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Backache

Lumbar pain or low back pain is felt in the lower spine , it can be an inflammation of the spine, but also a muscle disorder, ligaments, disks, etc. 
How often does it happen to be visited by a doctor who only observes MRI and says: the symptoms are caused by a herniated disc , or the pain is caused by an arthrosis ; while the patient’s problem has nothing to do with these disorders.

Exercises for low back pain and back pain

This introduction is necessary because low back pain can have many causes, some of which are easily detectable with an instrumental examination, but in most cases the patient has non-specific pain that is not identifiable with imaging tests (tomography, radiography , etc.).

The pain can be bilateral or only on one side, the type of discomfort is classified as dull, dull, deep, superficial, localized, intermittent or constant. 
It is usually accompanied by muscle tension, stiffness and movement restriction. 
In most cases, low back pain is non-specific, ie imaging tests and orthopedic exams do not identify a cause. 
Inflammation of the spine can be accused by patients of all ages. 
A history and physical examination should exclude all possible causes of visceral origin.

Most patients who seek a doctor or a physical therapist also suffer from neck pain , back pain  or diffuse rachialgia, if the pain is also in the legs can be a lombociática . The pain in the lumbar spine can be acute or chronic, the difference is that in acute pain disappears within thirty days if the pain is chronic continues beyond thirty days without knowing for how long. 
Lumbago  is an episode of acute low back pain characterized by very intense or excruciating pain. The affected individual stands motionless and leaning forward because every move they try to make is extremely painful.
From that moment the patient sits or lies sideways waiting for an improvement that will not come before 24 hours.

It is strongly discouraged to try to straighten up with this pain as this could damage other structures as well as aggravate pain and inflammation. 
The  lumbago  is a type of back pain much more intense and characterized by a strong stiffness. 
Some patients sleep comfortably in the less painful part, left or right, others are able to rest only with their belly up. 
To indicate the lumbar vertebrae, write “L” followed by a number that indicates the position of the vertebra, starting from the top: (for example, L2 is the second vertebra, starting from the skull towards the feet). 
It is important to distinguish the vertebrae because certain anatomical abnormalities such as disc hernias and spondylolisthesismainly affect the level of L5-S1, to a smaller extent, L4-L5.

The hernia and protrusion cause more pain in the morning on awakening, because at night the disk absorbs the fluid lost during the day, the consequence is that the spine has a larger volume. The larger disk presses more nerves and causes a lot of pain. 
lumbar fracture occurs in most cases in the L1 vertebra, less frequently in L2, and rarely in lower levels.

 

What are the causes of low back pain?

The first thing to do is to exclude visceral diseases because lumbar pain can be projected from the abdominal viscera and organs like the uterus ( endometriosis or uterine fibroid ), kidneys, etc. 
When we ensure that the disorder is a consequence of the musculoskeletal apparatus we can treat as a back pain of competence of the physiatrist or orthopedist. 
Many patients come into the clinic saying they have low back pain because they have a herniated disc or because the vertebrae are crushed, but only in a very small percentage of cases is this true.

The causes of low back pain may be different: back pain from an exertion is caused by very heavy work with frequent lifting of objects. 
Predisposing factors include:

  • Hypotrophy of the abdominal and paravertebral muscles associated with poor physical shape,
  • Incorrect postures ,
  • Competitive sports activity,
  • Sedentary life.

Sometimes the experts believe that depression or an unsatisfactory and repetitive work can cause back pain because they have noticed that statistically this is so. 
You often suffer from low back pain during pregnancy because the body undergoes internal changes due to weight gain: anterior pelvic rotation and increased lumbar lordosis.

The ligaments and other soft tissues become more elastic and these body changes, coupled with dysfunction of the sacroiliac joint, cause the classic lumbosacral pain of pregnant women. 
Before the menstrual period , women often suffer from menstrual pain in the lower abdomen , spine, breast and buttocks . 
Another cause of back pain can be an uncomfortable shoe, very hard or low shoes can overload certain muscles compared to others and cause a right or left disturbance. 
The patient feels a pain that originates from the sole of the foot when he is standing, and when he is seated he feels relief.

