The back pain is the medical term for pain in the lower back, the lumbar region (see diagram). It is the most common form of back pain and most often without gravity. More than 80% of people will have low back pain one day and the prevalence of this disease continues to increase. It can occur at any age, with onset in adolescence and peaks around 45 years of age.
Types of low back pain: acute or chronic
Low back pain is the most common form of back pain. Indeed, the lumbar vertebrae are constantly solicited and support a significant part of the body weight, which makes it a fragile region.
Acute low back pain: lumbago
An acute pain that can last up to about 4 weeks (sometimes called kidney). Although it is short-lived, acute lumbar pain can cause a lot of discomfort, stop work for a while, and significantly interfere with daily activities. More than 90% of acute low back pain subsides or improves greatly by itself in 4 weeks or less.
Chronic low back pain
Constant pain that lasts more than 3 months. The causes of chronic low back pain are sometimes difficult to determine. People who suffer from it often have to consider making important changes to their lifestyle. About 5% to 8% of low back pain becomes chronic.
To find out more about chronic pain, consult our file: When we are in pain all the time…
Back pain is a complex problem that classical medicine alone cannot always relieve. In many cases, and especially if the pain is chronic, a comprehensive approach that considers psychological and emotional as well as physical factors is necessary. This can help to reduce the pain or at least learn to live better with it.
|The lumbar spine
The lumbar spine consists of 5 vertebrae: small cylindrical bones superimposed and empty in their center (see diagram). The spinal cord passes into this cavity. The marrow consists of a bundle of motor, sensory and associative nerve fibers. Between each vertebra is an intervertebral disc composed of soft tissue containing a “gel”? The function of the intervertebral discs is to allow vertebral mobility and shock absorption. The whole is surrounded by muscles, tendons and ligaments that ensure the stability and mobility of the delicate joints of the column. All these structures may be responsible for lower back pain.
Causes of Low back pain:
The back pain is a symptom whose causes are varied. In nearly 90% of cases, low back pain is benign, or “nonspecific”. This means that there is no major injury that could explain the pain. These can then be linked to the intervertebral discs, vertebrae, muscles, etc. Most of the time, it is impossible to pinpoint the origin of the pain, which disappears spontaneously in a few weeks.
For this reason, the doctor will not prescribe imaging examinations (radiography, scan, magnetic resonance) when the situation is clearly nonspecific, without any disturbing features. In other cases, especially in the presence of neurological symptoms, imaging is indicated. In rare cases, low back pain can be a sign of serious illness.
Here are the most common causes of pain.
- An injury to a muscle, tendon or ligament. It can come from an effort, an unusual twist or the accumulation of micro-lesions caused by repetitive movements. People in bad physical shape or exercising physical trades (construction, carrying heavy loads …) are the most at risk.
- Disc degeneration. With aging, the intervertebral discs lose their elasticity. There is disc degeneration in almost all people over 60 years. Some athletes also experience this problem around midlife, especially those who practice an activity resulting in pressure on the spine. This degeneration is not always associated with pain, but it can be involved in some lumbago.
- A herniated disc. It occurs when a portion of the gel contained in the intervertebral disc protrudes outward and compresses the nerve roots. Poor postures, excess weight, pregnancy and disc degeneration are the main causes of disc herniation.
- A gynecological problem. Many women have periodic or constant back pain due to painful periods, endometriosis, etc. The source of pain is not located in the lumbar region, but the pain still radiates in the lower back.
- The sliding of a vertebra on another vertebra (spondylolisthesis). This situation can occur because of congenital weakness in the vertebral structures or as a result of trauma.
- Arthritis, osteoarthritis or osteoporosis. These health problems are common in the elderly. If osteoporosis of the spine is important, this can cause a vertebral fracture. Some inflammatory rheumatism, such as ankylosing spondylitis, can also cause pain and stiffness in the lower back.
- In rare cases, low back pain can be caused by an abdominal aortic aneurysm, tumor, osteoporosis-related fracture, or infection.
