfort, a link to other pathologies can also be found.
They are given on the legs, on the back of the foot, sometimes - they affect the sacral spine. In most cases, they are caused by compression of the sciatic nerve by the fibers of the spasmodic piriformis muscle and are aggravated by bending, walking, and coughing. If compression persists for a long time, atrophic processes are possible in the gluteal muscle on the affected side.
Also, osteochondrosis can be the cornerstone of this symptom. It is accompanied by numbness in the limbs and a crawling sensation.
Arising suddenly, radiating to the outside of the thigh, they are a manifestation of the appearance of an intervertebral hernia or neuropathy of the lateral cutaneous nerve of the thigh. They are also characterized by a burning sensation, numbness, tingling sensation, chills and weakness of the thigh muscles.
Drawing, aching pains
If administered in the buttock and thigh, it indicates a possible presence in the lumbar spine of an intervertebral hernia, disc protrusion, ankylosing spondylitis, subacute inflammation of the sciatic nerve, less frequently a spinal cord tumor.
They are also a consequence of secondary damage to the sciatic nerve in degenerative-dystrophic diseases of the lumbosacral spine, protrusions or herniated intervertebral discs. They become more intense after physical efforts in the lower back, prolonged in a sitting or lying position on an uncomfortable surface, with a sedentary lifestyle.
They are also called reflected. They appear again, with the location of the pathological process in Organs pelvic organs - the ovaries, the fallopian tubes in women, the prostate - in men, as well as in the case of lesions in the urinary tract or rectum.
How is back and lower back pain diagnosed?
To make a preliminary diagnosis, the doctor talks to the patient:
- collects complaints (specifies which symptoms of back pain are still present in the patient);
- he is interested in the history of this disease (when the first manifestations appeared, how they changed over time, what affects its intensity and what facilitates it);
- clarifies the life story as a whole (asks what else the patient was sick with, what his close relatives suffered).
Then, the specialist will carry out an objective examination:
- examines the affected area of the body, paying attention to the color, purity of your skin, sometimes "by eye" you will find tense paravertebral muscles, and asymmetry of the spine, when the patient, trying to relieve sensations, takes a forced position;
- palpa (palpation with the fingers), in this way the doctor will assess the body temperature at the site of the injury (its increase is a sign of an inflammatory process), find the site of maximum pain, detect a spasmodic muscle or a deformed vertebra, and if the problem is located in the abdomen, it will conclude which organ became the cause of the reflected pain;
- if necessary, he will perform percussion, or tapping (this method will help determine the lower edge of the liver, stomach, kidneys, in order to check for possible pathology of these organs).
The data obtained at this stage are sufficient for the physician to suspect a certain disease. To confirm the diagnosis, he will prescribe additional research methods for the patient:
- clinical blood test (will show the inflammatory process in the body, if any);
- general urine analysis (excludes renal pathology);
- Ultrasound of the abdominal cavity, retroperitoneal space and small pelvis;
- Lumbosacral spine X-ray or other more modern imaging methods (CT or MRI);
- consultations with experts of different profiles.
How to relieve a low back pain attack?
If this symptom has arisen as a manifestation of a spinal disease, you should:
- reduce the load on the spine as much as possible (preferably lie down on a flat, hard surface, first on your stomach, and after 5 minutes gently roll onto your back and lift your legs to reduce tension in the nerves);
- apply an anti-inflammatory agent to the skin of the lower back, or inject a drug from the NSAID group into the gluteal muscle, or take such drug in tablet form (preferably not on an empty stomach);
- after the intensity of the sensations subsides, gently stand up and secure your lower back with a special scarf or corset.
If the back pain is reflected - it has arisen in the context of somatic pathology, taking an antispasmodic will help alleviate the person's condition. You should not apply heat to the pain site - this can aggravate the inflammatory process, if any.
How is lower back pain treated?
Depending on the identified cause of the back pain, the patient will receive prescribed treatment. It can be conservative or surgical.
Conservative treatment is often complex - it includes a range of medications and physical therapy techniques.
Medicines from the following groups can be used:
- non-steroidal anti-inflammatory drugs in the form of injectable solutions, capsules, pills, gels, ointments, special patches (have analgesic effect, reduce edema, reduce the activity of the inflammatory process; a single patient can be designated not one but several at once (two or three) drugs from this group in different dosage forms);
- muscle relaxants (effectively relax the spasmodic muscle);
- local irritating ointments and gels (reflex pain reduction);
- B vitamins (used as part of a complex treatment, improve metabolic processes in nervous tissue);
- antibiotics (if the process is based on inflammation of a bacterial nature);
- antispasmodics (if the cause is a disease of Organs abdominal or pelvic organs, which occurs with damage to the smooth muscle layer of your wall).
When the acute pathological process is eliminated, physical therapy exercises (massage, electrophoresis, magnetics, laser therapy) and physical therapy, gymnastics (with pathology of the musculoskeletal system) are associated with the treatment.
Surgical treatment is recommended as an emergency measure in life-threatening acute conditions (perforation of a stomach ulcer), with cancer, or routinely in chronic processes in the spine that cannot be conservatively compensated for (severe hernias, protrusions, fractures).
Which doctor should I contact for back pain?
Most patients with this complaint initially seek a therapist or neurologist. In this situation, the therapist acts more as a "regulator" - he helps the person discover the nature, profile of the illness and then refers him to the appropriate doctor. Many cases of low back pain are precisely associated with neurological pathology, so treating and, more importantly, curing these patients is primarily the neuropathologist's task.