Lower back pain
Lower back pain indicates a disease or damage to the spinal column, nerve structures, soft tissues, internal organs, observed in feverish conditions of various genesis. It can be acute, blunt, constant, periodic, burning, shooting, bursting. Sometimes it is associated with physical activity, weather changes. Pathologies manifested by lower back pain are diagnosed on the basis of complaints, anamnesis, examination data and additional studies: radiography, MRI, CT. Before the diagnosis, rest is necessary, sometimes it is permissible to use ointments, taking analgesics.
Why does the lower back hurt
Diseases of the spine
Curvature of the spine
Osteoporosis
Spinal injuries
Soft tissue and kidney injuries
Infections of the spine and spinal cord
Local inflammatory processes
Infectious diseases
Other muscle lesions
Other diseases
Diagnostics
Treatment of lower back pain
Assistance at the pre-hospital stage
Conservative therapy
Surgical treatment
Prices for treatment
Why does the lower back hurt
Diseases of the spine
A common cause of lower back pain is congenital anomalies and acquired diseases of the spinal column. The nature of the pain syndrome varies. The pain caused directly by the pathological process is more often periodic, local, aching or pulling, associated with the weather, physical exertion, being in an uncomfortable position.
Lumbago (lumbago) occurs due to muscle spasm – sharp pain accompanied by restriction of movements. With many pathologies of the spine, lumboishialgia is observed – aching, burning or shooting pain in the lower back, radiating along the back of the thigh. Painful sensations are often found as part of the root syndrome. They can be detected in the following diseases of the spinal column:
Degenerative pathologies: osteochondrosis, intervertebral disc protrusion, intervertebral hernia, spondylosis, spondyloarthrosis.
Congenital anomalies: sacralisation, lumbalisation.
Polyethological conditions: spondylolysis, spondylolisthesis.
Vascular diseases: disorders of cerebrospinal circulation.
Other diseases: Forestier’s disease.
Secondary lesions of nervous structures: lumbosacral radiculitis, lumbosacral plexitis, myelopathy of various genesis.
Curvature of the spine
Minor or moderate aching pains are noted with all types of curvature of the spinal column, which is associated with non-physiological redistribution of load, overstrain of the muscles and ligaments of the back. Soreness appears due to an uncomfortable position of the body, sleeping on a bed that is too hard or too soft. The symptom is accompanied by:
lordosis;
kyphosis;
scoliosis;
kyphoscoliosis;
flat back syndrome.
Lower back pain
Lower back pain
Osteoporosis
Pulling or aching painful sensations in the lumbar and thoracic spine for a long time are the only symptom of osteoporosis. The pain syndrome is expressed slightly, it increases after exertion, before changing weather conditions. The symptom is observed in the following types of osteoporosis:
postmenopausal;
juvenile;
idiopathic;
senile.
Similar pains are detected in patients with secondary forms of pathology caused by genetic diseases, endocrine disorders, chronic intoxication, taking certain medications. Secondary osteoporosis can also occur against the background of malabsorption syndrome, liver diseases, CRF, rheumatoid arthritis, SLE.
Increased soreness, increased duration of pain may be associated with the development of a pathological fracture. Other signs of injury are often not pronounced, so the fracture often remains undiagnosed.
Spinal injuries
The most common injury is a contusion of the spinal column. In mild cases, the pathology is manifested by moderate pain in the lower back, which increases with movements, local edema, sometimes – hematomas and hemorrhages. With severe bruises, neurological disorders are added to the listed symptoms.
Compression fracture of the lumbar spine occurs due to forcible flexion of the trunk. It is characterized by sharp pain, breath retention at the time of injury. Then there is an increase in soreness when turning the body, soft tissue edema is detected. Palpation of the spinous process is painful. Other possible fractures include damage to the arches, transverse processes, spinous processes.
In addition, lower back pain is found in patients with traumatic spondylolisthesis and subluxation of the vertebrae. The painful sensations are paroxysmal, reminiscent of lumbago, complemented by a feeling of heaviness and numbness of the lower extremities.
