There is practically no person who at least once in his life would not experience back pain in the lumbar region. This is how we pay for walking uprightly and our daily habits.
In addition to injuries that can affect the spine, its muscles, nerves and ligaments, it should be borne in mind that sometimes the back hurts in the lumbar region with internal diseases - diseases of the kidneys, gastrointestinal tract and female genital organs.
Symptoms of low back pain can range from dull to sharp. The pain may go away on its own or become chronic (the symptom has been present for more than three months).
Dangerous! You should immediately consult a doctor if:
- pain in the lumbar region suddenly arose after an obvious back injury;
- the temperature has increased significantly, there are vegetative disorders, loss of consciousness, sweating, breathing difficulties;
- involuntary bowel and bladder emptying occurs;
- there is numbness in the hip area;
- there was weakness of the lower extremities, their paresis or paralysis, impaired sensitivity;
- pains are given to the stomach and increase significantly when you cough or sneeze;
- symptoms appeared against the background of sharp weight loss, prolonged use of steroids, lack of immunity;
- in the family history there have been cases of cancer, inflammatory or degenerative diseases of bone and cartilage tissue.
Why does the back hurt in the middle region?
Myofascial pain
A muscle strain or spasm can develop gradually or occur suddenly. With a high load, the damage affects not only the muscle fibers, but also the ligamentous apparatus and the fascia.
Muscular pain in the lower back appears after:
- lifting heavy weights or overexertion at work or playing sports;
- playing sports occasionally. Muscles are especially vulnerable if you are inactive during the work week and then spend hours in the gym on weekends;
- a sharp increase in the weight of one's own body, after which the muscles do not have time to grow;
- sitting or prolonged standing in an uncomfortable position;
- daily carrying a bag in one hand or over the shoulder;
- posture disorders. The back performs its best supportive and protective function when you are not bent over. The muscles in the lower back experience less stress when you sit with good support under the back and in a standing position, distribute the weight equally on both legs.
If the back hurts after a bruise, fracture, sprain, hypothermia, an infectious disease or an established 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 spasm. Inflammation can be acute or take a chronic form. With a long course of the disease, the pain is unstable, worsens by lying down or sitting for a long time, in the late afternoon or when the weather changes. Touching the muscles causes a feeling of pain and discomfort, the muscles of the lower back are in constant tension, inflammatory edema is formed, the temperature rises locally and at the level of the whole organism.
With muscle spasms, the roots of the spinal nerves are damaged, so the attacks often resemble a picture of sciatica or sciatica - there are strong burning pains along the back of the thigh and leg, the limbs become numb, they lose sensitivity. Pronounced muscle tone in miosis makes the patient take a forced position, he walks and lies bent, moves on bent legs.
How to treat muscular pains 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 a gradual release of active substances. Irritant and warming ointments are also used, which reflexively increase blood flow to the muscles of the lower back. A larger volume of incoming blood contributes to washing away 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 an infection or poisoning of the body with worm toxins, then antibiotics or anthelmintic drugs are used first. In this case, heating ointments or compresses cannot be used.
Diseases of the spine involving nerve endings
In the lumbar region, the vertebrae are separated by elastic cartilage discs, which protect the spine from injury, but are themselves subject to wear and tear.
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 hold water: when the load increases, it accumulates water, and the elasticity increases, when the pressure decreases, the core releases water and becomes flatter.
Osteochondrosis in the vertebral region develops when the intervertebral discs are malnourished (their "drying") or with excessive local load. Most often, back pain is due to the fact that the lower poles of its intervertebral discs bear the greatest load when you are sitting, when you lift weights in front of them. At the same time, tears, displacements are formed in the discs, the vertebral ligaments are damaged, there is a constant aching pain, throbbing.
Back pain has several mechanisms of development:
- violation of microcirculation in the tissues surrounding the spine and, in particular, in the spinal canal, the formation of congestion and edema. Such conditions develop against the background of hypothermia, overheating, inflammatory processes.
- degenerative processes in the fixation ligaments of the spine. Increased mobility of the vertebrae leads to their easy displacement and non-physiological compression, which causes damage to nerves, blood vessels and the formation of hernias.
- axial compression of the vertebrae during weight lifting or their damage during excessive rotation (twisting).
- aseptic inflammation. Destruction of the core 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 affect the neighboring vertebrae - above and below the hernia. Gradually, the reaction covers the entire lumbar region and leads to the fact that every movement causes a sensation of pain.
