Back pain in the lumbar region: causes, types of pain, treatment

The discomfort that brings pain in the lumbosacral spine can be temporary or permanent, weak and aggravated by any external factors, etc. Pain in the lower back is not an independent disease, but is a sign of some kind of disorder in the body. This disorder may be associated with the musculoskeletal system or problems with internal organs. If you ignore the signal that your body sends, in addition to discomfort, this can also lead to a deterioration in your health in general and impaired motor functions in particular.

Main causes of lower back pain

The overwhelming number of visits to the doctor with such a complaint are associated with pathology of the lumbar spine - with degenerative-dystrophic changes in the osteoarticular apparatus of the back. However, the pain may be caused by diseases of an infectious-inflammatory or other nature. Let's take a closer look at them.

Ankylosing spondylitis

Another name is ankylosing spondylitis (spondylitis). One of the systemic connective tissue diseases. Characterized by non-infectious inflammation of the spinal structures. The vertebrae gradually fuse with each other, which limits the range of movements in the affected area - ankylosis is formed. The paravertebral ligaments ossify. Gradually, the spinal column completely loses the ability to bend and turns into one solid bone.

It debuts in young people, the first symptom is pain in the back, in the lumbar region of the back, which, as the pathology progresses, spreads to other parts of it. At first they occur only from time to time, but very soon they become permanent, decreasing temporarily only after taking the drug.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Other characteristics of pain:

accompanied by a feeling of stiffness of movements;
more pronounced in a state of rest, especially painful in the second half of the night, in the morning;
their intensity decreases after active movements - physical exercise, as well as after taking NSAID medications.

It is accompanied by damage to joints located remote from the spine - morning stiffness occurs in them, and during exacerbation there is intense pain, swelling and hyperemia (redness) of the soft tissues around them.

Hernia and osteochondrosis

Osteochondrosis is characterized by malnutrition and subsequent destruction of the cartilage tissue of the intervertebral discs, hernial protrusion of the latter towards the spinal canal, the formation of marginal growths of bone tissue in the areas adjacent to the affected discs, as well as arthrosis of the spinal joints.

All these changes lead to the appearance of dorsalgia - a constant aching or shooting acute pain in the lower back, often radiating (radiating) to the buttock area, to the legs, accompanied by weakness of the limbs and numbness. Locally at the site of the lesion, it is possible to palpate (feel) the tense paravertebral muscles, and the patient at this moment notes an increase in discomfort. Pinching of the nerve roots by a spasmodic muscle is accompanied by a burning sensation, tingling, numbness or a feeling of “crawling goosebumps”.

Intervertebral hernia is a complication of osteochondrosis, in which a fragment of the intervertebral disc protrudes or falls into the spinal canal. At an early stage it is asymptomatic, but as it progresses it leads to gradually increasing frequent back pain and limited range of motion in the affected part of the spine.

Unpleasant sensations intensify with high physical activity, static load on the lower back (during a long stay in a standing or sitting position), limit movements, and sometimes there are “lumbagoes” radiating to one or both buttocks and lower limbs. Severe hernias are accompanied by decreased sensation in the legs, which does not recover after rest, as well as dysfunction of the reproductive system and pelvic organs.

Kyphosis and scoliosis

With curvature of the spine, the back also hurts in the lumbar region. According to its anatomy, the spinal column is not a strictly straight structure, it has physiological curves: forward - cervical and lumbar lordosis, backward - thoracic and sacral kyphosis. The bends are necessary to ensure that the load is distributed evenly across the vertebrae; they help the post to absorb shock during movements.

In some congenital diseases, the curves are formed incorrectly; changes in their depth can also be observed in a number of acquired pathologies. Lumbar lordosis is often smoothed out against the background of spondylitis and spondyloarthrosis (degenerative-dystrophic and inflammatory processes in the joints between the vertebrae). Kyphosis also forms due to injury.

Lumbar scoliosis (sideways curvature) develops in response to curvature of the thoracic spine compensatory (the body strives to gain stability and distribute the load more evenly). Visually, it is manifested by an S-shaped back, asymmetry at the waist and shortening of the lower limb. Lumbar scoliosis is a fairly rare condition - the curvature develops mainly in the thoracolumbar column.

The initial stages of kyphosis and scoliosis occur without any symptoms. As the disorders progress, the patient notes fatigue of the back muscles, especially towards the end of the working day, periodic pain appears, which later becomes constant. By nature, these are unpleasant, dull, pressing or aching pains, more pronounced during exercise, less so after rest.

Spondyloarthrosis

A degenerative-dystrophic disease characterized by the destruction of articular cartilage in the vertebrae and the formation of bone growths on them - osteophytes. As a result, the spinal canal narrows to the point that in some areas the spinal cord begins to be compressed. In recent years, spondyloarthrosis has become significantly younger - it develops in people who have reached 30-35 years of age, but more often in mature and elderly people.

