What causes back pain in the lower back?

Back pain is one of the most common reasons for a patient to seek help from a neurologist or therapist. Lumbosacral spine pain can go away forever, making it impossible to move and take care of yourself. Acute low back pain affects both men and women equally. More often than not in middle-aged and older people, back pain can often be observed in adolescents and young adults. This is due to rapid growth, weakness in the fragile muscles of the lower back, injuries. Thus, lumbosacral spine pain is the most pressing problem that anyone can face.

An elderly patient saw a doctor with back pain

Possible causes of low back pain

Lumbosacral spine pain can be associated with processes occurring both inside and outside the spine.. . . Consider the main pathological conditions in which acute low back pain can be observed.

  1. The most common problem and cause of pain is lumbosacral osteochondrosis. . . This is caused by age-related changes in the spine, dystrophy (nutrition) of the relevant segments of the spine and cartilage, and a decrease in the height of the vertebrae. These pathological processes lead to bone growth and damage to nerve roots at the site of narrowing. As a result, there is severe pain in the lumbosacral spine. Osteochondrosis of the lumbosacral region develops more in obese people, but also in patients with prolonged physical exertion, which contributes to the erosion of all structures of the vertebrae. Frequent injuries, back falls, weight bearing, and concomitant osteoporosis aggravate the picture and course of the disease. Pain in the lumbosacral region is also associated with the involvement of paravertebral muscle fibers (causing muscle tension) and ligaments in the process.
  2. Herniated discs are an equally rare cause, the clinical manifestation is lumbosacral low back pain. In addition to long-term traumatic exposure, the intervertebral disc (inner nuclear pulposus) loses its elastic properties and elasticity with age. With continuous exposure (overweight, trauma, progressive osteoporosis), the disc fibrosis of the disc becomes thinner and defects appear. Through these weak points in the annulus fibrosis, the nuclear pulp of the disc can change and even come out.

    When the Hernulus fibrosus ruptures and the pulposus nucleus compresses the elements of the nerve roots that leave the spinal cord, a herniated disc is formed. Compression causes the pain in the lower back to be extremely intense, sometimes unbearable. Disc herniation may be accompanied by lumbosacral spinal pain, sensory disturbances in the relevant decompression segments, and various types of numbness. Low back pain spreads (gives) to the lower extremities, causing muscle tension due to spasm. A herniated disc that lasts for a long time causes chronic pain in the lumbosacral region. Back muscle tension steadily exacerbates the pain syndrome and becomes chronic.

  3. Narrowing of the spinal canal- Lumbosacral back pain is associated with prolonged walking or physical exertion. Acute low back pain may be accompanied by weakness in the legs, convulsive symptoms in the lumbar and gluteal muscles. With significant damage, there may be disturbances in sensory functions.
  4. Tumor lesion in segments of lumbosacral vertebraeoften manifests itself in varying degrees of pain in the lower back. Typically, back pain tends to worsen as the process progresses. The nature of the tumor lesion can be both benign (vertebral cysts) and malignant (metastatic lesions by a spinal tumor or a distant tumor). Due to its morphological nature, the tumor may be osteosarcoma, hemangioma or myeloma. With this pathology, pain in the lumbosacral region often bothers the patient both at night and at night (continuous, without light gaps), increasing at rest, shaking, hitting. Low back pain is accompanied by muscle tension, cramps, emotional disorders, weight loss, changes in the blood (anemia).
  5. Osteoporosis (bone loss)- is often the cause of pain in the bones of various localizations. Osteoporosis develops as a result of the rapid excretion of calcium from the bones, as a result of which all the bones become brittle and prone to fractures with little mechanical stress (often of a domestic nature). In osteoporosis, lumbosacral low back pain is associated with other bone pain, with moderate pain syndrome. Pain in the lower back, along with a decrease in the patient's neck, muscle tension, can cause cramps. The most common type of osteoporosis is postmenopausal, which develops in women after ovarian failure.
  6. Ankylosing spondylitisoften, it is characterized by pain in the lumbar region and ileosacral joint, along with pain along the spine. The disease over time leads to stiffness in the spine and the involvement of other peripheral joints in the chronic process.

In addition to these conditions, low back pain can have a number of causes that are not related to vertebrogenic defects:

  • kidney disease, renal pelvis(exacerbation of chronic pyelonephritis), urolithiasis of the kidneys, neoplastic diseases of the kidneys and metastases of tumors in the kidneys. At the same time, the pain in the lumbar region is slightly higher (at the projection of the kidneys), the pain in the lumbosacral region is not very typical. Pain is accompanied by other characteristic changes (frequent urination, dysuria, changes in urine analysis, temperature reaction);
  • diseases of the upper gastrointestinal tract(peptic ulcer, inflammation of the pancreas, pancreatic cancer) sometimes manifests itself as pain in the lumbosacral region at a certain localization. However, back pain is not related to movements and may be combined with other complaints (vomiting, stool discomfort, nausea, burning along the esophagus);
  • Acute low back pain can occur in some casesfor various inflammatory diseases of the female genital area(adnexitis, endometriosis), cancer (uterine cancer), fibroids, tumors of the abdominal cavity. In women, back pain sometimes occurs during or shortly before menstruation. There may also be heaviness and pain in the lower back and sacrum during pregnancy;
  • deformable osteoarthritis of the hip joint(coxarthrosis), especially with exacerbation of the process, along with gait discomfort, difficulty walking, may cause pain in the lumbosacral region in the muscles of the gluteal region on the relevant side of the lesion, tension in the muscles of the back and thighs.

Acute back pain: what to do?

If the patient has severe low back pain, it is necessary to immediately seek the help of a qualified specialist to determine the cause of the pain. More often, the patient goes to a neurologist, who diagnoses spinal disease after appropriate diagnosis (X-ray, computed tomography, MRI) and neurological examination.

In the absence of convincing data for spinal pathology (osteochondrosis, herniated disc), additional methods (ultrasound of internal organs, densitometry, pelvic ultrasound) and consultation with relevant specialists (oncologist, gynecologist, endocrinologist) may be required.

Treatment of low back pain

Acute low back pain, as prescribed by a doctor, is stopped with the appointment of non-steroidal anti-inflammatory drugs (tablets or injections), muscle relaxants, rest, bed rest, anti-inflammatory ointments. application of compresses. In the acute stage, treatment can be carried out in an inpatient setting or in an outpatient clinic.

With acute low back pain, prescribe drugs that improve microcirculation, used in blockade. Sometimes surgical treatment is resorted to by the ineffectiveness of other therapeutic effects (with compression of the nerve roots). When combined with osteoarthritis, chondroprotectors are used for a long time, in osteoporosis - calcium and vitamin D3. Physiotherapeutic effects (in the absence of contraindications), physiotherapy exercises and in the rehabilitation phase - follow-up treatment in sanatoriums can be used.