Regardless of the origin of the back pain, there is often a contraction of the muscles located near the sore area. This is a protective reflex. This contraction can itself cause pain. A vicious cycle can then trigger and contribute to chronic pain.
Symptoms of low back pain
In reality, low back pain is not a disease but a symptom. Due to the complex anatomy of the lumbar spine and multiple causes of low back pain, the symptoms accompanying low back pain can vary considerably from person to person. For the same condition, 2 people can describe their pain in a very different way.
- If the lower back pain occurs suddenly and is manifested by a sudden and intense contraction of the muscles, it is usually the sign of muscle injury, ligament sprain, rupture or displacement of a disc. This type of pain typically occurs after a “wrong move” or after carrying a heavy load.
- When the pain descends along the posterior part of one or both legs, it may be a sciatic neuralgia, that is to say a “pinching” of the sciatic nerve. The pain is then exacerbated by coughing, sneezing or stress. This type of pain can also be a sign of a herniated disc.
- If the pain in the lower back is more intense at night, it can be caused by the pressure of inflammation , a diseased organ, or a tumor.
When to consult a doctor?
In some cases, back pain is caused by a serious illness, such as cancer, infection, or vertebral fracture. It is therefore imperative to consult a doctor without delay when the lumbar pains : – occur after a trauma (fall or stroke on the back, for example); – are constant and intensify, mainly at night; – occur after prolonged use of corticosteroids ; – radiate in one or both legs; – cause weakness, numbness or tingling in one or both legs; – coincide with the appearance of intestinal or urinary problems;
– are accompanied by chest or abdominal pain;
– are associated with urinary incontinence or loss of sensation in the perineal region;
– are accompanied by unexplained weight loss, chills or fever.
– occurs in persons under 20 or over 55 years of age.
– Occurs in a person with cancer, osteoporosis or HIV infection
– occurs in an intravenous drug user.
If there are no such alarms mentioned above, but the pain remains present a few days after onset, despite the self-treatment provided (see Medical Treatments section), it is also important to consult .
People at risk for low back pain
- People whose job requires long hours of sitting or standing.
- Workers called to lift or pull heavy loads.
- Workers who must frequently lean forward or torso side torso.
- The pregnant women because they carry extra weight from 9 kg to 12 kg and their hormones control a relaxation of muscle tissue (mainly in the pelvic area to facilitate childbirth, but also near the spine).
- People whose parent has suffered from disc degeneration, osteoarthritis or osteoporosis.
- Lack of physical training or overtraining.
- Bad postures
- Wearing shoes with high heels.
- The prolonged stress. Repressed emotions or an unsatisfactory work situation contribute to lower back pain. Stress increases muscle tension in the back.
- Depression, which can be both a cause and a consequence of chronic back pain.
|Risk factors for chronicity
In about 5% to 8% of cases, low back pain becomes chronic. Some factors are known to cause this chronic condition 45: being female, belong to a lower social class, being depressed or having undergone back surgery. In addition, dissatisfaction at work has a strong impact on the transition to chronicity. Finally, the fact of undergoing imaging tests and discovering the presence of the lesions (even if they are normal lesions related to aging) contributes to worsening the prognosis, worrying the person and preventing him from believing in his healing.
Prevention of low back pain
|Basic preventive measures|
|Some ways to reduce muscle tension in the back and reduce the risk of low back pain.
A healthy lifestyle
Think about it
|Measures to prevent recurrence|
|See the Complementary Approaches section.|
Medical treatments for low back pain
Rest the back
In acute pain, we try to control the pain. It is important to avoid sudden movements and to rest the back. A rest period of 48 hours is recommended. After, it is imperative to mobilize, even if the pain is still present. The strict bed rest that was prescribed in the past is proven to be ineffective and even deleterious.
The positions that best fit the lumbar spine are as follows.
- Lying on the side, knees bent, a pillow under the head and another between the knees (pregnant women can add a pillow under their belly).
- Lying on the back, no pillow under the head, with one or more pillows under the knees and a rolled towel or a small cushion in the hollow of the lower back.
