Lumbago or low back pain

Lumbago or low back pain occurs in the lower part of the spine. This can be an inflammation of the spine, but also complaints of the muscles, ligaments and intervertebral discs, etc.

It often happens that a doctor only looks at magnetic resonance imaging and says: “the symptoms are caused by a herniated disc” or “the pain is caused by osteoarthritis”, while the type of back pain one suffers from has nothing to do with these degenerative processes.

This premise is necessary because back pain can have many causes. Some can be easily visualized by an instrumental examination, but in most cases the affected person shows non-specific pain that is not visible by imaging techniques (CT, X-ray, etc.).
The pain can occur bilaterally or only on one side, the type of discomfort can be stabbing, dull, deep, superficial, local, constant (incessant) or intermittent.
As a rule, it is accompanied by muscle tension, stiffness or movement restrictions.
In most cases, the lumbalgia is non-specific, i.e. the imaging examinations or orthopedic tests do not lead to any cause.

Inflammation of the spine can occur in patients of any age.
The anamnesis and an accurate medical examination can exclude all possible pains of visceral origin.
Most patients who turn to the doctor or physiotherapist also suffer from neck pain (cervicalgia), dorsalgia or diffuse back pain. If the pain also passes into the legs, it could be sciatica. The lumbar back pain can be acute or chronic. The difference is that in acute cases, the pain passes over the course of thirty days. If the pain is chronic, it persists for more than thirty days without knowing how long it will last.

Lumbago is an acute lumbar syndrome, characterized by a very intense and unbearable pain. The affected person remains in a forward-leaning posture, because every movement he wants to perform is extremely painful.
At this moment, he sits down or lies down sideways and waits for an improvement that will not occur before 24 hours.
It is strongly discouraged to stand up under this pain. This could damage other structures and worsen pain and inflammation.
Lumbago is a very painful lumbalgia and is characterized by high stiffness.
Some patients sleep comfortably on the less painful right or left side, others can only rest in a supine position.

Herniated disc and intervertebral disc protrusion cause more pain in the morning in adults, because during the night the disc has reabsorbed fluid that it has lost during the day. The result is that the spine has a larger volume. The enlarged intervertebral disc presses on the nerves and causes discomfort.
A lumbar vertebra fracture takes place in most cases in the vertebral body L1, less common in L2 and rarely in the lower levels.
L3 is the vertebral body with the greatest mobility and is located in the middle of the lumbar spine.

To designate the lumbar vertebrae, an “L” is written followed by the number indicating the position of the vertebra seen from top to bottom (for example, L2 is the 2nd lumbar vertebra from above).
It is very important to distinguish the vertebrae because certain anatomical changes, such as a herniated disc and spondylolisthesis, mainly affect the (lumbosacral) level L5-S1, and only to a lesser extent L4-L5.


What are the causes of lumbago or low back pain?

First of all, visceral diseases must be excluded, because lumbar pain can be projected from organs and abdominal intestines, such as the uterus (endometriosis), kidneys, etc.
If you are sure that the complaints are caused by the skeletal muscular system, you can treat the back pain physiotherapeutically or orthopedically.
Many patients come to the practice and say that they suffer from lumbalgia because they have a herniated disc or because the vertebral bodies have collapsed. But this is only true in a very small percentage of cases.
The causes of nonspecific lumbar pain can be different: overload back pain is associated with frequent lifting of heavy objects due to too heavy work.

Favouring factors include:

  • hypotrophy of the abdominal muscles and paravertebral muscles, associated with poor physical fitness,
  • incorrect posture,
  • exaggerated competitive sport,
  • Lack of exercise.

Sometimes specialists assume that depression or repetitive and unsatisfactory work could cause back pain, as statistical surveys indicate.

Often one suffers from back pain during pregnancy, because the body is subject to internal changes due to weight gain: forward tilt of the pelvis and increase in lumbar lordosis.
Ligaments and other soft tissues become more elastic. To this altered aspect of the body is added a subluxation of the sacrum versus the ilium of the pelvis, which leads to the classic lumbosacral pain in pregnancy.

Before the menstrual cycle, women often suffer from menstrual pain in the lower abdomen, back, chest and buttocks.