Back pain in children can be caused by a dysmetria of the lower limbs that require a crooked posture or a scoliosis, this condition can cause symptoms even in adults. 
There are visceral causes for spinal pain such as endometriosis, rheumatology such as ankylosing spondylitis and rheumatoid arthritis , vertebral fractures, spondylolisthesis, arthrosis (spondylosis), infection, and a lumbar area tumor (for example, a neuroma or kidney cancer ).

A medical examination is required that excludes all conditions that are not related to the orthopedist or physiatrist before starting a treatment.

 

Causes of low back pain during movements

In adults and especially in the elderly, spondylarthrosis and formation of osteophytes may cause inflammation of the intervertebral joints and therefore cause pain. 
In my experience I recommend treating mechanical pain in the spine as a joint or muscle disorder, in fact, in almost all patients appearing in a clinic, this is the cause.

During the movement, if one vertebra does not flow straight in relation to another, the slip will produce friction and pain. 
Many patients have pain when they arise from a chair, this is often caused by a joint block at the level of the sacrum. 
As a consequence of trauma, repetitive microtraumas or muscle overload, it is possible that they form from the adhesions between the bands of connective tissue at the point of greatest tension of the muscles that perform a particular movement. 
These points of collagen compress  a nerve end, thus causing pain during movement and in some cases even being stopped beyond loss of strength and functional limitation.

 

Difficulty of sudden spinal movement

The causes of low back pain are jerking or straining to pick up a heavy object from the floor (for example, a vessel) with flexion of the lumbar spine. 
If there is a contraction of the small muscles that attach one vertebra to another, these are made in a decomposed form of the vertebrae that do not slide one over the other and the patient feels pain.

In this case, a millimetric rotation of the last lumbar vertebra L5 occurs in relation to the sacral bone. 
More in detail, the reasons that predispose to this disease are: to raise objects of the ground without bending the knees, accidents or trauma in general, excessive effort. 
Exposure to cold does not cause back pain, as is often thought, although it may harden muscles and complicate a problem that already existed. 
The lack of elasticity of muscles is a factor that predisposes to low back pain. 
The strong contraction of the spinal muscles is a defense mechanism, comparable to a torticollis , but is often bilateral.

 

Back pain at night

Generally, backache at night that does not let sleep is caused by: 
1. Visceral organ diseases such as liver or colon, for example irritable bowel syndrome . In this case, the pain is lateral (right or left side). 
2. A large hernia that presses the sciatic nerve (the patient feels pain, especially when the body is bent forward). 
3. Heavy work during the day.

 

What symptoms can occur with low back pain?

The patient may feel:

  • Ardor
  • Muscular stiffness
  • Need to move and change position
  • Light fever in case of rheumatic diseases such as fibromyalgia or ankylosing spondylitis
  • In the case of sciatica there may also be leg pain, loss of strength and sensitivity, tingling in the feet

 

Diagnosis of low back pain

MRI of the lumbar spine

The doctor always seeks injuries, disc pathologies, rupture of ligaments or tendons, scoliosis , visible misalignment, infection , inflammation, etc. 
In most cases the doctor prescribes an anti-inflammatory or forward to a neurologist-psychiatrist, etc., even when the patient does not have any disturbance that originates from the mind. 
Low back pain simply means pain in the lumbar spine, so the differential diagnosis serves to identify the type of pain: mechanical, inflammatory, etc.

A thorough medical examination is the first thing to do and is irreplaceable by any instrumental analysis. 
The doctor should examine the painful area, perform routine examinations, and evaluate the painful response to palpation to determine if further investigation is needed if you suspect pathologies that can be confirmed with an X-ray  or MRI . 
The physical examination can  show  if the movements are free or if there is a blockage of movement.

