Back pain is one of the most common reasons why a doctor is consulted in Germany. The reasons for this are generally incorrect stresses and strains in everyday life caused by sitting in the office for too long or heavy physical work. If pain occurs in the lower back, the lumbar spine, which forms the lowest part of the spine, is affected.
Causes
Whereas back pain used to occur after physical work due to overstrain and wear and tear, today a lack of movement and poor posture, for example when working at the computer, are often the cause of lower back pain, which can also manifest itself as pulling or burning in the back. If the person does not move sufficiently, no stable musculature is formed around the spine, resulting in instability.
Diseases
Muscle tension is the most common cause of back pain. They occur when the muscles in the area of the spinal column are overloaded or irritated due to poor posture and are a protective mechanism and warning signal of the body. Often they also occur due to stress, as stress is accompanied by increased muscle tension.
Because of the pain that the tensions cause, the body adopts an unnatural relieving posture, which in turn leads to tension and pain, so that the patient is drawn into a vicious circle. Therapy of muscle tension During therapy it is important that the vicious circle of pain is broken by consistent action. It is helpful to take anti-inflammatory painkillers such as ibuprofen or diclofenac for a few days.
By inhibiting the pain, a natural posture can be restored and movements can be performed. Heat applications on the lower back can also relieve tension and thus ease the pain. Other physical applications such as massages are also helpful.
Especially stress-related tensions can be treated with targeted relaxation exercises. In the long term it is advisable to build up muscles in the area of the spine. This helps to make the supporting apparatus of the spinal column more robust and to reduce tension due to poor posture.
- Muscle Tensions
The lumbago, also called lumboischialgia, is characterized by a suddenly shooting back pain in the lower back. In addition, the pain is transmitted to the leg. This pain is caused by the irritation of nerve roots that emerge between the vertebrae.
This is often caused by tense back muscles. The tense muscles can exert pressure on the nerves and thus cause a mechanical irritation. The pain radiating into the leg is also caused by such irritation, usually affecting the sciatic nerve at the back of the leg.
In addition to tense muscles, a bulging disc (see below) or degenerated intervertebral joints (facet joint arthrosis, see below) can also irritate nerve roots in the lower back and lead to lumbago. Therapy of lumboischialgia In principle, it is important to determine the cause of the complaints and then to treat them specifically. The therapies presented above are helpful for muscle tension.
It is important for severe pain that occurs in the context of lumboischialgia that sufficient medication is administered so that the patient can move and not remain in relieving postures. It is also important in this context that the chronification of the pain can be prevented in this way. In order to prevent a recurrence of lumbago in the long term, it is important to build up muscles.
A stable supporting apparatus in the lower back is essential for long-term freedom from pain.
- Lumbago (lumboischialgia)
The intervertebral discs are located between the vertebral bodies and serve the human body as shock absorbers. In addition, they give the spine its mobility.
They consist of a gelatinous core, which is surrounded by a fibrous cartilage ring. With increasing age, the flexibility of the intervertebral discs decreases and they become less stable, which can lead to problems. Disc problems occur more frequently in the lumbar spine, which can lead to pain in the lower back.
With every movement the intervertebral discs are exposed to high pressures.If an intervertebral disc can no longer withstand this pressure, it can lead to a bulging or prolapsed disc. During the protrusion, the fibrous ring of the intervertebral disc is only pressed slightly in the direction of the spinal canal. During the prolapse the fibrous ring tears and parts of the nucleus emerge into the spinal canal.
Both clinical pictures can cause severe nerve pain in the back due to nerve entrapment. These pains often occur suddenly and abruptly and radiate into the leg. In the leg, there may also be sensory disturbances and loss of strength or even paralysis.
In severe cases, urinary and fecal incontinence may occur, which requires immediate medical attention to prevent permanent nerve damage. To make a reliable diagnosis, a magnetic resonance tomography (MRI) of the lumbar spine is performed, which depicts the conditions around the intervertebral disc. Therapy of disc protrusion and herniated disc Therapy should initially be conservative.
Only in the case of a herniated disc and after unsuccessful conservative therapy for at least six weeks or severe paralysis should surgery be considered. The conservative therapy is carried out with painkillers, physiotherapy, physical applications and the like. Local injections to the irritated nerve roots with painkillers or anaesthetics can also be helpful.
It is important in connection with the decision for an operation to weigh up carefully whether the disc problems are actually the cause of the pain. Studies have shown that a high percentage of the population has a herniated disc without feeling pain. Conversely, this means that if pain is present, the diagnosed herniated disc does not necessarily have to be the cause.
In this case surgery is useless.
- Disc protrusion of the lumbar spine and herniated disc of the lumbar spine
With increasing age there is progressive wear and tear of the spine, and facet joint arthrosis can be the result. This is the joint wear of the facet joints that connect the individual vertebrae with each other and are also called intervertebral joints.
The degeneration of these joints is accelerated by poor posture, increased stress due to overweight and degenerative disc disease. Symptomatically, facet joint arthrosis manifests itself with back pain, which can radiate into the buttocks and legs. It is important for the treating physician to localize the leg pain in order to distinguish facet joint arthrosis from a herniated disc.
Emotional disturbances do not usually occur with facet joint arthrosis. Back pain can be aggravated by movements such as spinal hyperextension. An X-ray or MRI image is also helpful for diagnosis.
Therapy of facet joint arthrosis Especially in the early stages of the disease, heat applications relieve the symptoms. In addition, cortisone and locally acting painkillers can be injected into the area around the facet joints to relieve pain. This procedure is called facet joint infiltration and is carried out under X-ray control to ensure that the correct structures are hit.
In order to prevent facet joint arthrosis or to stop it from worsening, it is advisable to build up good spinal support muscles, as this will relieve the joints. If you are overweight, this should be counteracted, since with every kilo lost, the load on the spine decreases.
- Facet Joint Arthrosis
