Lower Back Pain : Lumbago – Symptoms, Causes, and Treatment

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Lower back pain can happen to anyone, most of the time it can result from strenuous activities like carrying heavy objects or by simply sitting in the office all day. Surprisingly, several researchers have discovered that there isn’t any correlation between lower back pain in runners due to higher training mileage. In fact, symptoms of lumbago (low back pain) are more of a common problem for the general population as compared to athletes.  Apparently, this may sound comforting to runners who do not have any issues with low back pain, but few athletes do struggle with the achy issue. Most especially when the pain travels down to the legs and causes other symptoms such as “sciatica.”  Running with discomfort can be bothersome, or much worse, can cause severe injury over the long term. It is best for runners to educate themselves with this article information cowritten by Ashley Delmar and curated by Diana Rangaves, PharmD, RPh  about the risks of lower back pain and how to prevent it from happening over the course of this article.  Prevention can often be the best cure and according to Irish novelist Samuel Lover, “It is better to be safe than sorry!”

What is Lower Back Pain?

Low back pain or LBP is a common disorder that involves the muscles, nerves, and the bones of the back. Levels of pain can vary from a dull constant ache to a sudden prickly feeling. Duration often classifies lower back pain and is divided into three types:

  • Acute, pain lasting less than six weeks
  • Sub-chronic, pain lasts six to 12 weeks
  • Chronic, more than 12 weeks

The underlying cause of this condition may further classify the infirmity as either mechanical, non-mechanical or referred pain. In most cases, its particular cause is not identified or even looked for, in many instances, runners often assume that mechanical problems like muscle or joint strain cause the pain. Apparently, there is more than meets the eye when it comes to low back pain.

Symptoms

Lumbago or lower back pain has a broad range of symptoms, it can be mild and slightly annoying, or it could be severe and debilitating for many runners. It could start suddenly after a morning jog or could begin slowly, gradually getting worse over time.

To break it down, these are the most common symptoms of low back pain to watch.

  • Pain that is dull or achy to parts of the lower back
  • Stinging, burning pain that moves along the back of the thighs, lower leg or feet.
  • Numbness or tingling of the lower legs, more commonly known as sciatica
  • Muscle spasms and tightness in the lower back, pelvis, and hips
  • Emergence of pain from prolonged sitting or standing
  • Difficulty standing up straight, walking, or going from a standing to a sitting position

Classifying of Low Back Pain

Lower back pain can come from many different reasons. To fully understand the physiology of lumbago or low back pain, runners must figure out what causes its symptoms. Presumably, the pain can arise from three different reasons.

  • Mechanical pain
  • Radicular pain
  • Referred pain

Mechanical pain is the most common cause of low back pain. The discomfort primarily originates from muscle groups, ligaments, joints (facet joints and sacroiliac joints), or bones in and around the lumbar vertebrae. Moreover, the pain tends to occur on the lower back, buttocks and in some instances, at the top of the legs. Its cause usually occurs by loading the spine and may feel different based on forwarding, backward and twisting motions. Various physical activities including sports can influence mechanical pain. Also, sitting and standing in a wrong posture can advance its symptoms.

Radicular pain can occur if a spinal nerve root becomes interrupted or inflamed. It may follow a nerve root pattern or in many cases a dermatome down into the buttocks or leg that can cause a sharp and electric-like pain associated with sciatica or weakness of the legs. It often happens on one side of the body.

Referred pain has many variations, most often low back pain is caused by the onset of other conditions including claudication that comes from stenosis and other circumstances like myelopathic pain, neuropathic pain, deformity, tumors, and infections. Furthermore, lumbago can also stem from inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis. Other reasons include pain that originates from other parts of the body like kidney stones and ulcerative colitis.

