Low Back Pain
Is low back pain common?
It comprises one third of all rheumatic complaints. About 80% of the society suffer from low back pain in a certain portion of their active life. Although 70% of patient recover in one month, 90% recover in two to three months, recurrence is frequent. 70% of the patients experience three or more recurrences. Low back pain starts between the ages of 20 and 40, maximum frequency is observed between the ages of 45 and 60.
Who has higher risks of low back pain?
Low back pain risk is high for smokers, long-distance drivers, those who stand up for a long period of time, those who sit down fixed in the same position, those who lift heavy loads, those who make sudden movements by bending, those who work with vibrating equipment, those who cough, and people with low income. People who have weak back and abdominal muscles are prone to low back pain.
What are the causes of low back pain?
Primary low back pain causes are as follows:
- Birth defects
- Disc herniation
- Facet syndrome
- Lumbar spinal stenosis
- Lumbar spondylosis
- Spondylolysis and spondylolisthesis
- Seronegative spondyloarthropathies
- Thoracolumbar junction syndrome
- Myofascial pain syndrome Sacroiliac joint dysfunction
- Pains originating from different areas (abdomen, artery and pelvic organs)
Lumbar spondylosis (Degenerative disorder of the low back, arthritis)
Lumbar spondylosis occurs with degenerative changes in the structure of lumbar spine. It is commonly accepted that spondylosis is an aging phenomenon. With age, the bones and ligaments in the spine wear. Its prevalence increases with aging, and it would be rare to have a normal spine after the age of 60. Although many people experience these changes, some don’t have any complaints.
Low back complaints may be as a result of a movement or lifting weight or may start insidiously. Pain is generally localized in the low back. It may expand to buttocks and thigh bone. Pain increases with standing up and household chores and decreases with resting. Morning stiffness last for a short time. While radiologic tests are used as a basic and routine method to evaluate the patients with low back pain, association between the low back pain and radiological changes could not be established well. After the age of 60, a normal spine is observed rarely. Nevertheless, more than half of them doesn’t suffer from pain. Treatment targets the relief of current symptoms and prevent recurrences. Steel boned corset braces can be prescribed to reduce the load and limit the motion for the patients who has increasing pains following standing and moving. Once the pain severity decreases, exercises starts for strengthening back and abdominal muscles. Regulating exercises and daily life activities is very important to prevent recurrences. Medications, physical therapy and ozone can be administered for the treatment of lumbar spondylosis.
It is a mechanic instability syndrome which occur with the degenerative changes in the facet joints located in the back parts of the spine. Patient has complaints for mechanical low back pain extending towards buttocks and thigh bone. Pain that spreads over the thigh bone’s back and external sides is reflective pain. Pain increases with movement and decrease with resting. Radiological tests are highly useful for the diagnosis and differential diagnosis. Facet joint injection is used for both diagnosis and treatment.
Degenerative changes that are visible for facet joints in MRI images are equal for people with and without low back pain.
In the acute period, analgesic and muscle relaxant are prescribed. Several days of resting may be needed. Manual therapy, local injection and physical therapy, and ozone can be applied for the patients who cannot benefit from formerly mentioned treatments.
Lumbar disc herniation
It is a clinical picture characterized with low back and leg pain which occurs due to the compression of degenerated disc on the nerve root spanning across the leg. Most of the patients with lumbar disc herniation are between the ages of 30 and 50. Main complaints are low back and leg pains. Patients usually indicate that their pre-existing mild low back pains have increased after a strain and gone down to their legs. Pain increases with coughing, sneezing, straining and low back movements. Patients have hard time to stand upright. Some of the patients may express that they have more pain while seated. Patients may also complain of numbing, tingling, paresthesia, weakness and thinning in the legs accompanying the pain. X-Ray and MRI directly help the diagnosis. Lumbar disc herniation management can be divided into two titles which are conservative (without surgery) and surgical. Most of the cases respond positively to the conservative treatment. 75% - 90%, and even more, of the patients had reported recovery. It would be a rational decision not to be in a hurry for surgical treatment, to start the conservative treatment first, monitor the patient closely, and decide in accordance with the progress and result of the treatment. Bed rest should be kept short (2-4 days). Medications may be added to the treatment. In order to increase the muscle strength, exercises should be started for back and abdominal muscles. After a while, patient is allowed to stand up and walk with a corset. Patient attends a physical therapy program in this period. Caudal Epidural ozone injection to the coccyx in both acute and chronic stages can generate impressive results. If patient doesn’t respond to the conservative treatment, surgical treatment is implemented.
