There is practically no person who would not experience back pain in the lumbar region at least once in their life. This is how we pay for walking upright and our daily habits.
In addition to damage that can affect the spine, its muscles, nerves and ligaments, it should be remembered that sometimes the back hurts in the lumbar region with internal diseases - diseases of the kidneys, gastrointestinal tract and female genital organs.
Symptoms of lower back pain can range from dull to sharp. The pain may disappear on its own or become chronic (the symptom is present for more than three months).
Dangerous! Contact your doctor immediately if:
- pain in the lumbar region arose suddenly after an obvious back injury;
- the temperature has risen sharply, there are vegetative disorders, loss of consciousness, sweating, difficulty breathing;
- involuntary bowel and bladder emptying occurs;
- there is numbness in the groin area;
- weakness of the lower extremities, their paresis or paralysis, impaired sensitivity appeared;
- pain occurs in the stomach and suddenly intensifies when coughing or sneezing;
- symptoms appeared against the background of sharp weight loss, long-term use of steroids, immunodeficiency;
- there were cases of cancer, inflammatory or degenerative diseases of bone and cartilage tissue in the family history.
Why does the back hurt in the lumbar region?
Myofascial pain
A muscle strain or cramp can develop gradually or suddenly. With a heavy load, the damage affects not only the muscle fibers, but also the ligament apparatus and fascia.
Muscle pain in the lower back occurs after:
- lifting heavy weights or overexertion at work or playing sports;
- playing sports from time to time. Muscles are especially vulnerable if you're inactive during the work week and then spend hours at the gym on weekends;
- a sudden increase in the weight of one's own body, after which the muscles do not have time to grow;
- prolonged sitting or standing in an uncomfortable position;
- daily carrying a bag in one hand or over the shoulder;
- posture disorders. The spine performs its best supporting and protective function when you are not slouching. The muscles in the lower back experience the least stress when you sit with good support under the lower back, and in a standing position you distribute your weight evenly on both legs.
If the back hurts after a bruise, fracture, sprain, hypothermia, an infectious disease or a confirmed helminthic invasion, then myositis (inflammation) of the muscles of the lower back can be suspected. Strong pain is constantly present due to inflammation of muscle fibers, "knots" are felt in the muscles - places of spasms. Inflammation can be acute or chronic. With a long-term 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 soreness and discomfort, the muscles of the lower back are in constant tension, inflammatory edema is created, the temperature rises locally and at the level of the whole body.
The muscle spasm causes damage to the roots of the spinal nerves, so the attacks often resemble the image of sciatica or sciatica - there are burning severe pains along the back of the upper leg and lower leg, the limbs become numb, they lose sensitivity. Pronounced muscle tone in myositis forces the patient to take a forced position, walk and lie hunched over, move on bent legs.
How to treat pain in the muscles of the spine? Nonsteroidal anti-inflammatory drugs and analgesics are used to eliminate inflammation and pain. Medicines can be taken in the form of tablets, ointments, injections, transdermal patches with gradual release of active substances. Fats that irritate and heat are also used, which reflexively increase blood flow to the muscles of the lower back. The larger volume of blood entering the body contributes to flushing out the products of inflammation and tissue breakdown.
Reduction of inflammatory edema is facilitated by injections of corticosteroids and vasoconstrictive drugs.
If the cause of myositis is infection or poisoning of the body with worm toxins, then antibiotics or anthelmintic drugs are initially used. In this case, ointments or warming compresses cannot be used.
Diseases of the spine 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 jelly-like nucleus pulposus surrounded by a denser layer of anulus fibrosus. The elasticity of the core is due to its ability to bind and retain water: when the load increases, it accumulates water, and elasticity increases, when the pressure decreases, the core releases water and becomes flatter.
Osteochondrosis in the spine occurs when the intervertebral discs are malnourished ("drying out") or with excessive local load. Most often, pain in the lower back occurs due to the fact that the lower poles of its intervertebral discs bear the greatest load when sitting, when lifting weights in front of you. At the same time, tears and displacements are formed in the discs, ligaments of the vertebrae are damaged, there is constant aching pain, pulsation.
Pain in the spine has several mechanisms of development:
- violation of microcirculation in the tissues surrounding the spine, especially in the spinal canal, creating congestion and edema. Such conditions develop against the background of hypothermia, overheating, and inflammatory processes.
- degenerative processes in the fixing ligaments of the spine. Increasing the mobility of the vertebrae leads to their slight displacement and non-physiological compression, which causes involvement of nerves, blood vessels and the formation of hernias.
- axial compression of the vertebrae when lifting weights or their damage during excessive rotation (spinning).
- aseptic inflammation. Destruction of the nucleus leads to the release of sensitizing factors into the spinal canal. There is irritation of the nerve endings, which causes a spasm of the muscles that encroach on the adjacent vertebrae - above and below the hernia. Gradually, the reaction covers the entire lumbar region and leads to the fact that every movement causes a feeling of pain.
