Low back pain

April, 2020 Low back pain

As we mentioned earlier, the cause of back pain can be based on a variety of factors, such as sitting position,aging …. In this article, Dr. Kazemi will try to explain these factors in more detail. 

Causes of low back pain :

Many low back pain is due to changes in lumbar biomechanics, many of which are due to degenertive changes and increased age .Common causes of back pain includes:

Muscular spasm : It,s one of major causes acute low back pain. Over-stretching is an important complication that can be caused by excessive rotation, improper lifting…

Skeletal problems : Lumbar spine changes, scoliosis or other congenital vertebral problems.

Spondylolisthesis : One of the lumbar vertebrae places itself on the adjacent vertebrae forward or backward, causing a narrowing of the canal and pushing the nerves out of the socket.

Disc degeneration : Aging and degeneration of the discs means that the disc has lost its elasticity, is dehydrated and enters the spinal canal, causing nerve fibers to press and stimulate

Radiculopathy (involvement of lumbar nerve roots) : It is a condition caused by the mechanical pressure of the disc and its chemical inflammation resulting a spinal nerve root irritation. Pressure on the nerve root causes pain, numbness, itching, burning pain and spasm of the leg muscles.

Sciatica : In fact, it is the radiculopathy in which the sciatic nerve is pressured and stimulated. The sciatic nerve is the largest nerve in the body that passes through the back of the hips to the back of the thighs and extends to the legs and foot. This problem causes paresthesia or burning pain in the lumbar region, along with the area of ​​the hips and legs, sometimes reaching the tip of the foot. In cases where the severity of pressure and nerve inflammation is high, other symptoms such as numbness, weakness, and muscle spasms in the legs occur due to impaired nerve function.

causes :

The lumbar region supports the weight of the head and trunk and problems in this region can cause pain and movement limitation.

Common causes of back pain :

Muscle Stretching: Overuse of the back muscles in various exercises

Osteoarthritis: Increasing age ,trauma can cause erosion and loss of cartilage between the vertebrae, which can affect joint movement and cause pain, the lumbar bones will be rougher. The disc near the vertebrae will lose its water. The ligaments that hold the bones in place become harder as a result of the movement of the ligaments and intervertebral discs and may tighten the spinal canal and put more pressure on the spinal cord and nerves that move to the legs.

Lumbar disc herniation: Lumbar disc herniation can cause pressure on the nerve and cause diffuse pain in the lower extremity.

Injury: Car accident and other trauma can cause severe blows and elongation in the soft tissue of the lumbar and adjacent bones that makes changes and arthritis in the lumbar spine.

Body posture: It is more common in people with lower back and abdominal discomfort. Poor back and abdominal muscles cannot protect the spine well, and this is clearly seen in pregnancy and abdominal obesity, and even in children carrying heavy school bags or carrying heavy loads.

Occupational Risk Factors:

Occupations with lifting heavy objects,jobs with sitting position and inactivity are more likely to have low back pain.

Mental Health Factors: Anxiety, depression and stressors can reduce pain thresholds, which means that painful stimuli are more intense.

Diseases: Certain diseases, such as rheumatic diseases can cause back pain.

Diagnosis :

A complete history and physical examination are very helpful in identifying the causes of pain. Neurological tests are performed along with a complete lumbar examination to determine the causes of pain and appropriate treatment, along with imaging techniques such as lumbosacral x-ray, CT scans, MRIs, and myelography, etc. It is also used for nerve and muscle testing .

Treatmant :

Non-invasive treatments :

Heat and cold:Can help to reduce pain and inflammation for people with acute, subacute and chronic pain.

Activity Limitation: Rest should be limited. People should avoid pain intensifying activities, but daily activities should be started as soon as possible, because prolonged rest may cause laziness and muscle weakness, which will cause further damage to the lumbar spine.

Lumbar muscles strengthening activities : Exercise accelerate the recovery of chronic back pain. Increasing muscle strength is especially important in people with skeletal problems. Doctors help with strengthening and supporting lumbar muscles by providing useful exercises.

Physical strengthening of the spine : Physiotherapy is used to strengthen lumbar muscle groups and improve mobility and flexibility and to improve body posture, along with other treatments such as high-powered laser therapy and lumbar exercise therapy. Other noninvasive treatments for back pain include manipulation of the spine, traction and acupuncture which are used in cases of chronic low back pain.

Medication :

Painkillers are designed specifically to relieve pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation

Anticonvulsants: To suppress abnormal pain signals caused by nerve fibers stimulation

Antidepressants: With increased serotonin levels, norepinephrine in the synaptic space inhibits pain signals.

Interventional  procedures :

Epidural Injection: A common way to treat short-term back pain and sciatica pain caused by inflammation. The technique uses local anesthetics and corticosteroids and pro-inflammatory compounds (such as ozone….).

Transforminal injection :

In this method, the nerve root that has been inflamed by disc compression is injected separately and exclusively into the outflow space of the root, which relieves nerve fiber inflammation and pain and other symptoms.

Radiofrequency :

In this techniques, radiofrequency  waves are used instead of injecting the drug, which results in a long-lasting healing effect.

Tissue Electrical Nerve Stimulation (TENS) :

An electrical device that sends electrical impulses onto the skin of a painful area and disables pain signals in the adjacent nerves. It is hypothesized that stimulation of the nervous system can alter the perception of pain. Early studies of TENS showed that this method increased the level of endorphin (the body’s natural painkiller).

Other methods for treatment of back pain such as platelet, ozone, TENS spinal cord stimulation… are also used which have been elaborated elsewhere.

Lumbar open surgery :

When other treatments fail to work, the last step (after failing other ways) is open back surgery. Open surgery can cause degenerative arthritis of the vertebral facet joints and epidural tissues adhesions that may require intervention in the future.

Prevention :

It is possible to prevent back pain by correct sitting posture and avoiding sudden movements and proper lifting. The use of medical belts has been controversial, and many studies have shown that using these devices to prevent or treat normal low back pain may even exacerbate arthritic injuries by using less back muscles and weakening them. And may cause or aggravate low back pain, and its use is recommended only in cases of severe arthrosis ans scoliosis and very severe stenosis.

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