Lower back pain (lumbago)

Back pain (lumbago) is a very common symptom. The most common cause is muscle strain combined with insufficient physical training. Rest for 2-3 days and perhaps mild painkillers may resolve the problem.

In rarer cases, the cause is more serious: a herniated disc (otherwise known as a herniated disc), spondylolisthesis, fracture, or tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the leg, difficulty urinating, and so on.

Treatment for back pain begins with a detailed history (when the pain started, how long it lasts, where it affects, what makes it worse, etc. ), followed by a physical examination. Other parts of the body that may cause back pain similar to back pain should be examined, such as the kidneys and abdomen.

If necessary, tests such as plain x-rays as well as MRI will be requested. Conservative treatment (rest, medications, physical therapy) is usually sufficient. In rare cases, special surgery is required. As an alternative, there are injections into the spine under local anesthesia.

Lower back pain

Frequently asked questions about back pain

What does the middle (lumbar) spine consist of?

The spine at the waist consists of:

  1. bones (vertebrae);
  2. intervertebral discs (between two adjacent vertebrae there is a disc, like a pillow);
  3. joints (there are two joints at the back of each vertebra);
  4. ligaments;
  5. tendons;
  6. muscles and finally;
  7. nerves emerging from the spine (one on the right and one on the left at each level) that provide nerve stimulation to the legs.

In a broader sense, the intervertebral disc is also a type of joint.

Which of the following elements of the spine can cause back pain?

All of the anatomical elements described in the question above have sensory nerve endings, so damage to any of them can cause pain. The most common cause of back pain is soft tissue strain, i. e. muscles, ligaments and tendons. Then we say that the pain is "muscular. "

The following paradox is also true: the image during an x-ray examination does not always correspond to the intensity of pain. So, one patient may have terrible back pain from a muscle strain (without showing anything on a plain X-ray or MRI), while another patient with a large herniated disc may have no symptoms.

What can cause back pain?

The cause of back pain is:

  1. muscle tension in the muscles, tendons and ligaments surrounding the spine. This is the most common reason (more than 70%);
  2. wear of intervertebral discs (for example, herniated disc);
  3. joint damage;
  4. spondylolisthesis;
  5. fractures (as a result of trauma, as well as automatically as a result of osteoporosis or metastases);
  6. other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (eg, ankylosing spondylitis), Scheuermann's disease;
  7. causes outside the spine, for example, nephrolithiasis (kidney stone), abdominal aortic aneurysm, cholecystitis.

The cause of pain may vary from age to age.

Yes, the reasons change with age, because the structure of the spine changes. In young people, the intervertebral disc is usually affected: the most common cause (besides muscle strain) is a herniated disc.

In old age, wear and tear on the posterior elements of the spine (such as joints) increases, so the most common causes are osteoarthritis and lumbar stenosis (spondylolisthesis), and fractures due to osteoporosis also begin to occur.

Can back pain be related to body weight?

Yes, the role of increased body weight in the occurrence of back pain is empirically known and scientifically confirmed. This may be due to the fact that an overweight person does not usually play sports and therefore has not "built" the appropriate muscular system to protect the back from minor injuries. People who are overweight and obese (with a body mass index of more than 25-30) are more likely to experience attacks of back pain.

I have back pain. Should I stop lifting weights?

In the acute phase, i. e. when the pain is recent, heavy lifting should be avoided. That is, you can lift a package from the supermarket, but you are not allowed to lift, for example, a heavy box. When this stage is over and the pain goes away, you can lift small weights, but you need to learn how to do it correctly, that is, bend your knees and not straighten them, as weightlifters do. Additionally, the more a person exercises their spinal muscles, the more stress their back can bear.

Generally speaking, everyday life certainly involves lifting weights: the human body is designed to lift weights and to do heavy lifting, such as a parent lifting their child.

Lifting weights in the gym is a different matter: as a general rule, unless it is absolutely necessary (i. e. unless the person is an athlete), it is recommended that a person with back problems avoid weight training in the gym.

Can osteoporosis cause back pain?

Only in case of a fracture. These types of fractures usually occur automatically (i. e. not caused by a fall) and the symptoms may not be as noisy as with "normal" fractures, i. e. pain may be minimal.

What does chronic lumbago mean?