The application of a hot water bottle or a heating belt lumbar reduces the pain. Some people prefer to apply ice, but studies have shown that the effect on pain was less important .
|It is important not to unduly prolong the rest period beyond 1 or 2 days and to resume activities as soon as possible. In general, bed rest should be avoided or kept as short as possible, as it is a factor that contributes to chronic low back pain. Inaction and immobility contribute to the atrophy and weakening of the back muscles. They can compromise the normal mobility of the joints of the lumbar spine.|
Acute low back pain
To control pain temporarily and for a short time, it is advisable to take acetaminophen (such as Tylenol ). The nonsteroidal anti-inflammatory drugs (Aspirin, Ibuprofen, including Advil, Motrin) or muscle relaxants (eg Robaxacet or Robaxisal) counter can also relieve pain. If the pain is intense and persistent, the doctor may prescribe more powerful painkillers (opiates). It is important to obtain effective pain relief, as suffering can lead to a fear of movement, which contributes to the chronicization of pain.
Chronic low back pain
Of cortisone injections close to the painful area are sometimes given in case of chronic pain.
Some antidepressants tricyclics may also be prescribed to relieve some chronic back pain. Indeed, they have an analgesic effect. If necessary, they can also treat a depressive syndrome, which can contribute to accentuate the pain.
Physiotherapy and exercise
The exercises and physiotherapy are not useful against pain in acute low back pain . On the other hand, people with subacute or chronic low back pain who maintain physical activity (stretching and strengthening exercises, walking, etc.) heal faster. A physiotherapy program is therefore often recommended for sub-acute low back pain. (Lasting for more than 4 weeks). At first, the sessions may be limited to gentle movements and the application of heat in the lumbar region. Gradually, the patient will learn a series of exercises that will be repeated daily at home to rehabilitate and rehabilitate the muscles and joints of the lumbar spine. The massage can be helpful.
After that, walking, swimming and road cycling (with a bicycle that is well adjusted to its size) are recommended as these are soft sports for the back. Yoga is also effective in relieving long-term low back pain. See the Complementary Approaches section.
Mind-body approaches (mind-body)
When the pain is chronic, we often have to make major changes to our lifestyle: change of work, renouncing certain activities, learning new postures, joining an exercise program, etc. In addition, the link between emotions and lower back pain seems more and clearer in the eyes of back specialists. Thus, believing in your recovery and giving less importance to pain (by learning to manage it better) increases the chances of recovery.
Mind-body approaches can help to make this important shift. The author of a synthesis of studies on pain control mentions that these approaches constitute a valid complementary treatment to treat chronic low back pain. In addition to reducing the intensity of pain, they help to better manage stress, to learn to relax and to have a more positive attitude. The cognitive behavioral therapy appears effective.
There is no clear recommendation about the lumbar belts (wide belts that wrap around the lower back), because data on their effectiveness are conflicting. In some cases, a lumbar belt can help relieve pain and help the person resume normal activity quickly. It also reduces the use of medication and reduces recurrence through a reminder to avoid “false movements”. In chronic low back pain, wearing a lumbar belt is also controversial. It is usually only recommended for certain situations that may revive pain: long trips, shopping, etc.
When a nerve is compressed, it can be decompressed by surgery. The procedure will be performed in the acute phase if a nerve linked to the sphincter of the bladder or anus is affected. Otherwise, if the affected nerve causes muscle weakness in the legs or feet, doctors usually only consider surgery when the situation does not improve with time and other treatments. In general, we decide not to operate if the compression causes only pain, without muscle weakness. According to studies, this type of surgery does not effectively relieve pain in the long term.
Research is currently taking place on replacement discs.
Reintegration at work
If low back pain has caused a prolonged work stoppage, help can be obtained from organizations that facilitate reintegration into the workplace. They will ensure, among other things, that the requirements of the job are well adapted to the physical capabilities of the person. They can also offer ergonomic advice. Check with your doctor.