Lower back pain (low back pain)

Back pain (lumbalgia) is a very common symptom. The most common cause is muscle tension combined with insufficient physical training. Rest for 2 to 3 days and perhaps mild painkillers can do the trick.

In rarer cases, the cause is more serious: herniated disc (also known as herniated disc), spondylolisthesis, fracture or tumor. Back pain is considered dangerous if it is accompanied by pain, numbness, weakness in the legs, 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 it, what makes it worse, etc. ), followed by a physical exam. Other parts of the body that can cause back pain similar to back pain should be examined, such as the kidneys and abdomen.

If necessary, tests such as plain x-rays and magnetic resonance imaging will be requested. Conservative treatment (rest, medications, physical therapy) is usually sufficient. In rare cases, special surgery is required. Alternatively, there are spinal injections under local anesthesia.

Pain in the lower back

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 tension in soft tissues, i. e. muscles, ligaments and tendons. So we say the pain is "muscular. "

The following paradox is also true: the image during x-ray examination does not always correspond to the intensity of pain. Thus, one patient may have excruciating back pain due to a pulled muscle (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. muscular tension in the muscles, tendons and ligaments that surround the spine. This is the most common reason (more than 70%);
  2. wear of intervertebral discs (e. g. herniated disc);
  3. joint damage;
  4. spondylolisthesis;
  5. fractures (due to trauma, as well as automatically due to osteoporosis or metastases);
  6. other rare causes such as bone tumors, inflammation (spondylodiscitis), rheumatological diseases (e. g. ankylosing spondylitis), Scheuermann's disease;
  7. causes outside the spine, e. g. nephrolithiasis (kidney stones), 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 often affected: the most common cause (apart from muscle tension) is disc herniation.

In old age, wear on the posterior elements of the spine (such as joints) increases, which is why 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 often play sports and therefore has not "built" the appropriate muscular system to protect the back from minor injuries. Overweight and obese people (with a body mass index greater than 25-30) are more likely to experience bouts of back pain.

I have a backache. Should I stop lifting weights?

In the acute phase, that is, when the pain is recent, heavy lifting should be avoided. In other words, you can lift a package from the supermarket, but you cannot lift, for example, a heavy box. When this phase passes 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 was designed to lift weights and do heavy work, like a father lifting his child.

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

Can osteoporosis cause back pain?

Only in case of fracture. These types of fractures usually occur automatically (that is, they are not caused by a fall) and the symptoms may not be as loud as with "normal" fractures, meaning the pain may be minimal.

What does chronic low back pain mean?

Back pain (low back pain) 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 who have suffered from back pain for more than 3 months have certain characteristics that make treatment difficult:

  1. pain with a "strange" character, that is, described as a burning sensation, "electric current";
  2. the cause of the pain may appear resolved, for example, a herniated disc may be "resolved" on an MRI;
  3. the patient experiences the psychological impact of pain and presents 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 provokes 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 can remain, as if imprinted in the brain. This is why, for chronic back pain, medications that affect the central nervous system are prescribed, such as antidepressants (in addition to conventional painkillers).

When should you see a doctor for back pain?

  • when the pain does not go away with simple analgesics in a few days;
  • when pain occurs not only in the back, but also in the leg;
  • when the leg becomes numb or starts to paralyze;
  • if back pain persists at night, during sleep or even wakes the patient up;
  • 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 (e. g. 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, computed tomography or magnetic resonance imaging will be carried out.

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

No. Around 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 a radiographic 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. But the exam does not tell us when this injury occurred, ie. recently or a long time ago, so it does not prove to us that the back pain is currently caused by this specific herniated disc. Furthermore, many "degenerative changes" occur in everyone, whether they feel 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 the indication of surgery) for back problems should never be suggested simply by observing an MRI image. It is appropriate to first perform a history and clinical examination and then correlate the MRI findings with the patient's symptoms.

What is the most specific test for back pain: plain x-ray, computed tomography or magnetic resonance imaging?

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

  1. conventional radiographyIt is 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. Computed tomographyIt takes a few minutes and has an average cost, but at the same time it has a high dose of radiation. It portrays 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 exam for people who suffer from claustrophobia. The cost is high, but there is no radiation. This is the most detailed exam we have and maps all structures of the spine, especially the nerves. There are a few twists missing, especially the small ones. In any case, the doctor, after examining you, will select and recommend a suitable examination.

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, certain medications can be used, such as analgesics, non-steroidal anti-inflammatory drugs, etc. ;
  • Visiting a physiotherapist often helps, especially if done in a certain way and according to specific instructions;
  • alternative forms of treatment, such as acupuncture, yoga and Pilates, can provide significant benefits to individual patients;
  • Sometimes spinal injections may also 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 to 3 days and only in case of emergency. Studies have shown that staying in bed for more than 2 to 3 days worsens, 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 due to unbearable pain, this usually indicates a serious problem and should be consulted by a doctor.

Should you use heat or cold to relieve back pain?

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

  • Hot (heat) causes muscle relaxation, that is, it relaxes muscles contracted by pain and increases blood circulation. You can use a heated cloth on the radiator or take a warm (not hot) shower.
  • cold prevents pain fibers from conducting pain (for example, athletes apply soda while playing football). You can use an ice pack wrapped in a cloth (no direct contact with the skin). An easy alternative: a bag of vegetables from the freezer.

What medicines can you take for back pain?

Medications that can 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 start 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, that is, morphine-type drugs. Usually given intravenously or intramuscularly in the hospital, but some oral medications are also available.
  5. Antiepileptic or antidepressant medications, 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 checking first.

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

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

  1. immediate relief measures such as electrotherapy (e. g. TENS), ultrasound, diathermy, massage;
  2. aerobic exercise, such as walking, swimming or hydrotherapy and, in some cases, even cycling;
  3. trunk stabilization and proprioception exercises, 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, that is, learning to stand, sit, lift weights, etc.

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

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

It is best for a back pain patient to consult a doctor first to rule out rare and serious causes of back pain. The doctor then refers the patient to a physiotherapist, with whom the patient should stay in contact to discuss the progress of the treatment. The ultimate responsibility for the patient's progress lies with the doctor.

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 protections, such as those used for fractures, do), but it limits excessive and sudden movements and thus reminds the patient on their back to maintain the correct posture, especially at work.

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

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

It's a small chance. Out of every 100 patients who consult a doctor for back pain, only 5 to 10 will require surgery, and this is after all other remedies (conservative treatments) have been exhausted.

What can I do during times when I don't feel 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 which exercises are suitable for other health problems, such as heart disease.
  • Strengthen the muscles that support the waist region (abdominal and back muscles). Consultation with your physiotherapist or physiotherapist is essential.
  • Quit smoking or at least reduce the amount you smoke.
  • Maintain adequate body weight, lose excess weight.
  • Help your back: learn how to lift weights, how to stand, which mattress to sleep on and how to sleep, how to sit at a desk, etc.

Which doctor should you see for back pain?

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