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Lumbar Pain: Causes and Treatment

Lumbar pain is one of the most common health problems regarding the hospital applications and rate of labor loss. A sudden and unusual movement during the routine daily life, e.g. lifting a heavy object, may cause severe lumbar pain with sudden onset.

Most of the lumbar pain reliefs with simple precautions within a few weeks. However, in a minority of patients, pain persists and additional treatments are needed.

CAUSES of LUMBAR PAIN

Prolonged contraction of the muscles and ligaments: Lifting heavy loads or sudden movements may injure the lumbar muscles and ligaments supporting the spinal column. Painful muscle spasms are common in persons with restricted mobility due to the persistent load on the lumbar region.

 

Disc herniation: There are disc-shaped pillow-like structures between the vertebras. The soft part in the middle of the disc may be displaced. In more severe cases, the fibers surrounding the disc may tear and the content of the disc may protrude and compress the spinal nerves and medulla spinalis. However, an anomaly in the disc does not necessarily mean that the pain is caused by the bulging disc..

 

Sciatica pain: The spinal nerves compressed due to hernia and calcifications may cause a sharp and severe sciatica pain starting from the hip and back side of the leg and spreading to the foot.

 

Skeletal deformities: The spinal column should be straight from the back and front view. The waist has a normal curvature from the side view. The deviations from the normal anatomy (scoliosis, flatback syndrome, herniation) are risk factors for the lumbar pain.

 

Osteoarthritis: In the osteoarthritis (also called spondylosis), the corners of the bones proliferate and narrows the spinal canal and holes, through which the spinal nerves pass through. This deformity is called spinal stenosis. The erosion in the facet joints between the vertebras may cause painful disorders called facet syndrome.

 

Osteoporosis: Isolated osteoporosis does not cause pain. However, the compression fractures related to the osteoporosis may occur. Compression fractures may lead to complaints such as kyphosis, height loss, and pain.

 

Other problems related to bones: Paget’s disease, osteoid osteoma, fractures etc.

 

Rheumatoid diseases: Ankylosing spondylitis, psoriatic arthritis, rheumatic manifestations of the inflammatory bowel disease may cause lumbar pain.

 

Other causes: The lumbar pain may not always be caused by the musculoskeletal system. Kidney stones, problems of the aorta (weakening, aneurysm and rupture of the aortic wall), tumor in the abdomen or chest, infections (brucellosis, tuberculosis, zona zoster) may also cause lumbar pain.

The anatomy of the lumbar region

The spinal column protects the spinal cord, carries the body, and enables movements like bending and standing. The discs between the vertebras and the muscular structures surrounding the spine enable the mobility while the bones and ligaments of the hip are responsible for the functions like protection and load carrying. The spinal cord, which is a very sensitive organ, is localized through the canal in the middle of the spine. The nerves originating from the spinal cord pass through the small holes in the vertebral bodies and extend to the legs. Several problems in this complicated region may cause pain.

 

Other symptoms accompanying lumbar pain

During the lumbar pain; muscular cramps, different sensations extending from blunt pain to knife-like pain and pain spreading to the legs may emerge. Bending, load lifting or walking may aggravate pain. Pain can be relieved with the supporting the lumbar region or repositioning of the spine at a certain angle. In other words, functional scoliosis may develop due to the temporary muscular spasms in some patients with lumbar pain.

 

For what kind of pain you should visit a physician?

Most of the lumbar pain recover within a few weeks simultaneously with the implementation of simple methods. If the pain persists, a visit to the physician becomes necessary. In rare cases, it may be a sign of serious diseases. Therefore, you should not waste time. Bladder and bowel problems with a new onset (urinary hesitancy, incontinence, inguinal paresis), fever, pains after falls or trauma are important reasons to visit a physician. If pain is very severe and does not disappear with resting, spreads down to one or two legs, particularly to the area under the knee, if there is loss of strength in legs (inability to flex and extend the toes or ankle), paresis and tingling, an unexplained weight loss, you should visit a physician without wasting time.