The signs are:

chronic low-intensity or moderate-intensity pain at the lumbar level, spreading to the buttock, hip joint area on the right or left, intensifying with exercise, as well as during walking or long standing, decreasing after rest;
palpation - muscle tension and soreness at the site of the lesion;
decreased mobility of the spine;
when the spinal cord is compressed - numbness, weakness of the lower extremities, dysfunction of the pelvic organs.

Protrusion

It is characterized by the appearance of an unnatural protrusion of the intervertebral disc while maintaining the integrity of its fibrous ring. It is a consequence of the progression of osteochondrosis and other degenerative diseases. If timely assistance is not provided to the patient, it leads to the formation of a hernia.

Factors provoking the development of protrusion:

spinal injuries;
increased load on the lower back as a result of a person’s excess weight or work associated with heavy physical labor or heavy lifting;
multiple microtraumas of the intervertebral disc;
weakness of the back muscles;
sedentary lifestyle;
heredity.

Manifestations of this pathology are:

feeling of discomfort, tension, chronic pain in the affected area of the back
decreased range of motion in the area of protrusion;
chilliness, numbness, discomfort in the lower extremities.

Arthritis

Arthritis of the joints of the spine is a fairly rare problem, but its occurrence significantly affects human health. This is an inflammatory process of an infectious or non-infectious nature, which is accompanied by pain in the affected joints. It can be chronic, being dull and aching, or be acute, sharp, severe, taking on the character of lumbago in the lower back that occurs after overwork or hypothermia. There is pronounced stiffness in the back after a long stay at rest in one position.

Osteomyelitis

A serious disease of a bacterial nature, characterized by purulent-necrotic inflammation of bone tissue. Initially, it is acute in nature - a paroxysmal, sharp, bursting pain appears, which, if left untreated, becomes chronic - its intensity decreases, its character changes to aching, dull, constant. These sensations are more pronounced when moving, but at rest they also persist and do not go away completely. There are also manifestations of general intoxication of the body - low-grade fever (slight increase in body temperature), weakness, fatigue, headache, sweating.

Pancreatitis

It is also accompanied by back pain: if the head of the pancreas is affected, it hurts in the right hypochondrium, the body - in the epigastrium (upper abdomen in the middle), the tail - in the left hypochondrium. If the inflammatory process affects the entire gland completely, the pain is characterized as girdling, radiating to the lower back, groin area, and perineum. It occurs after eating or physical activity, it can be pulling, cutting, stabbing, and sometimes occurs in the form of severe attacks.

Spinal stenosis

It is a complication of protrusion or herniation of the intervertebral disc. These pathological formations compress the roots of the spinal nerves, causing disruption of their function: numbness, weakness, tingling, dim comfort along the nerve. The pain is also observed at rest, and when a person walks, it intensifies when trying to straighten the back, and decreases when bending it forward.

Facet syndrome

It occurs as a consequence of degeneration of facet (formed between the articular processes) joints, which, in turn, develops against the background of pathology of the intervertebral discs. Damage to the discs leads to an increase in the load on the facet joints - inflammation is initiated in them, and then spondyloarthrosis - degeneration. This pathology affects 4 out of 5 patients aged 80 years and older.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Pain occurs locally in the area where the affected joints are located, intensifies when bending the body or during rotation in the lower back, as well as during prolonged standing and when changing body position from sitting to lying down and vice versa. It can radiate to the groin, buttock, lower limb on the affected side, and be cramping. Morning stiffness lasting up to an hour is typical, with an increase in the strength of unpleasant sensations towards the end of the day.

Injuries of the lumbar and coccygeal spine

Nagging pain can occur as a result of a bruise in the lumbar region, a fracture of the lumbar vertebra or coccyx. The fact is that sometimes injuries, especially compression fractures in older people, occur due to the mechanical impact of a small force and the person does not attach due importance to this.

However, heaviness and pain then increase due to compression or pinching of the nerve roots in the fracture zone. If you do not consult a doctor, serious complications may arise due to displacement of the vertebrae and disruption of the spinal cord.

Localization of pain in the lumbar region

By the location of the pain, one can indirectly judge its possible cause. But it is important to understand that this is just a guess and does not replace consultation with a doctor.

Pain above the lower back, but below the shoulder blades

It may be based on:

diseases of the lower thoracic and/or lumbar spine of a degenerative-dystrophic, traumatic or other nature;
osteoporosis;
muscle pathology (tension, spasm of muscle fibers);
benign and malignant neoplasms (tumors);
diseases of the digestive system (pancreatitis).