Another cause of back pain can be poor footwear. Shoes that are too hard or too flat and have poor support on the foot can strain certain muscles more than others and cause right- or left-sided discomfort.
The patient feels the pain originating from the feet when standing, while relief occurs when sitting.

Lumbalgia in children may be caused by asymmetry of the lower extremities, leading to impaired posture or scoliosis. This condition can also cause symptoms in adults.

For back pain, there are visceral causes such as endometriosis, rheumatic causes such as ankylosing spondylitis and rheumatoid arthritis, fractures of the vertebral bodies, spondylolisthesis, osteoarthritis (spondylosis), infections and a tumor in the lumbar region (for example, neurinoma or kidney tumor).
Before starting treatment, it is necessary to see a doctor who excludes all diseases that are not orthopedic or physiatric in nature.

Causes of movement-dependent pain
In adults and especially in the elderly, spondylarthrosis and the formation of osteophytes can cause inflammation of vertebral joints and thus pain.
In my experience, back pain of mechanical origin such as joint or muscle complaints should be treated, and in fact this is the case with almost all patients who present in practice.
If one vertebra does not shift in a straight line against another during movement, it creates friction and pain.

Many people experience pain when they rise from sitting. This is often caused by a joint blockage in the sacrum area.
As a result of trauma, repeated microtraumas or muscular overload, it is possible that adhesions form between the fascia of connective tissue at the site of the greatest tension of the muscles performing a certain movement.
These collagen bridges form and include nerve endings, which then cause pain during movements and, in certain cases, at rest, in addition to loss of strength and functional limitations.

Sudden back blockage

The causes of lumbago are abrupt movements or excessive loads, such as picking up a heavy object from the floor with a bent lumbar spine (for example, a flower pot).
If these flexion movements are performed in malfunctioning vertebrae, which do not push binary over each other, but “derail” even a little, the reaction of the body is a violent contracture of the small muscles that connect the vertebrae with each other.

In this case, there is a millimeter-sized rotation of the last lumbar vertebra L5 relative to the sacrum.
So the situations that can lead to this disorder are: lifting objects from the floor without bending the knees, accidents or general trauma, overexertion.
If the pain persists in the morning, the cause may be that you sleep on a bulging mattress.
A patient who gets cold or drafts does not develop lumbalgia, as is often assumed, even if this can stiffen the muscles and aggravate an already existing problem.
The lack of elasticity of the muscles is an element that predisposes to lumbago.
The strong contraction of the back muscles is a defense mechanism. This can be compared to neck stiffness, but often it occurs on both sides.

Low back pain at night

As a rule, nocturnal low back pain that does not allow you to sleep has the following causes:

  1. Complaints of visceral organs such as the liver or colon, for example irritable bowel syndrome. In this case, the pain occurs laterally (right or left side).
  2. A strong herniated disc (hernia) that presses on the sciatic nerve (the patient feels pain, especially when bending forward).
  3. Heavy physical work during the day.

What symptoms can occur along with lumbar pain?

  • Burn.
  • Muscle stiffness.
  • Urge for movement and change of position.
  • Mild fever in case of rheumatoid diseases such as fibromyalgia or ankylosing spondylitis.
  • Sciatica can also cause pain along the leg, loss of strength and sensitivity, and tingling ants on the feet.

Diagnosis of lumbalgia

The doctor is always looking for injuries, intervertebral disc disease, tearing ligaments or tendons, scoliosis, visible deformities, infections, inflammations, etc. If he finds nothing, what does he say? In most cases, he prescribes an anti-inflammatory or refers to the neurologist, psychiatrist, etc., even if the patient does not have organic mental disorders.
Lumbalgia simply means pain in the lumbar spine. Thus, differential diagnosis is necessary to identify the type of pain: inflammatory, mechanical, etc.

An accurate medical examination is the first thing to do and cannot be replaced by instrumental examinations.
The doctor must see the painful area, perform routine tests, and evaluate the painful reactions to palpitation to decide whether further investigation is needed if a suspected disease needs to be confirmed by X-ray and MRI.
The movement tests show whether the back has a blockage or the movements are free.

First, the patient is asked whether he feels the pain at night or during the day, and also suffers from abdominal pain, nausea and vomiting.
If he cannot sleep at night because of the pain, an organ disorder can be the cause, but it can also be a tumor (for example, bladder tumor).