Soft tissue and kidney injuries
Soft tissue injury is accompanied by minor or moderate rapidly subsiding local pain, slight swelling. Hemorrhages are possible. There is no admixture of blood in the urine. Bruises of the kidney are manifested by soreness and minor short-term hematuria. With moderate kidney injuries, the pain syndrome is intense, the pain radiates to the lower abdomen, groin, genitals. A hematoma is visible in the lumbar region. In severe cases, severe pain and prolonged macrohematuria are observed. A state of shock develops.
Infections of the spine and spinal cord
Osteomyelitis of the spine can be hematogenic, post-traumatic, contact, postoperative. The acute form of the disease is manifested by rapidly increasing pain in the lower back, combined with chills, fever, intoxication syndrome, deterioration of the general condition. The pain is twitching, bursting, so intense that it prevents any movement, forcing the patient to freeze in bed. In chronic osteomyelitis, the manifestations are smoothed out, a fistula with a purulent discharge is formed.
Tuberculosis of the spinal column develops gradually. At first, there are periodic deep pains that increase after exertion, increased skin sensitivity in the projection of the affected vertebrae. Stiffness of gait is formed. Against the background of significant destruction of bone structures, the nature of pain changes, since it is caused by compression of nerve roots. The pains become burning, radiate into the legs, are supplemented by paresthesia, numbness.
In patients with spinal epidural abscess, the pain is severe, deep, diffuse, combined with chills, hyperthermia, muscle tension. Tapping on the spinous processes of the vertebrae is painful. With the progression of pathology, a radicular syndrome occurs, then paresis develops, violations of the pelvic organs.
Local inflammatory processes
Purulent processes in the superficial tissues and perinephrine tissue are accompanied by intense pain in the lower back. Possible causes of pain syndrome are boils, carbuncles and paranephritis.
In the first two cases, an abscess forms in the skin, looks like a limited, sharply painful seal with a diameter of 1 cm of a purplish or purplish-bluish hue with one or more rods in the center. The pain quickly intensifies, becomes twitching, throbbing, sleep-deprived. There is a general hyperthermia, a slight or moderate violation of the general condition.
With paranephritis, a pronounced fever occurs at first. Pain syndrome develops after 2-3 days. The pain is very intense, it can give to the abdomen or hypochondrium, it increases with walking, movements, deep breathing. In some forms of paranephritis, due to pain, the patient assumes a forced position. The lumbar muscles are tense. Edema, local hyperemia, hyperthermia are detected. The condition is serious.
Infectious diseases
Diffuse aching pains in the lower back, causing a desire to change the position of the body, are characteristic of acute infections accompanied by fever and intoxication syndrome. In most cases, they are caused by myositis, often combined with pain in the muscles of the extremities. They are observed with influenza, sore throat, ARVI. Sometimes pain is provoked by kidney damage. The number of infectious diseases accompanied by soreness in the lower back area includes:
hemorrhagic fevers;
japanese mosquito encephalitis;
Ebola fever;
foot – and – mouth disease;
severe form of coronavirus infection;
generalized forms of bacterial, fungal, and viral infections.
In a number of patients, lower back pain is observed with cytokine storm – an inflammatory reaction that develops against the background of severe infectious diseases. Epidemiological myalgia is accompanied by intense paroxysmal pains lasting up to 10 minutes, which appear not only in the lower back, but also in other parts of the back, in the abdominal wall, chest, limbs. Repeated at intervals of 30-60 minutes. Combined with rhinitis, conjunctivitis, severe hyperthermia.
Other muscle lesions
Aching pain in the muscles of the lumbar region is determined after intense physical exertion – performing strength exercises for the back muscles, prolonged stay in a forced position with a strained lower back. Myalgia subsides at rest, increases with movements, weakens after warming up, careful warm-up, disappears after a few days.
Myositis develop not only in infectious diseases, but also after hypothermia or overload, against the background of exogenous intoxication, metabolic disorders. Accompanied by prolonged aching pain. There are also special forms of myositis:
specific infectious myositis in syphilis and tuberculosis;
idiopathic, juvenile dermatomyositis and polymyositis;
polymyositis and dermatomyositis in oncological pathologies, systemic diseases of connective tissue.
Chronic diffuse pain throughout the body, including the lower back, is observed with fibromyalgia. Combined with sleep disorders, asthenia, neurotic disorders.