 

A lumbar pain emerged after 50 years of age, previous history of cancer, long-term steroid treatment, and extensive alcohol consumption may require further investigation.

 

How to differentiate between acute and chronic lumbar pain?

Lumbar pain lasting shorter than six weeks is called acute lumbar pain. On the other hand, pain persisting longer than 3 months is called chronic pain.

 

 

In whom is lumbar pain more common? What are the risk factors?

Everyone including children and youngsters may complain from lumbar pain. Following factors may increase the incidence of lumbar pain:

  • Age: Old problems accumulate and osteoarthritis may develop in addition to them.
  • Sedentary Lifestyle: Sitting in a bent position for a long time (office work, driving etc.), standing for a long time, lying without spine support may increase the risk of lumbar pain.
  • Occupational Stresses
  • Lumbar pain increases during the pregnancy due to the weight gain and the increase in the flexibility of the connective tissue.
  • Obesity
  • Load lifting and carrying in a wrong body position
  • Psychological problems (stress, anxiety)
  • Structural and genetic risk factors (spine deformities, genetic disorders with unusually flexible connective tissue etc.)
  • Smoking
  • Additional diseases like cancer or rheumatism

 

How can be the lumbar pain prevented?

Lumbar pain can be prevented or relieved with very simple precautions.

  • Exercise (aerobic exercise like swimming, running are very useful in several conditions, particularly for cardiovascular diseases. If you have never exercised before, you should first consult a doctor).
  • Strengthening the arm muscles
  • Weight maintenance
  • Smoking cessation
  • Correct body position during sitting and standing
  • Using a bed with spine support.

 

How can lumbar pain be diagnosed?

The diagnosis is mainly based on medical history and physical examination. Visual inspection, palpation, detection of the movements creating and aggravating the pain, muscle strength, sensorial and reflex examination are the main parts of the examination. The physician diagnoses the condition after the initial examination and asks for further examinations if he/she wants to confirm the diagnosis and to exclude other possible conditions. X-ray, MRI, CT, scintigraphy, blood, and urine examinations, and electromyography (EMG) may be needed.

 

 

Treatment of the Lumbar Pain

 

The majority of the acute lumbar pains can be alleviated with some simple precautions within a few weeks. However, in a small group of patients, pain persists and additional treatments become necessary.

You may use simple analgesics. Cold treatment for 1-2 days followed by heat treatment can be applied by the patient. Bed rest is not recommended. You should keep on with the daily activities, but you should avoid extensive movements.

In more severe cases, you may use muscle relaxants, second or third line analgesics, and steroid injections if prescribed by a physician. Some antidepressants are useful in the treatment of chronic lumbar pain.

The chronic lumbar pain can be explained with the biopsychosocial approach. In other words, this kind of pain may be caused by biological as well as by psychological and social factors. Patient education has an important role in the integrative approach. Information about the lumbar anatomy, active lifestyle, exercises strengthening the hip and waist, training of protective waist movement, avoidance of stress are the most important components of the education.

 

Physiotherapy In Lumbar Pain?

Heat treatment, therapies including electrical current (TENS, electrical stimulation etc.), ultrasound therapy, traction, manual therapy and massage are used in the physiotherapy of lumbar pain.

Stretching movements for the lumbar muscles, strengthening the hip and waist muscles, posture correction are useful. Special exercise techniques like yoga, plates may be preferred in suitable patients.

 

Alternative and Complementary Medical Methods

Methods such as acupuncture, cupping, ozone therapy, prolotherapy, neuraltherapy can provide good results, if they are implemented by certificated practitioners in suitable patients.

 

Surgery

Surgical intervention is rarely necessary in patients with lumbar pain. Patients with persistent pain spreading to the legs, progressive weakness in legs and feet due to the spinal nerve compression may benefit from the surgery. Except for these conditions, physiotherapy is the first choice of treatment in spinal stenosis and disc hernia.