A weakened disc can rupture, resulting in a bulge, protrusion or prolapse of the nucleus and eventually a herniation. The appearance of a hernia puts pressure on the spinal cord and spinal nerve roots. In such conditions, a throbbing pain in the lower back appears sharply, which diverges along the pinched nerve. The most common cases of compression of the sciatic nerve (sciatica), which are manifested by sharp pain along the back of the thigh and in the lower part of the leg, numbness of the limbs on the side of the hernia, muscle weakness, involuntary tightening of the legs.
Pain in the spine is aggravated in the sitting and standing position, when turning, tilting. Often there is a protective reaction of the muscles - a painful contraction of the muscles (formation of rolls) on both sides of the spine, which isolates the department from unnecessary movements. Osteochondrosis then leads to the appearance of sciatica (inflammation of the 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 pressed. At the same time, the stomach hurts, the function of the bladder and intestines is disrupted, there are problems with potency in men and gynecological diseases in women.
Many patients, due to the fact that the lower back hurts a lot, take analgesic positions - they turn the body to the left, if the right side hurts, lie on the right side. If the hernia is on the left. Also characteristic is the appearance of severe pain when a hernia is pressed in the intervertebral space (ringing symptom).
How to treat if your back hurts with osteochondrosis:
- during a pain attack, you can take an anesthetic pose - lie on your back and put a roller under your knees. It is also recommended to sleep on a hard surface;
- of the analgesic drugs, NSAIDs can be taken orally or as injections on both sides of the spine in the lumbar hotel;
- use local irritants as a distraction therapy - mustard plasters, iodine mesh, peppercorns and ointments;
- elimination of miotic spasm through manual therapy, acupuncture, vacuum massage, reflexology, gymnastics;
- during the mitigation of the acute period, mud treatment, ozocerite, heating can be used.
Treatment of pain in radicular syndrome includes:
- providing bed rest, lumbar traction (dry or under water);
- the use of novocaine blockades at the site of the violation, the use of NSAIDs or weak opiates;
- physiotherapy - microcurrent stimulation, electrophoresis with analgesics.
Indications for surgery are persistent acute pain, as well as impaired 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 height and volume of the intervertebral discs. Pain in the lower back is caused by excessive stretching 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, thus increasing the overload of the intervertebral joints. Especially discomfort in the lower back is aggravated by wearing high-heeled shoes, walking for a long time, descending 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 increases during the day or after exercise. It has a diffuse character and it is difficult to clearly indicate the boundaries: the discomfort is determined in the gluteal muscles, the inguinal region, the lower abdomen and the scrotum in men. This spondyloarthrosis differs from radicular syndrome, when you can accurately identify the source of the pain.
What should be done to relieve the pain? It usually helps to take a lying position, bending the legs at the hip and knee joints.
Their preferred drugs are non-steroidal anti-inflammatories and non-narcotic analgesics.
Muscle relaxants are also added as they relieve muscle tension and improve spinal mobility.
Psychotherapy has a positive effect, as chronic pain puts the patient into a state of depression.
Spondylosis, unlike osteochondrosis, affects more the fibrous ring of the intervertebral disc and the anterior longitudinal ligaments. With this disease, calcification of connective tissue structures occurs with the formation of growths along the edge 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, vitamins. A good effect is given by electrophoresis with novocaine, lidase, manual therapy, physiotherapy (amplipulse, laser installation, shock wave therapy for the destruction of compressed elements and increasing spinal mobility).
Note! In the advanced stage, osteophytes do not resolve. While their size is small, the treatment is aimed at eliminating inflammation, pain, improving metabolism. If the back does not hurt much, then nothing is done with the increases. If the osteophytes cause persistent pain or are large, they can be removed during surgery.
Tumorous diseases
Lumbar pain can occur from compression of the spinal cord by a tumor from the outside (extramedullary formations) and from the inside (intramedullary, originating from the cerebrospinal substance 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 resembling sciatica (it can be unilateral and bilateral), a general deterioration of the patient's condition and exhaustion.
If the pathology affects the area of lumbar vertebrae I-IV, then there is a burning pain in front and on the sides of the upper part of the thigh, incomplete paralysis of this area.
With a lesion in the region of sacral segments IV lumbar - II, there is numbness of the paragenital region, impaired motor and sensory innervation of the gluteal muscles, back thigh, calf, fecal matter and urinary incontinence.
A marked disturbance in the functioning of the pelvic organs occurs with a neoplasia in the region of the V-III sacral vertebrae. The patient suffers from sexual impotence or menstrual disorders, constipation or faecal and urinary incontinence.
Tumor treatment is specific, painkillers and cancer drugs are prescription drugs.
As you can see, lower back pain is usually caused by musculoskeletal pathologies. They can be diagnosed with 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 have lower back pain, we recommend that you always seek the advice of a neurologist or orthopedist.