Pain below the waist

Can talk about the following diseases:

osteochondrosis of the lumbosacral spine;
osteoporosis;
diseases of the gallbladder, intestines;
pathology of the genitourinary system (pyelonephritis, urolithiasis, inflammation of the ureters).

In women, this symptom may be accompanied by a complicated pregnancy (for example, one with a threat of miscarriage), premenstrual syndrome, and menstruation itself.

Lower back pain that occurs when internal organs are damaged is called referred pain. They are secondary in nature and are accompanied by other symptoms:

abdominal discomfort;
bloating;
nausea, vomiting;
bowel dysfunction (frequency, constipation);
increased or difficult urination, pain during urination;
increase in body temperature.

If there are no other symptoms, and pain occurs after a long stay in one position, heavy lifting or long walking, it is probably associated with problems in the musculoskeletal system, and you should first undergo an examination to exclude this particular cause.

Left lower back pain

Sudden, acute pain in the left side, radiating to the left shoulder blade, the left half of the neck, may be a manifestation of myocardial infarction, requiring emergency treatment. Also, a sudden sharp (“dagger”) pain in this area of a piercing, cutting nature is a sign of perforation of a stomach ulcer. This is a dangerous, even life-threatening condition that you need to be aware of in order to begin treatment as early as possible.

In other cases, this symptom is a sign of a pathological process of the musculoskeletal system:

posture disorders;
osteochondrosis;
radiculitis, radiculopathy.

More often it is aching, occurs during a sedentary lifestyle, after physical activity on the lower back (long walking, sitting), and does or does not go away after rest.

Right lower back pain

Cramping or dull, aching pain may be a sign of kidney disease or reproductive system disease.

A gradually increasing intensity of sensations and pain when touching the affected area indicate the presence of an inflammatory process of an infectious or non-infectious nature.

Sharp, acute pain, like being hit with a dagger, that occurs suddenly is a symptom of perforation of a stomach or duodenal ulcer, internal bleeding, or rupture of the appendix.

Pulling sensations originating in the spine and spreading to the right side are a sign of muscle strains, radiculopathy or other diseases of the musculoskeletal system.

Lower back pain when coughing

The main reasons are the following:

osteochondrosis;

facet syndrome (if you relax the muscles on the affected side, reduce the load on the damaged joints, leaning towards them, the intensity of the discomfort decreases);
herniated disc in the lumbar spine (usually accompanied by decreased sensitivity of the lower extremities or dysfunction of the pelvic organs);
stenosis (narrowing) of the spinal canal (accompanied by intermittent claudication, impaired sensitivity and movement in the legs);
radiculopathy;
kidney diseases.

Diseases of internal organs

A number of diseases of the digestive system (colitis, cholecystitis, pancreatitis) can cause lower back strain. Such sensations are always accompanied by additional signs from the gastrointestinal tract: a person may feel sick, may experience bloating and various stool disorders.

In men, discomfort in the lower back can be caused by prostate adenoma or prostatitis. In these cases, there is also a disturbance in the process of urination, potency and libido suffer. To make an accurate diagnosis, you need to see a doctor and undergo an examination.

Types of severe back pain that radiates to the legs

When describing what back pain means, we want to focus on this sensation radiating to the legs. Usually it occurs when the nerve roots are damaged - when they are pinched by a spasmodic muscle or damaged by osteophytes, however, depending on the nature of the discomfort, a connection can be found with other pathologies.

Severe pain

They radiate to the legs, back of the foot, and sometimes affect the sacral spine. In most cases, they are caused by compression of the sciatic nerve by the fibers of the spasmodic piriformis muscle; they intensify when bending over, walking, or during coughing. If compression persists for a long time, atrophic processes in the gluteal muscle on the affected side are possible.

Osteochondrosis may also be the basis of this symptom. Accompanied by numbness of the limbs and a crawling feeling.

Acute pain

Arising suddenly, extending to the outer side of the thigh, they are a manifestation of the onset of an intervertebral hernia or neuropathy of the lateral cutaneous nerve of the thigh. They are also characterized by a burning sensation, numbness, tingling, crawling, and weakness of the thigh muscles.

Drawing, aching pain

If they radiate to the buttock and thigh, then they indicate the possible presence of an intervertebral hernia, disc protrusion, ankylosing spondylitis, subacute inflammation of the sciatic nerve in the lumbar region, or, less commonly, a spinal cord tumor.

Chronic pain

They are also a consequence of secondary damage to the sciatic nerve in degenerative-dystrophic diseases of the lumbosacral spine, protrusions or herniations of intervertebral discs. They become more intense after physical activity on the lower back, prolonged sitting or lying on an uncomfortable surface, and a sedentary lifestyle.