Symptoms That Indicate A Serious Medical Issue

In rare cases, low back pain can signal a serious underlying medical problem. People who encounter any of the following symptoms are advised to seek immediate medical attention:

  • Loss of bowel and bladder control
  • Sudden weight loss that is not due to lifestyle changes such as diet and exercise
  • Frequent Fever, chills and severe pain in the abdomen

Additionally, individuals that experience the symptoms after a major trauma are advised to see a doctor. More importantly, if lumbago interferes with sleeping, mobility and other daily activities, immediate medical attention is recommended.

Herniated-Disc-Lower-Back-Pain-Symptoms

Causes of Lower Back Pain

The most common causes of lumbago or low back pain are mechanical issues and soft-tissue injuries that induce the condition. These can often range from damages in intervertebral discs, compression of nerve roots, and abnormal movement of spinal joints. However, the single most common cause of lower back pain is a torn or pulled muscle and ligament.

A low back muscle strain and ligament sprain can suddenly happen or develop over time from repeated movements. Strains result when a muscle is stretched too far and tears, damaging the tissue. Meanwhile, sprains occur when overstretching and tearing affects ligaments that connect the bones together. In the medical field, doctors often treat muscle and ligament damage the same way due to the similarities of their symptoms and for practical purposes.

Common causes of muscle strain and ligament sprain include:

  • Raising a heavy object or twisting the spine while lifting
  • Sudden movements that put too much stress on the low back such as falling and slipping down to a hard a surface
  • Poor sitting and standing posture over time
  • Sports related injuries that involve twisting the spine like basketball or large forces of impact often characterized by elements of American Football

Causes of Chronic Lower Back Pain

Medical experts consider lumbago chronic if it lasts for more than three months and beats our body’s natural healing process. More often, chronic pain in the low back includes and underlying disc, joint, and an irritated nerve root problem. Common causes include the following:

Lumbar herniated discs occur when the jelly-like center of a lumbar disc can break through its tough outer layer and irritate nearby nerve roots. The herniated portion of the disc is full of proteins that cause inflammation upon reaching a nerve root. These instances can cause swelling and nerve compression that can lead to severe nerve root pain. Also, the richly supplied nerve fibers can tear the wall and induce severe discomfort.

Degenerative disc disease happens when intervertebral discs lose hydration and wear down as people age over time. At birth, the discs are full of water, and at their healthiest state. As we age, the discs lose hydration and force the disc wall to weaken. In a period, the weakened wall may develop tears that can lead to herniation. Also, other cases may result in the wall’s collapse and cause stenosis.

Facet joint dysfunction can occur when the two facet joints behind each disc at each motion segment found in a human body’s lumbar vertebrae develop some issues. These joints have cartilage in between the bones that are enclosed by a capsular ligament. The nerves richly innervate these joints and at most times can be painful by themselves or in a combination of disc pain.

The sacroiliac joint attaches the sacrum at the base of the spine to each side of the pelvis. It is an active low-motion joint that absorbs shock and tension between the upper and the lower body. A sacroiliac joint dysfunction occurs when the joint becomes irritated and inflamed or if there is too copious or too diminutive movement of the joint.

Other Causes

Spinal stenosis can often emerge from the narrowing of the spinal canal where the nerve roots are. The restriction can be central, forminal, or both. It can often occur at a single level with instances of happening at multiple areas in the lower back.

Spondylolisthesis is an ailment that occurs when one vertebra slips over an adjacent one. In the medical world, there are five types of this malady, but the most communal are secondary to a defect or break of the parts between the facet joints. It can also happen through mechanical instability of the facet joints that causes pain due to the compression of nerves.

Osteoarthritis is a degenerative state that results from the wear and tear of the disc and facet joints. It causes many symptoms including pain, inflammation, weakness, and stenosis to a fitful degree. It can occur at a single level or multiple levels of the lower spine. Often, spinal osteoarthritis correlates with aging and is slowly happening. Its other names include spondylosis and degenerative joint disease.