A weakened disc can rupture, resulting in bulging, protrusion or prolapse of the nucleus, and eventually herniation. The appearance of a hernia puts pressure on the spinal cord and spinal nerve roots. In such conditions, a pulsating pain in the lower back suddenly appears, which spreads along the strangled nerve. The best-known cases of compression of the sciatic nerve (sciatica), which are manifested by sharp pain along the back of the thigh and lower leg, numbness of the extremities on the side of the hernia, muscle weakness, involuntary pulling in of the leg.
Pain in the lumbar spine intensifies when sitting and standing, when turning, bending. Often there is a protective muscle reaction - painful muscle contraction (formation of rollers) on both sides of the spine, which isolates the department from unnecessary movement. Osteochondrosis then leads to sciatica (inflammation of spinal nerve roots).
Radicular syndrome is dangerous when the nerves of the lower back, which are responsible for the innervation of the internal organs (horns of the cauda equina), are pinched. At the same time, stomach pains occur, bladder and bowel function is disturbed, potency problems occur in men and gynecological diseases in women.
Many patients, due to the fact that the lower back hurts a lot, take analgesic positions - they move their body to the left, if the right side hurts, they lie on the right side. If the hernia is on the left side. The appearance of severe pain when pressing on the hernia in the intervertebral space (ringing symptom) is also characteristic.
How to treat if your back hurts due to osteochondrosis:
- during an attack of pain, you can take an anesthetic position - lie on your back and put a roller under your knees. It is also recommended to sleep on a hard surface;
- of analgesics, NSAIDs can be taken orally or as injections on both sides of the spine in the lumbar hotel;
- use local irritants as distraction therapy - mustard plasters, iodine mesh, pepper plaster and ointments;
- eliminate miotic spasm through manual therapy, acupuncture, vacuum massage, reflexology, gymnastics;
- during the calming of the acute period, mud treatment, ozokerite, heating can be used.
Treatment of pain in radicular syndrome includes:
- providing bed rest, lumbar traction (dry or under water);
- use of novocaine blocks at the site of injury, use of non-steroidal anti-inflammatory drugs or weak opiates;
- physiotherapy - microcurrent stimulation, electrophoresis with analgesics.
Indications for surgery are constant acute pain, as well as damage to the function of internal organs, development of limb paralysis, sequestration of a hernia in the spinal canal.
Degenerative inflammatory lesions
Spondylarthrosis (inflammation of the facet joints of the vertebrae) occurs with degeneration, reduction in the height and volume of the intervertebral discs. Pain in the lower back occurs due to overstrain of the capsule and increased pressure on the surface of the intervertebral joints. The pain causes the patient to bend more in the lower back, increasing the strain on the intervertebral joints. In particular, discomfort in the lower back is aggravated by wearing shoes with heels, long walks, dismounting from elephants, positions when the body deviates backwards, for example, when looking at something above the head.
In patients with this diagnosis, stiffness in the lower back is observed in the morning, the pain intensifies during the day or after exercise. It has a diffuse character and it is difficult to clearly indicate the boundaries: discomfort is determined in the gluteal muscles, inguinal region, lower abdomen and in the scrotum in men. This spondyloarthrosis differs from radicular syndrome, when you can pinpoint the source of the pain.
What can you do to relieve the pain? Lying down, bending the legs at the hip and knee joints usually helps.
Their preferred medications are non-steroidal anti-inflammatory drugs and non-narcotic analgesics.
Muscle relaxants are also added because they relieve muscle tension and improve spinal mobility.
Psychotherapy has a positive effect, because chronic pain puts the patient in a state of depression.
Spondylosis, unlike osteochondrosis, affects more the fibrous ring of the intervertebral disc and the anterior longitudinal ligaments. In this disease, the connective tissue structures are calcified with the formation of growths along the edges 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-inflammatory drugs, analgesics, and 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).
Note! In the advanced stage, osteophytes do not recede. Although they are small in size, the treatment is aimed at removing inflammation, pain, and improving metabolism. If the back does not hurt much, then nothing is done with the growths. If osteophytes cause persistent pain or are large, they can be removed during surgery.
Diseases of a tumor nature
Pain in the lower back can occur due to compression of the spinal cord by a tumor from the outside (extramedullary formations) and from the inside (intramedullary, originating from the cerebrospinal fluid itself).
Cells of various tissues can grow pathologically:
- fatty - a lipoma is formed;
- nerve roots - neuroma;
- vessels of the spinal cord - hemangioma;
- auxiliary tissue - glioma;
- bone tissue - osteosarcoma;
- cartilage - chondrosarcoma.
The tumor process, especially malignant, is characterized by a pain syndrome reminiscent of sciatica (it can be unilateral or bilateral), a general worsening of 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 front and on the side of the upper leg, incomplete paralysis of this area.
With a lesion in the region of the IV lumbar - II sacral segments, numbness of the paragenital region, impaired motor and sensory innervation of the gluteal muscles, the back of the thigh, calves, fecal and urinary incontinence is observed.
Pronounced disorder in the work of the pelvic organs occurs with a neoplasm in the area of the V-III sacral vertebrae. The patient suffers from sexual impotence or menstrual disorders, constipation or fecal and urinary incontinence.
Tumor treatment is specific, pain medications, and cancer medications are prescription medications.
As you can see, lower back pain is usually caused by pathologies of the musculoskeletal system. 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.