Back pain (lumbago) is classified as chronic if it persists for more than 3 months without interruption. The 3 month limit is not arbitrary: it has been observed that patients suffering from back pain for more than 3 months have certain characteristics that make treatment difficult:

  1. pain with a "strange" character, i. e. described as a burning sensation, "electric current";
  2. the cause of the pain may appear to be resolved, for example, a herniated disc may be "resolved" on an MRI;
  3. the patient experiences the psychological impact of pain and exhibits symptoms such as anxiety and depression.

What is the scientific explanation for this strange type of back pain?

The prevailing theory of chronic pain is that persistent and prolonged stimulation of a neural pathway (i. e. , the path from the site of pain to the brain) causes "sensitization, " so that the stimulus causes an exaggerated or strange response.

Thus, a low-intensity stimulus can cause very intense pain or pain that does not correspond to the type of stimulus, such as feeling like you are on fire when there is no part of the body that is heating up. Thus, even if the anatomical cause of pain is treated, the pain and psychological reaction may remain, as if imprinted on the brain. It is for this reason that for chronic back pain, drugs that affect the central nervous system, such as antidepressants, are prescribed (in addition to conventional painkillers).

When should you see a doctor for back pain?

  • when the pain does not go away with simple painkillers within a few days;
  • when pain occurs not only in the back, but also in the leg;
  • when the leg goes numb or begins to paralyze;
  • if back pain persists at night, during sleep or even awakens the sufferer from sleep;
  • if you have problems with urination, bowel movements and/or sexual function;
  • when accompanied by fever;
  • when it is triggered by a fall or accident;
  • when accompanied by weight loss;
  • if there is a history of cancer, osteoporosis, long-term cortisone use, intravenous drug use (eg, heroin), or alcoholism.

What are the next steps?

The doctor who will examine you will take a complete medical history and examine you. Then, if necessary, tests such as plain x-rays, CT or MRI will be carried out.

Do I need to undergo an X-ray examination if I have back pain?

No. About 70% of back pain cases are caused by a simple muscle strain, and in these cases there is no need for examination.

What if an X-ray or MRI shows something?

This is very, very common: someone does a back exam and discovers an x-ray finding such as a herniated disc, osteophytes, etc. But that's what the word says: an x-ray finding. This means that the disk was damaged at some point in time. But the examination does not tell us when this injury occurred, i. e. recently or a long time ago, so it does not prove to us that the back pain is currently caused by this particular disc herniation. Additionally, many "degenerative changes" occur in all people, whether they experience pain or not. Therefore, when making a diagnosis, one cannot be guided only by the results of an x-ray examination.

For this same reason, treatment (or even indication for surgery) for spinal problems should never be suggested simply by looking at an MRI image. It is appropriate to first conduct a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

Which is a more specific test for back pain: plain x-ray, CT scan, or MRI?

There is no single answer to this question. Each test has indications and each test has disadvantages:

  1. conventional radiographyis a very quick and simple test that costs very little. But it only shows bones. This means that a fracture, scoliosis or kyphosis, or spondylolisthesis is clearly visible, but the intervertebral discs and nerves are not visible.
  2. CT scantakes very few minutes and has an average cost, but at the same time has a high dose of radiation. It depicts all the elements of the spine relatively well. This is relatively disadvantageous when imaging nerves and discs.
  3. MRIIt takes a long time, for example 20 minutes, and is an inconvenient examination for people suffering from claustrophobia. The cost is high, but there is no radiation. This is the most detailed examination we have and maps all the structures of the spine, especially the nerves. It is somewhat lacking in kinks, especially small ones. In any case, the doctor, after examining you, will select and recommend a suitable test.

How is back pain usually treated?

  • in most cases, rest and some simple measures at home help, for example, "hot and cold" and lumbar protection (belt);
  • To relieve pain, you can use certain medications, such as analgesic, non-steroidal anti-inflammatory drugs, etc. ;
  • A visit to a physiotherapist often helps, especially if it is done in a certain way and for specific indications;
  • alternative forms of treatment such as acupuncture, yoga and Pilates can provide significant benefit to individual patients;
  • Spinal injections may also sometimes be used.
  • In relatively rare cases, the above (conservative) treatment is ineffective and surgical intervention is required.

Does rest mean I have to stay in bed?

Only for 2-3 days and only in case of emergency. Studies have shown that staying in bed for more than 2-3 days aggravates rather than cures back pain. It is generally recommended to walk as much as possible.

If a person is unable to get out of bed despite conservative treatment because of unbearable pain, this usually indicates a serious problem and should be seen by a doctor.

Should you use hot or cold to relieve back pain?