The curve of the spine including conditions like scoliosis or kyphosis can increase the risk of individuals developing symptoms of low back pain; the deformity is often associated with lumbago if it leads to the decline of the discs, facet joints, and sacroiliac joints. Most of the time these symptoms lead to stenosis.

Trauma often occurs when acute fractures or dislocations of the spine can lead to pain or discomfort. Lumbago often develops after a shock injury such as a vehicular accident or a fall. The best-case scenario is to go to a medical specialist to evaluate the extent of the injuries and prevent the scope of further damage.

A compression fracture occurs in the cylindrical vertebra in which the bone typically caves in on itself. Its occurrence can cause sudden pain. Moreover, this fracture is most common to weak bones such individuals with osteoporosis and older people.

MRI Lumber
Credit Source: Lumbar Spine MRI 68M, T12 Compression fracture, L5-S1 spondylolisthesis

Less Common Causes of Lower Back Pain

Sometimes low back pain is caused by considerably less common reasons such as:

  • Infection
  • Tumor
  • Autoimmune Diseases

Infection or osteomyelitis is a rare spinal disease that can cause severe pain and is life threatening if untreated. Surgical procedures often trigger its cause and can spread through the bloodstream via injections. Patients with a jeopardized immune system are more sensitive to developing an infection in the spine.

Most spinal tumors start in a different part of the body and can metastasize to the spine. Common tumors that spread to the spine originate from cancer found in the various regions of the body. Breast, prostate, kidney, thyroid and lung cancer have links to the occurrence of spinal tumors. Individuals that have a history of cancer are advised for evaluation as soon as possible if they have developed symptoms of low back pain for a possible spinal contagion.

Back pain is also a possible symptom of rheumatoid arthritis, lupus, Crohn’s, ankylosing spondylitis or fibromyalgia with is associated with autoimmune diseases . There are also other autoimmune conditions associated with lumbago and finding a correct clinical diagnosis is vital for individuals that suffer from these maladies.

Risk Factors

There apparently factors that put the general population and runners of developing a greater risk for low back pain:

  • Age is one of the most common reasons why individuals develop lower back pain. The symptoms of lumbago become more prevalent as we age. It usually begins to occur to people aged 30 and above.
  • Exercise does not only prevent low back pain but can also give our bodies a healthy boost. Lack of physical activity can often lead to weak back muscles that cause back pain.
  • Being overweight is often caused by poor diet, and lack of exercise. Carrying excess weight puts extra stress on an individual’s back that causes lower back pain.
  • Some diseases like arthritis and cancer can contribute to the occurrence of back pain.
  • Improper lifting is a grave risk factor for low back pain, using your back instead of your legs can lead to severe back injuries
  • Psychological conditions also give individuals a higher risk for low back pain. Studies have shown that people that are prone to depression and anxiety have a greater chance of acquiring lumbago.
  • Smoking can also cause the condition by keeping your body from delivering vital nutrients to the disks in your back.

Epidemiology

Lumbago is often seen in manual laborers. Studies have shown that as many as 11% of female laborers and 9% of male laborers will develop acute lower back pain over the course of their career. The risk of developing severe low back pain increases for patients in their 30’s and continues to increase each decade thereafter until the age of 60 to 65. Interestingly, the risk of developing lower back pain decreases gradually after the age of 60. This goes against the common myth that older people have bad backs. In addition to age-related factors, there are also many socioeconomic risk factors associated with lumbago. Researchers have found that people who are poorly educated have an increased risk of developing lumbago.

