Introduction
Pain in the lower back is one of the most common reasons for consulting a doctor today. They expose patients to a very high level of suffering, but can usually be diagnosed and treated relatively easily, since in most cases no serious illness is the cause of the pain. The causes of pain in the lower back can be very different, which is why it is always important to carry out a thorough examination in order not only to be able to treat the pain, but also to identify any underlying disease of the back pain or to avoid consequential damage.
In principle, a physician first assumes that the complaints originate from the spine or are muscular in origin and then adjusts his examination accordingly. In such cases, the spinal column often shows bends in the lumbar region, which can explain the pain. Herniated discs in the lumbar spine also cause back pain.
Especially when a nerve originating from the spine is irritated or even squeezed by the slipped out disc, the affected person feels numbness and/or paralysis in the area of the leg supplied by this nerve, in addition to sometimes severe pain. It is more likely, however, that the lower back pain is caused by incorrect posture or lack of movement, often both factors are combined. The fact that many people sit for a very long time and are therefore in the same position means that the muscles of the lower back are put under heavy and one-sided strain, which leads to tension or cramps and incorrect posture, which in turn is a trigger for back pain.
To counteract this, you can make sure that you change your sitting position several times a day or use a sitting ball, which practically forces you to perform balancing movements at regular intervals. A lack of exercise is also a possible cause of back pain. If the spinal column is not stressed enough due to lack of movement, vertebral bodies can become porous and ligaments slacken, which also causes pain.
However, excessive strain can also damage the back, such as carrying or lifting heavy objects. In addition to the “functional” back pain described at the beginning, i.e. back pain caused by impaired interaction of the musculoskeletal system and incorrect loading, back pain in the lower back can also be an indication of a disease of the spine itself. These diseases can themselves cause pain, but they also often lead to a reflex-induced relieving posture and tension, which in turn can be the cause of back pain.
Diseases of the spinal column itself can be disturbances in the structure of the individual “components” and can be caused by wear-related, inflammatory and in the worst case even malignant processes. Vertebral bodies, the joints between the vertebral bodies and ligamentous structures are subject to aging and wear and tear over the years, especially where particularly high loads occur. This is particularly true at the transitions between the natural curvatures of the spine – these are also the places where problems caused by wear and tear frequently occur.
The bone density of the vertebral bodies decreases – as with all bones in the body – with increasing age. This process is particularly pronounced if there is also a disease of the bone metabolism, such as osteoporosis. If this degradation of substance is more advanced, it can lead to fractures at the edges of the vertebral bodies or to the collapse of the cover plates of the vertebral bodies.
This, in turn, can lead to poor posture, incorrect loading of other structures of the spine and resulting back pain in the lower back. Particularly affected by signs of aging are also the intervertebral discs, which lie between the vertebral bodies and buffer them against each other. They consist of a gelatinous core surrounded by a ring of firmer connective tissue fibers.
This outer ring becomes more and more brittle with increasing age, so that – especially in connection with incorrect loading – it can tear and parts of the intervertebral disc core can come out.If this happens in such a way that the protruding jelly mass presses on the spinal nerves emerging from the spine, this corresponds to the widespread and sometimes extremely painful “herniated disc of the lower back”. Even without the nucleus of the intervertebral disc coming out, the intervertebral discs can become the cause of lower back pain due to wear-related changes: for example, the height of the intervertebral discs decreases with age because the connective tissue of which they are composed can store less fluid. This reduction in height leads to the loosening of the tight ligaments that connect the vertebral bodies along the spine and stabilize the spine over its entire length.
As a result, the back muscles have to perform a considerable amount of extra work in balancing movements to correct posture, which can lead to pain due to overstraining – In the loosened combination of ligaments and vertebral bodies, spondylolisthesis, the slippage of individual vertebral bodies from their original position, can also occur. The intervertebral joints that connect two adjacent vertebral bodies with each other (“facet joints”) are also affected by the degenerative processes, all the more so if a loosening in the structure of the individual components has already occurred. Local overloading leads to excessive wear of articular cartilage and bony attachments at the articular processes, which can lead to the very painful “facet syndrome“.
For mechanical reasons, these degenerative changes in the intervertebral joints are particularly common in the lumbar spine. A rarer cause, which should also be taken into consideration when investigating lower back pain, is inflammation of the vertebral body (“spondylitis”) and the intervertebral disc (“spondylodiscitis“). These are caused by a seeding of infectious agents from other infection sources in the body via the bloodstream, but can also be caused by germ transfer from the body surface, e.g. when injecting painkillers near the spine.
The risk of an inflammatory disease of the spinal column is particularly increased in people who have a reduced resistance to infections as part of a chronic general disease such as diabetes mellitus. Inflammation of the renal pelvis can also manifest itself in back pain. Due to its anatomical position, kidney pain projects itself onto the region of transition from the lower to the middle back.
It is often an oppressive and very strong pain. The back is then very sensitive and reacts to even slight pressure with pain. The pain is usually unilateral and is accompanied by fever and pain when urinating.
Cold drafts can also cause tension in the back muscles and thus pain in the lower back. Such pain is usually not of long duration and can be relieved well with warm compresses or heat pads. A warm bath also helps very well against this type of back pain.
A light painkiller, such as ibuprofen from the pharmacy, can be taken as a support. The painkiller helps against the acute pain, so that the relaxation of the muscles is easier. Finally, if there is any suspicion, it must be clarified whether the back pain is caused by a tumor disease.
While malignant degenerations of the bone tissue are rare, there are some cancers that spread to the spinal column particularly frequently. These metastases can lead to bone resorption or overbuilding and can cause back pain themselves or through collapse of the vertebral body. Various malignant diseases of the blood cells also take place at the site of origin of these cells, in the bone marrow. Since the vertebral bodies are rich in hematopoietic bone marrow, the spinal column is a frequent manifestation site of these diseases. Because the degenerated bone marrow displaces normal bone tissue, it can cause back pain and instability of the vertebral bodies, which can lead to vertebral collapse.