Displaced pains

They are also called reflected. They occur secondarily when the pathological process is localized in the pelvic organs - the ovaries, fallopian tubes in women, the prostate in men, as well as in the case of damage to the organs of the urinary system or rectum.

How is back and lower back pain diagnosed?

To make a preliminary diagnosis, the doctor talks with the patient:

collects complaints (specifies what symptoms of back pain the patient still has);
is interested in the history of this disease (when the first manifestations occurred, how they changed over time, what affects their intensity and what makes it easier);
clarifies the life history as a whole (asks what other illnesses the patient had, what his close relatives suffered from).

Then the specialist will conduct an objective examination:

will examine the affected area of the body, paying attention to the color, cleanliness of its skin, sometimes “by eye” he will detect tense paravertebral muscles, and asymmetry of the spine, when the patient, trying to relieve sensations, takes a forced position;
palpates (feels with fingers; in this way the doctor will assess the body temperature at the site of the lesion (an increase in it is a sign of an inflammatory process), find the place of maximum pain, detect a spasmed muscle or a deformed vertebra, and if the problem is localized in the abdomen, make a conclusion about which organ caused referred pain);
if necessary, she will perform percussion or tapping (this method will help determine the lower border of the liver, stomach, kidneys in order to verify the possible pathology of these organs).

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

The data obtained at this stage is enough for the doctor to suspect a particular disease. To confirm the diagnosis, he will prescribe additional research methods to the patient:

clinical blood test (will show the inflammatory process in the body, if any);
general urinalysis (will exclude kidney pathology);
Ultrasound of the abdominal organs, retroperitoneum and pelvis;
radiography of the lumbosacral spine or other, more modern imaging methods (CT or MRI);
consultations with specialists of other profiles.

Diagnostic methods

After an appointment with a specialist, the following diagnostic control methods are usually used:

ultrasound examination of the kidneys, pelvic organs and abdominal area;
X-ray of the spine to check for changes in the intervertebral discs;
MRI image, reflecting a broad picture of the processes occurring in the spine;
biochemical analysis of blood, urine, cerebrospinal fluid, etc.

When determining the source of a painful symptom, a highly specialized specialist may prescribe additional types of studies based on the patient’s medical history.

How to relieve an attack of lower back pain?

If this symptom occurs as a manifestation of a spinal disease, you should:

reduce the load on the spine as much as possible (ideally, lie on a flat, hard surface, first on your stomach, and after 5 minutes carefully roll over onto your back and raise your legs to reduce the tension on the nerves);
apply an anti-inflammatory drug to the skin of the lower back, or inject an NSAID drug into the gluteal muscle, or take such a drug in tablet form (preferably not on an empty stomach);
after the intensity of the sensations has decreased, carefully stand up and secure your lower back with a scarf or a special corset.

If back pain is reflected - arose against the background of somatic pathology, taking an antispasmodic will help alleviate the person’s condition. You should not apply heat to the area of pain - it can aggravate the inflammatory process, if any.

Myositis

Inflammation in the back muscles also causes pain in the lower back. Typically, myositis occurs after hypothermia or exposure to a draft in hot weather. As people say, “I blew my back.” Inflamed muscles swell, become tighter and painful to the touch.

Against the background of aching pain, shooting pains may occur, provoked by turning the body, coughing or sneezing. The inflammatory process subsides after a few days while taking painkillers, reducing physical activity and dry heat.

How to treat pain in the lumbar region?

Depending on the detected cause of back pain, the patient will be prescribed treatment. It can be conservative or surgical.

Conservative treatment is usually complex - includes a number of medications and physical therapy techniques.

Medicines from the following groups can be used:

non-steroidal anti-inflammatory drugs in the form of injection solutions, capsules, tablets, gels, ointments, special patches (have an analgesic effect, reduce swelling, reduce the activity of the inflammatory process; not one, but several (two or three) can be prescribed to the same patient ) drugs of this group in different dosage forms);
muscle relaxants (effectively relax a spasmed muscle);
ointments and gels with local irritating action (reflexively reduce pain);
B vitamins (used as part of complex treatment, improve metabolic processes in nervous tissue);
antibiotics (if the process is based on bacterial inflammation);
antispasmodics (if the cause is a disease of the abdominal or pelvic organs, which occurs with damage to the smooth muscle layer of their wall).

When the acute pathological process is eliminated, physiotherapy (massage, electrophoresis, magnetic, laser therapy) and physical therapy, gymnastics (for pathology of the musculoskeletal system) are added to the treatment.

Surgical treatment is recommended as an emergency measure for acute life-threatening conditions (perforation of a stomach ulcer), for cancer, or as a planned procedure for chronic processes in the spine that cannot be compensated for conservatively (severe hernias, protrusions, fractures).