This may be because those who are poorly educated are more likely than highly educated individuals to work physically demanding jobs such as manual labor positions. Those suffering from depression, anxiety, or patients who lack social support in their places of work are also at an increased risk of developing lower back pain. This is because the areas for physical pain and emotional pain share a neurological pathway in the brain. The brain releases the neurotransmitters norepinephrine and serotonin in response to pain, however, these neurotransmitters also influence mood. Norepinephrine is released by the Autonomic Nervous System in response to stress and works to prepare the body for the so-called “fight or flight”, and causes alertness, increased focus, and restlessness, all of which can cause anxiety. Serotonin, which is sometimes known as the “feel-good neurotransmitter” is released by the brain and blood platelets in response to pain signals. Serotonin helps patients to tolerate pain and works in the brain’s dopamine pathway to elevate mood. This explains why a norepinephrine or serotonin imbalance could lead to the physical pain that often comes with depression and anxiety.

Lower back pain is far more prevalent in developed nations. Once study concluded that 18.9% of all Canadians and 36% of all British citizens have experienced lower back pain in the past year. The incidence of lower back pain is currently increasing in developing nations. The same study found that 18.9% of Israelis currently experience lower back pain, which could be due to the global increase of anxiety and depression and the rise of Western lifestyles in developing nations. Patients who experience lower back pain for 3 to 6 months out of the year, patients endured an average of 128.5 days with severe pain.

Patients who experience severe lower back pain for more than one day per year are likely to develop reoccurring episodes of lumbago. These reoccurring episodes can cause severe trunk stiffness, which in turn increase the likelihood of further lumbago episodes. These reoccurring episodes can have detrimental effects on the socioeconomic status of patients due to time off work. Since low socioeconomic status is a risk factor for lumbago because of stress and increased likelihood of working physically demanding jobs, the risk factors for lower back pain often form a vicious cycle of irritation, misery, and discomfort. The longer you have suffered from lower back pain, the more likely you are to experience reoccurring episodes.

After 1 year, 50% of patients experienced additional lower back pain episodes. The number of patients with reoccurring episodes rose to 60% after 2 years and 70% after 5 years. 20% of reoccurring cases took place within 6 months of the initial incident. School children between the ages of 10 to 16 are also at an increased risk of developing lumbago. This could be associated with the phenomenon of “growing pains”, sports injuries, or stress. Reoccurring episodes have also been documented in children. Women are more likely than men to experience multiple lower back pain episodes, possibly due to stress or the increased risk for bone density issues. People living in primary care facilities are at the highest risk for developing multiple episodes of lumbago, with 80% of primary care patients reporting reoccurring lower back pain episodes. Interestingly, the country with the highest prevalence of lower back pain incidences is Germany where lumbago is experienced by 56% of residents. Finnish citizens are the least likely to experience lumbago, with only 9% of residents reporting episodes of severe lower back pain.

Diagnosing Lower Back Pain

Obtaining an accurate diagnosis is critical in identifying the cause of low back pain. In many cases, a chosen treatment cannot fully correlate to the symptoms of lumbago, that is why an accurate prognosis is important in guiding the treatment.

Often, the diagnostic process for athletes and the general population is the same. The first significant step of diagnosing the condition is for a patient to provide a detailed description of symptoms and a complete medical history. Doctors will be given a general idea of the source of the patient’s low back pain and may proceed to further tests.

Patient History

Before starting any tests, the patient will be asked to provide information regarding underlying symptoms and medical history. Inquiries typically include:

  • Information about current symptoms
  • Activity level
  • Sleep habits
  • Posture
  • Injuries

Accurate answers to these questions provide the physician with detailed information that can indicate possibilities for low back pain. A medical history is often the most precise medium for finding the right diagnosis. Consequently, non-disclosure of past conditions may make it difficult for physicians to come up with the correct prognosis.

Physical Examination                                     

The purpose of a physical exam is to pinpoint possible causes of low back pain. Typically, the test includes a combination of the following steps:

Palpation is a method where a physician will feel by hand possible areas of tightness or tenderness along the lower back to locate muscle spasms and joint abnormalities.

Neurologic examinations involve motor movements from the hip, knee, and big toe extension. It also includes flexion or forward and backward movement of the ankles. Often involved in these tests are sensory exams that test the patient’s reaction to light touch, pinprick, or other senses in the lower trunk, buttocks, and legs.