Other diseases
In addition to these pathologies, lower back pain can be bothered with conditions such as:
Tumors of the spine, spinal cord: sarcoma, hemangioma, metastases, intramedullary and extramedullary neoplasms of the spinal cord.
Kidney diseases: pyelonephritis, glomerulonephritis, urolithiasis, kidney infarction, renal vein thrombosis, kidney cyst, kidney cancer, purulent processes.
Hereditary diseases: hereditary cerebellar ataxia of Pierre-Marie.
Exogenous intoxication: abuse of phenylpropanolamine.
Pathology of the heart and blood vessels: Leffler’s endocarditis, abdominal aortic aneurysm.
Emergency conditions: hemotransfusion shock.
In diseases of the small pelvis, there is sometimes an irradiation of pain syndrome in the lower back. The appearance of the symptom is possible with a number of female diseases, prostate cancer, proctitis, sigmoiditis.
Diagnostics
The primary diagnosis is carried out by an orthopedic traumatologist. In the presence of neurological symptoms, the patient is examined by a neurologist. The doctor interviews the patient, performs an objective examination. According to the indications, consultations of a surgeon, rheumatologist, urologist, and other specialists are prescribed. The diagnostic program may include:
Neurological examination. During the study, the specialist evaluates reflexes, muscle strength, coordination of movements, deep and superficial sensitivity.
Radiography. Radiographs of the lumbar spine show fractures, a decrease in the height of the intervertebral discs, other degenerative changes, bulky formations, signs of inflammatory processes, spondylolisthesis. If necessary, standard radiographs are supplemented with functional studies.
Other neuroimaging techniques. CT and MRI are used to clarify the radiography data. During computed tomography, the structure of solid structures is studied in detail, and the condition of ligaments and intervertebral discs is examined on MRI. To exclude stenosis, myelography is performed.
Functional studies. The condition of muscles and nerve conduction is assessed using electromyography, electroneurography, and evoked potentials studies.
Laboratory tests. To confirm the infectious nature of the disease, blood tests and microbiological examination are performed to determine the pathogen. Serological reactions are used to detect neuroinfections.
According to the indications, ultrasound of the kidneys, prostate, pelvic organs, urine tests, ultrasound of the abdominal aorta, and other studies are performed.
Manual therapy
Manual therapy
Treatment of lower back pain
Assistance at the pre-hospital stage
In case of traumatic spinal injury, the patient must be placed on a shield and immediately taken to a medical facility. In case of non-traumatic pain, it is necessary to reduce the load on the back, optimize the position of the body during work and rest. Acute pain syndrome is an indication for a neurologist’s consultation.
Before the specialist’s examination, a single dose of analgesics is possible. With lumbago, lumboishialgia caused by previously diagnosed degenerative diseases of the spine, the use of local warming and painkillers is allowed. If an infectious process is suspected, local remedies are not shown.
Conservative therapy
The basis of treatment is physiotherapy and drug therapy. The patient is prescribed a protective regime. The following methods are used:
NSAIDs. Effective for acute and chronic pain in the muscles and spine. They are used in the form of tablets, topical agents.
Neurotropic vitamins. Patients are injected with vitamins of group B, which enhance the effect of drugs of other groups, contribute to the reduction of pain syndrome.
Local anesthetics. With persistent and acute pain, therapeutic blockades with anesthetics are performed. To improve the result of treatment, painkillers are combined with glucocorticosteroids.
Physiotherapy. Ultrasound, magnetotherapy, percutaneous electrical stimulation, laser therapy, medicinal electrophoresis are used. It is possible to prescribe massage, manual therapy, acupuncture.
Surgical treatment
Taking into account the peculiarities of pathology , the following surgical interventions are performed:
Instability: interbody fusion, transpedicular fixation, plate fixation.
Tumors, osteoporosis, osteomyelitis, tuberculosis: sequestrectomy, vertebroplasty, kyphoplasty, corporectomy.
Intervertebral hernias: discectomy, microdiscectomy, nucleoplasty.
Narrowing of the spinal canal: laminectomy, facetectomy, puncture decompression of the disc.
In the postoperative period, analgesics and antibiotics are prescribed. Rehabilitation activities include physical therapy, massage, physiotherapy.