 

The first thing to do is ask the patient if he has pain at night or if he also suffers from stomach pain , nausea and vomiting . 
In cases where you can not sleep because of the pain it is possible that the cause is a disorder of an organ, it can also be a tumor (for example, bladder cancer ).

The most useful tests in the case of non-musculoskeletal low back pain are:

  • A magnetic resonance imaging to highlight any herniated disc;
  • The radiograph shows the bones and the space between them, shows the arthritis and fractures;
  • Blood and urine tests for the presence of a possible malignancy or paget disease or rheumatic diseases;
  • Bone scintigraphy looks for any metastases;
  • The  electromyogram  (EMG) to evaluate nerve conductivity, this test is performed if there is pain in the legs .

Scoliosis can be a cause of premature arthrosis in a part of the spine, which supports more weight but is not painful. 
Certain muscles are held in stretching because the vertebrae are tilted and have rotation to the opposite side, so the muscles on one side are in continuous stretching, this can cause muscle pain .

Low back pain is immediately apparent by the position of the patient and blockage of movement. 
The doctor consults the patient to find out if the cause of the disease is a sudden movement or if it is the consequence of other diseases. 
If the patient feels tingling or lumbar numbness, the cause is irritation of the nerves, so it is necessary to indicate which structure interferes with normal nerve activity.

 

What to do? What is the most appropriate treatment for low back pain?

Low back pain simply means pain in the lumbar spine, so let’s treat only that orthopedic. The general guidelines indicate posture control as the most important thing to do to avoid back pain, we also recommend performing a regular exercise program and stretching at the gym. 
Many patients ask me if it is just right to strengthen the abdominal muscles to solve the problem, my advice is to avoid them completely until when you feel pain in the spine. 
It is necessary to avoid recurrence of low back pain that is frequent if the cause is not eliminated, but only the symptoms. 
The patient should avoid leaning 
with the spine by keeping his legs straight, having to vacuum the spine straight and making the bed on his knees.

When you sit down it is advisable to keep a lumbar roller that retains physiological lordosis.

The most appropriate therapy for mechanic-inflammatory low back pain is the combination of instrumental therapy ( CO2 laser , TECR  ®) and manual therapy or osteopathy to remove the blockage of the vertebral joints and remove muscle and fascial tension. 
There are muscles in the buttocks that can cause pain in the spine, for example, the piriformis and the gluteus medius muscle, so it is important to remove tension at this level. 
Kinesiotherapy stretching and relaxation is advisable to prevent  low back pain , while massage relaxes and relieves muscle contractures.
As a home remedy, the hot water bottle can give a little relief, while ice is always discouraged because it delays healing. 
In the case of low back pain, the treatment is different, in the first 48 hours bed rest is preferred, and then therapy consists of massage and instrumental therapies for inflammation and serves to eliminate the cause of the disease.

Medication therapy consists of analgesics and anti-inflammatories: aspirin, paracetamol , voltaren, etc., 
Muscle relaxants such as muscoril and sirdalud have a temporary effect but relieve pain, the doctor can prescribe if the patient has no contraindications .

 

Natural Remedies for Low Back Pain

Among the natural remedies there are creams based on arnica or homeopathic medicines, but they have a similar action to the medicines, that is, they are palliative. 
If back pain is rebellious or causes relapse, you need to deal with structural disorder in order to eliminate the cause. 
Certain sports activities such as running are detrimental regardless of low back pain because they aggravate inflammation or cause repetitive microtraumas to the spine. 
Swimming is a permitted sport, but only if it does not cause pain. 
Often, cycling in the mountains causes muscle-type lower back pain. 
Among the exercises to avoid in the gym are squats, barbell weight lifting and leg press.

The  orthopedic brace  can provide temporary relief while it is useful in the early days of acute low back pain . 
Older people can use the strap for long periods of time if it is the only way to lead a normal life, but young people should use it at most 2/3 days.

The prognosis varies according to the patient’s age, the recovery time for those under 35 is less than one week, while for the elderly about 10 therapy sessions are required.

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