The range of motion test is also done to look for positions that worsen or cause pain and see if discomfort limits certain movements.

A reflex test analysis tests the patient’s reflexes in the legs to see weakened parts that have decreased muscle strength. If the reflexes are declining, a nerve root might not be as responsive as it should be.

In a leg raise test, a patient is asked to lay flat on his back and raise one leg from bottom to top and as straight as possible. If the leg raise recreates low back pain, it is possible that a herniated disc might be causing the issue.

Diagnostic Imaging Tests

Sometimes more tests are needed to gain more information if the physical exam and patient history do not pinpoint the exact cause of the condition. An imaging test can further point a situation that aggravates a patient’s severe low back pain. Standard imaging tests include:

  • X-rays
  • CT scan or Myelogram
  • Magnetic Resonance Imaging scan or MRI
  • Injection studies

X-rays are commonly used to view the bones of the spine. They can show abnormalities such arthritis, fractures, bone spurs and presence of various tumors.

A CT scan and Myelogram provides a more accurate cross-section image of the vertebrae. In the scan, an x-ray passes through the spine which a computer picks up and reformats into a 3D image. The detailed picture allows doctors to take a better look at the backbone at different angles. In rare cases, a myelogram performs in tandem with a CT scan in which dye is injected around the nerve roots to highlight spinal structures that give the image more clarity.

Herniated-Disc-x-ray-imaging

Other Tests

Injection studies are fluoroscopic-directed shots of local anesthetic and steroid medication in particular anatomic structures. Furthermore, the procedure is effective in confirming low back pain, they are often used in diagnosis, rehabilitation and are considered predictive of surgical results.

In many cases, doctors can predict the cause of the pain but not exactly where it is occurring. Imaging tests are very efficient in locating the primary source of the pain.

Basing on an individual’s diagnosis some treatments may work better than others or may work thoroughly with a combination of treatment methods. In some cases, self-care for low back pain is as effective in treating the condition as expensive remedies. Athletes (including runners) employ self-care practices that prevent the symptoms of lumbago.

Self-Care for Low Back Pain

Applying basic treatment techniques at home for treating mild and acute pain can be very effective. In some instances it can reduce the effects of chronic and severe pain, practicing self-care can easily be adjustable depending on the individual, these include:

Episodes of low back pain can lessen in occurrence by briefly avoiding strenuous physical activity that put stress on the lower back. Having a short rest period is highly advised, but too much inactivity can often make healing more difficult. Medical experts suggest that relaxing for a few days (depending on the severity of the pain) is better than resting for longer a period.

One technique allows patients to stay active but avoids strenuous physical activities. Activity modification allows patients to do their daily routine but with less action that aggravates low back pain. For example, if standing for a prolonged period intensifies the pain, doctors advise patients to sit in intervals to allow a favorable healing environment. Avoiding activities and positions that worsen the pain will help reduce lumbago in the long run.

Heat and ice therapy is a traditional method that is used by athletes to provide relief to low back pain. Heat generated by a warm bath, hot water bottle or heat wraps can relax the tense muscle and improve the circulation of blood. Increased blood flow allows nutrients and oxygen to heal the sore muscle. In the case of pain due to inflammation, ice or cold packs are effective in reducing swelling; most importantly, protecting the skin while applying heat and ice is important to prevent tissue damage.

ice-scoliosis-pain

Over The Counter Medication

Over the counter medication or OTC is one of the most convenient ways of relieving low back pain. Prescriptions such as aspirin, ibuprofen, and naproxen are proven anti-inflammatory drugs that reduce swelling and discomfort. Acetaminophen is also a popular OTC drug that works by interfering with the pain signal that the brain receives.