Spinal narrowing (Spinal stenosis)
Most of the patients are over the age of 50 although there may be cases in younger ages. Patients have an history of low back pain available for a long time and leg pain which has started recently. They complain of the pain in both of the legs while walking. Symptoms extend from thigh to the calf and foot. Patient needs to stop and rest while walking because of the pain in the legs. After several minutes of resting, patient can walk the same distance again. Patient cannot lie on her/his back by stretching legs. S/he can try to relieve the pain by standing and walking for a few minutes inside the room when there is pain, or s/he lies on her/his side while curling up. Patient complains about weakness, fatigue, numb and tingling in either one leg or both legs. Although it is not cold, s/he can say that her/his legs are cold, s/he feels like they don’t belong to her/him or feels like as if they were made up of rubber. More accurate information can be acquired by measuring the canal diameters and imaging the soft tissue and bone tissue by means of computerized tomography and MRI.
Satisfying results are achieved with physical therapy in mild cases. Epidural ozone injection can also be administered for these patients. Daily life activities of the patient should be organized, and exercises to strengthen back and abdominal muscles should be given. Progressive cases that are not responsive to physical therapy and medications would be eligible for surgery.
Spondylolisthesis occurs when a bone (vertebra) slips forward onto the bone below it. It is categorized in four grades according to the degree of slipping forward of the vertebral body. Major causes of spondylolisthesis are fracture, low back surgeries, arthritis and birth defects. Patients generally complain about low back pain. Pain can be felt in both sides of the low back and in both legs. Pain increases with movement and standing, and generally relieves with resting. Most of the patients are women. In general, abdomen is loose and droopy. Spondylolisthesis isn’t always symptomatic in adults. Rest is recommended in painful conditions. Steel boned corset brace that is prescribed to the patient when s/he remains standing stabilizes the low back and relieves the pain by reducing the load. Patients should avoid lifting heavy loads, fat patients should lose weight, exercises to strengthen abdominal and back muscles and stretching exercises should be given, and daily life activities should be regulated. Electrotherapy modalities are utilized in order to reduce the pain and muscle strain.
Sacroiliac joint syndrome
Pain felt in a range of various severity may extend from buttocks to the back parts of thigh, and knee. Localization of the pain is typical for the sacroiliac joint syndrome. Sometimes, pain may spread down to back or external side parts of the calf, wrist, foot and toes. Major treatments are manual therapy and physical therapy. Manual therapy administered by master hands is generally the cure for this disease.
Do tumors cause low back pain?
Yes, they cause. Spinal tumors aren’t common. However, since diseases that had causes death are treatable and human lifetime is longer, tumors and metastatic tumors in particular are often considered as the causes of low back pain. Cancers that extend to the spine are mostly lung, breast and prostate cancers.
May an infection be the cause of low back pain?
It may be. If diabetics, drug addicts, alcoholics and those who take cortisone have low back pain, infection should be taken into consideration as a cause. The most frequent infection causes are staphylococcus, tuberculosis and brucella bacteria. If two adjacent vertebrae are involved, it may pass onto the active disc. Spine collapses gradually.
What are the rules to follow in order to get rid of low back pain and/or to prevent it?
- Lie on your back or on your side by bending knees.
- While getting up from the bed, first lie on your side, then sit by straightening up, and standing up by supporting with your hands.
- Sit up straight and support your back while seated.
- Stand upright. If you stand for a long time, put something under one of your feet so that one foot would be higher than the other.
- Do not try to pick up something from ground / floor by bending down. Bend your knees while picking up something from the floor or standing up to work.
- Share the load on your both hands and carry it very close to your body.
- Do not try to perform an action while lying down.
- Do not stay in the same position for a long time. Avoid sudden movements.
- Use European-style toilet.
- Do not smoke.
- Do regular exercises.