Both methods have been tested and help, depending on the situation. The mechanism of action is different:

  • hot (warmth) causes muscle relaxation, i. e. relaxes muscles contracted by pain and increases blood circulation. You can use a cloth heated on a radiator or take a warm bath (not hot).
  • cold prevents pain fibers from conducting pain (for example, athletes apply coolant while playing football). You can use an ice pack wrapped in a cloth (not in direct contact with the skin). An easy alternative: a bag of vegetables from the freezer.

What medications can you take for back pain?

Medicines that may be used to treat back pain include:

  1. Mainly an analgesic from the anilide group, alone or in combination with codeine or a muscle relaxant. This is the simplest and safest medicine, and treatment should always begin with it.
  2. Non-steroidal anti-inflammatory drugs (there are several classes). Stronger painkillers, but when taken chronically they have many side effects, such as gastritis, gastrointestinal bleeding, increased blood pressure, kidney damage, bleeding, etc.
  3. Glucocorticosteroid- a powerful and effective pain reliever, but with a large number of side effects when used chronically and without clearly proven benefits for back pain.
  4. Opioids, i. e. morphine-type drugs. Usually given intravenously or intramuscularly in the hospital, but some oral medications are also available.
  5. Antiepileptic drugs or antidepressants, mainly for chronic pain, but also for some acute conditions.


All of the above medications should be taken on the recommendation of a doctor who has previously examined you. It is careless and potentially dangerous to take medications on your own by listening to friends, getting ideas from the Internet, or talking to your doctor on the phone without first checking.

How can a physical therapist help me with my back pain?

The role of a physical therapist is very important in the treatment of back pain. The most appropriate is an initial program lasting several days, and then the patient can learn to perform the necessary exercises on his own. Severe pain is initially treated so that the patient can walk (i. e. is not bedridden), and when the pain subsides, exercises begin to strengthen the muscles and restore the spine. The program may include:

  1. immediate relief measures such as electrotherapy (eg TENS), ultrasound, diathermy, massage;
  2. aerobic exercise, such as walking, swimming or hydrotherapy, and in some cases even cycling;
  3. exercises for trunk stabilization and proprioception, which "teach" the muscles to better support the spine;
  4. strengthening exercises, such as abdominal and back exercises (not at the beginning of the program);
  5. exercises to develop range of motion;
  6. mechanical diagnosis and therapy McKenzie;
  7. retraining, i. e. learning how to stand, sit, lift weights, etc. correctly.

If you have back pain, should you first see a physical therapist or a doctor?

Physiotherapy is one of the methods for treating back pain. Other methods are medications, care, walking and finally injections and spinal surgeries. Therefore, there must be a central person who will select the methods used and evaluate the patient's progress.

It is best for a patient with back pain to first see a doctor to rule out rare and serious causes of back pain. The doctor then refers the patient to a physical therapist, with whom the patient should maintain contact to discuss the progress of treatment. The final responsibility for the patient's progress lies with the physician.

Should I wear a talisman (belt) for back pain?

A simple soft pad can be used for a few days. It does not provide complete immobilization (rigid guards, such as those we use for fractures, do), but it limits excessive and sudden movements and thus reminds the back patient of correct posture, especially at work.

Long-term chronic use has the opposite effect as the spinal muscles atrophy, leading to increased pain. In conclusion, it should be noted that when used for 1-2 weeks, the amulet can be useful. It is best used in conjunction with a spinal muscle strengthening program to ultimately eliminate the need for protection.

How likely is it that I will need surgery for my back pain?

It's a small chance. Out of 100 patients who see a doctor for back pain, only 5-10 will ultimately require surgery, and that's after all other remedies (conservative treatments) have been exhausted.

What can I do during periods when I don't have pain to prevent back pain?

  • Exercise regularly in consultation with your doctor. Walking and swimming are two excellent exercises that strengthen the spine. Before you start exercising, ask your doctor what exercises are okay for other health problems, such as heart disease.
  • Strengthen the muscles that support the waist area (abdominal and back muscles). Consultation with your physiotherapist or physiotherapist is essential.
  • Quit smoking or at least reduce the amount of smoking.
  • Maintain proper body weight, lose excess weight.
  • Help your spine: learn how to lift weights, how to stand, what mattress to sleep on and how to sleep, how to sit at a desk, etc.

Which doctor should you see for back pain?

You may want to see a doctor who specializes in spine, such as a neurosurgeon or orthopedic surgeon.