Although self-care treatments do not need guidance from a physician, discretion is still important because any medication carries possible risks and side effects. If a patient still suffers low back pain despite the self-care methods, talking to a physician might be the course of action.

scoliosis-drugs-painkiller

Exercises to Help Relieve Low Back Pain

Physical therapy is an effective way of managing low back pain, types of exercises used to rehabilitate the spine include:

  • Stretching
  • Strengthening exercises

Stretching is an essential exercise that targets muscles in the low back, buttocks, hips, and legs. These muscles are vital in supporting the weight of the upper body, and the more flexible these muscle groups are, the chances of lower back pain tend to occur less.

Strengthening exercises add strength to the abdominal, hip, and gluteus muscles that support the spine. Stronger core muscles can help relieve low back pain; two favorite techniques that are used to strengthen the muscle groups are:

  • The Mckenzie Method
  • Dynamic Lumbar Stabilization

The McKenzie method stretches the spine through building core muscle strength. This exercise reduces the pain that is caused by compressed spinal structures like a herniated disc due to a compressed disc space. The Dynamic Lumbar Stabilization Exercise strengthens the back muscles to maintain a “neutral spine” or posture that prevents the occurrence of lumbago.

Other methods include low-impact aerobic exercises that increase the flow of blood that supports healing from an injury without jerking the spine. These activities can range from stationary bikes, elliptical or step machines, walking, and water therapy. Athletes and common folk who regularly do aerobic exercises reportedly have a lower risk of recurring low back pain.

Overall, any exercise that elevates the heart rate for a sustained time benefits the body. Consequently, regular physical activity is vital for keeping the range of motion and elasticity of a healthy spine. Lack of exercise often contributes to a stiff spine that causes discomfort and the emergence of low back pain.

Ankle-Sprains-The-Runners-calf-stretch

Stretches for Relieving Lumbago:

As mentioned in the section above, stretching and exercising can be effective in treating minor cases of lumbago. Stretching sore and tight muscles can cause more insult to injury and only serve to irritate the area. It is important to soften the tissues of your back before you stretch in order to perform a deeper stretch that will have the greatest effect on the affected area and move your back through a complete range of motion.

Warming up the area and softening your back tissues before you stretch will help to increase blood flow the area with will promote healing of the tissues. A great and very relaxing way to warm up your back is to soak in a tub of warm water before you stretch. The buoyancy of your body in the water will also work to reduce strain on your muscles and spine. Laying down in the tub or using a bathtub pillow will help to reduce pressure on the discs of the lower back, which are often affected in cases of lumbago. If you have a bit more time to soak and relax, adding Epsom salts to your bath water will help your muscles relax. To maximize your relaxation, choose an Epsom salt brand with a pleasing smell to take advantage of the aromatherapy benefits.

If you don’t have time to bath a bath before you stretch, you can apply a warm compress to the affected area to soften the tissues instead. Warm compress pads can be purchased for under $15 from your local drug store, or you can make your own using a towel. To make your own hot compress, soak a towel in water and place the towel in the microwave for 30 seconds to 1 and half minutes depending on the size of the towel. You can also purchase premade microwaveable hot compresses at your local pharmacy or homecare supplies store. Once your towel is sufficiently warm, place the compress on your back until the pain in your back begins to subside and you are ready to stretch. For extra pain relief, you can apply a pain relief cream like Rub A535 or a natural alternative to the affected area.

Once your back is sufficiently loose, you can begin with light stretches. A good way to ease into your stretching regimen is to start by performing hip slides, windmills, and gentle lower back extensions. To do a hip slide, lay down on your back and begin sliding your hips up and out towards the shoulder on the same side of your body. When you are ready, raise your hips and slowly twist your hips toward the opposite shoulder, being careful not to extend past your body’s comfortable range of motion, especially if you are injured. Windmills are one of the easier stretches in this list and are done by making large arm circles to loosen the joints. To perform a basic lower back extension, stand up with your legs shoulder width apart. Bend your knees slightly, and bend your back so that you are staring up at the ceiling. After warming up your back and performing these warm up stretches, you will be ready to move on to more advanced back stretches.