The most helpful examinations for non-musculoskeletal back pain are:

  • magnetic resonance imaging to reveal any disc hernia;
  • radiography assesses the bone and its interstitial spaces, revealing arthrosis and fractures;
  • blood and urine tests to detect possible neoplasms or Paget’s disease or rheumatic diseases;
  • bone scintigraphy looks for any metastases present;
  • Electromyography (EMG) to evaluate nerve conductivity. This examination is carried out if the pain also occurs in the legs.

Scoliosis can be a cause of early osteoarthritis in a section of the spine where most of the body weight is supported, but it itself is not painful.
Some muscles remain under tension because the spine is bent and turned to one side so that the opposite side remains continuously stretched, which can lead to muscle pain.
lumbago is immediately apparent through the posture of the patient and the blockage of the vertebrae.
The doctor will examine the individual to determine whether the cause was an abrupt movement or a consequence of other conditions.
If the patient feels a lumbar tingling sensation or numbness, the cause is the irritation of one or more nerves. It is therefore necessary to determine which structure interferes with normal nerve activity.

What to do? What is the appropriate treatment?

Lumbalgia simply means pain in the lumbar spine. Thus, we are only talking about the orthopedic type here.
The general guidelines point to postural control as the most important factor in preventing back pain; in addition, it is recommended to regularly carry out a targeted program of stretching exercises in a gym.
Many patients ask me whether it is right to strengthen the abdominal muscles to solve the problem. My advice is to absolutely avoid this as long as there is back pain. Only when the pain has passed, you should integrate abdominal exercises into the program.
It is necessary to avoid recurrences of lumbalgia, which often occur when the cause has not been eliminated and only the symptoms are treated.
The patient should avoid bending his back while keeping his legs stretched, should keep his back straight when vacuuming and make the beds in kneeling.

When sitting, a lumbar roller is recommended, which supports physiological lordosis.

The best therapy for lumbalgia of the mechanical-inflammatory type is the combination of instrumental therapy (CO2 laserTecar®), manual therapy and osteopathy to bring the vertebrae back into their axis and release the tension of muscles and fascia.
There are gluteal muscles that can lead to discomfort in the back, for example the piriformis muscle and the middle gluteal muscle. It is therefore important to release the tension at this level.
Physio-kinesitherapy with stretching and relaxation is also carried out with the aim of prevention, while massage relaxes and releases muscle contractures.
The hot water bottle is a home remedy that can bring some relief, while ice treatments are not recommended as they do not promote healing but slow it down.
In the case of lumbago, the therapy is different. In the first 48 hours, bed rest is preferable, after which the treatment consists of massages and equipment treatment against inflammation. Also, light physio-kinesitherapy helps to eliminate the causes of the disorder.

Drug therapy includes nonsteroidal anti-inflammatory or painkillers: NSAIDs, aspirin, paracetamol, voltaren, etc., muscle relaxants such as Ortoton and Sirdalud. Although these remedies have only a temporary effect, they relieve the pain. The doctor may prescribe them to the patient if there are no contraindications.

Natural remedies

Among the natural remedies, there are creams based on arnica or homeopathic medicines that have a medicinal-like effect and have a soothing effect.
If the lumbalgia is very severe or recurrent, the symptoms must be addressed in a fundamental way to eliminate the causes.
Certain sports activities, such as running, are damaging regardless of the type of lumbalgia, because they can aggravate the inflammation or repeatedly cause microtraumas on the spine.
Swimming is a permitted sport in the case of back pain, but only if it does not cause pain. Better in this case is freestyle and backstroke, as they do not strain the lumbar muscles. The same goes for cycling and exercise bikes.
Cycling uphill often leads to muscular back pain.
Exercises that are better avoided in the gym are squats, weight lifting with barbells and leg press.

Elastic bandages or supports can provide temporary relief, while the orthopedic corset with metal struts is helpful in the first days of acute lumbalgia because the weight of the upper body is shifted from the ribs to the pelvis.
Elderly people can wear it for long periods of time if it is the only means of following normal everyday life. However, young people should only use it for 2-3 days.

The prognosis varies depending on the age of the person concerned. Recovery time for those under 35 is less than a week, while older people need about ten therapeutic sessions.

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