Pelvic Tilts, Knees-to-Chest Stretches, Side Knee Drops, Hamstring Stretches, the Cobra Stretch, the Child’s Pose, and the Cat Stretch can be extremely effective in relieving back pain when done correctly. The proper way to perform each stretch is outlined below.

 

Pelvic Tilts:

  • Begin by laying down on the ground with you knees bent, feet planted on the floor, and your hand placed on your stomach
  • Gently press your lower back into the floor. As you do this, your abdominal muscles will tighten and your pelvis will roll backwards
  • Hold the move for 3 to 20 seconds and repeat

 

Knees-to-Chest Stretch:

  • Lie on your back and bring you knees as close to your chest as possible
  • Place your hands under your knees and pull them close to the chest
  • As you pull your knees, press your back gently into the floor
  • Hold the stretch for a minimum of 10 seconds, and repeat up to 10 times

 

Side Knee Drop:

  • Lie down on your back with your knees bent, keeping your feet on the floor
  • Keep your shoulder pressed against the floor as you allow your knees to drop to one side of your body
  • Rotate your knees to the other side of your body, keeping your shoulders on the floor
  • Hold the stretch for 30 seconds on each side and repeat

 

Hamstring Stretches:

  • Extend one leg and place your other foot behind the knee of your extended knee
  • Place your hands on the ankle of your extended leg and bend forward so that you are looking down at your knee
  • Hold the stretch for 20 seconds on each side and perform 6 to 12 stretches on each leg

 

Cobra Stretch:

  • Lie down on your stomach with your hands placed on either side of your chest, near your shoulders
  • Push up with your hands so that your arms are fully extended and your back is extended towards the ceiling
  • Bend your back as far as is comfortable so that your back resembles as slight arch
  • Hold the stretch for 10 to 15 seconds and repeat

 

Child’s Pose:

  • Kneel on the floor and extend your back so that your chest is resting slighting past your knees
  • Reach towards the wall and extend you back as far as is comfortable
  • Hold the stretch for 30 seconds and repeat

 

Cat Stretch:

  • Kneel on the floor and place your hands on the floor in front of you about shoulder width apart
  • Look down at the floor, keeping your neck straight and relaxed
  • Move your spine up towards to ceiling and roll your pelvis backwards, keeping your abdominal muscles tight
  • Hold the stretch for 10 seconds and rotate your pelvis and back back to the starting position
  • Repeat

 

Medical Treatments for Low Back Pain

Use of medical procedures reduces symptoms of lumbago but does not necessarily affect the underlying source of the condition. A doctor will usually prescribe medicine along with a physical therapy program or regimen, these include:

  • Muscle relaxants
  • Narcotic pain medications
  • Back braces
  • Epidural steroid injections

Muscle relaxants act as a depressant of the central nervous system and increase the fluidity of tense muscles; this relieves pain from a muscle tightness. Most of the time these prescriptions have no role in managing chronic pain.

Narcotic pain medications or painkillers alter a patient’s acumen of pain by weakening signals that the brain receives. A physician uses narcotic drugs for treating severe short-term pain after an operation. Its use is rare in the treatment of long-term chronic pain because they have adverse side effects and can easily become addictive.

Back braces also provide comfort and reduce pain by supporting the weakened back muscles. Researchers have found out that the use of a corset-style brace in combination with physical therapy can speed up the healing of low back pain.

Epidural steroid injections are administered directly into the outer part of the dural sac that surrounds the spine. It temporarily relieves pain by reducing inflammation around a compressed nerve root.

Surgical Procedures

If these methods do not work, a doctor may recommend surgery. Also, it is always the patient’s decision to undergo surgical proceedings. In rare situations, a physician may decide to do the operation if a patient is involved in an accident that requires immediate action.

A decompression surgery removes anything that is pressing on a nerve root from the vertebrae that might include a herniated part of a disc or a bone spur. Minimally invasive techniques that use relatively small incisions that cause minimal discomfort is common among the procedures. Usually, most of these surgical procedures take less than a day to perform.

There are two types of decompression methods for low back pain:

Microdiscectomy is a minimally invasive procedure for individuals that suffer from a lumbar herniated disc that is causing sciatica.

Laminectomy is a procedure that removes a layer of the bone or soft tissue that is constricting a nerve or multiple nerve roots. This surgical operation also works with individuals that suffer from spinal stenosis.

Hip-Bursitis-Bursae-Inflamed-surgery-last-resort

Lumbar Spinal Fusion

Lumbar fusion surgery is a process that removes soft tissues between two or more adjacent vertebral bones. The operation usually replaces the removed tissues with bone or metal that enables a 6 to 12-month recovery after fusing into one long bone to stabilize and eliminate the movement of the spinal segments.

Surgical fusion procedures often use a posterior, anterior, or a lateral approach to join the parts of the bone. Newer techniques have made the operation more predictable with a faster recovery.

Lumbar spinal fusion is useful in treating conditions like spondylolisthesis, fracture, instability, and the onset of spinal deformity. It is also effective in treating degenerative disc disease, and stenosis. Lumbago that is caused by a sacroiliac joint dysfunction is also a candidate for fusion surgery, in rare cases, the same method is used to treat tumors and infections.

Alternative Treatments

Alternative or non-medical treatments have also become popular among athletes and the general population. While the term alternative does not mean that it is inferior to medical therapies, the term instead provides traditional methods to treat lumbago. Furthermore, many individuals have reported relief by undergoing these processes, standard options include:

  • Manual manipulation
  • Acupuncture
  • Massage Therapy
  • Meditation

Manual manipulation by a chiropractor or a physical therapist helps alleviate the pain by making physical adjustments to the spine. The goal is to improve mobility that reduces stiffness and discomfort. Moreover, applying hand thrusts of varying speed and intensity adjusts spinal structures that often impede nerve roots.

Acupuncture is a traditional Chinese practice that stimulates the points of the body by placing needles on the skin for periods of time. Practitioners of this method believe that it corrects the body’s “qi” or life force. Researchers have shown that method provides significant pain relief for some people.

Massage to the low back relieves muscle spasms that usually contribute to lumbago. The method increases blood that speeds up healing by bringing nutrients and oxygen to damaged muscle groups.

Meditation is another traditional way of relieving back pain. Moreover, it helps by reducing the perception of pain via mind over matter. It can also reduce depression, anxiety and sleep problems that commonly occur with prolonged low back pain. Meditative techniques include deep breathing exercises and yoga.

Preventing Lumbago

The best cure for lumbago is to prevent it in the first place. Over time, the repetitive stress on the lower back from work or poor posture can cause small tears in the tissue that can develop into more severe injuries. When you slouch, your back muscles and spine are under increased strain to keep your body upright and balanced, which is why practicing healthy posture is an important step in preventing lower back pain. Good posture also helps to maintain your spine’s natural curves, which are located at the base of the neck (cervical curve), in the middle of the upper back (thoracic curve), and in the lower back near the back of the hips (lumbar curve).

Poor posture causes pulling on the spine’s natural curves, which can cause severe pain over time. Strain and pulling on the lumbar curve is related to lumbago, another reason why practicing good posture is so important. To correct your posture, stand up straight with your shoulders back, imagining you have a string attached to your head that is pulling your spine up toward the ceiling. Keeping your abdominal muscles pulled in will help you keep your balance and take some of the strain off your lower back. When you walk, aim to focus most of your weight on the balls of your feet, keeping your feet shoulder width apart and letting your arms fall naturally by your side.

 

Strengthen Your Abs

Your abdominal muscles are important for keeping you balanced and maintaining good posture. Building ab strength will help you prevent lower back pain, along with helping you look good on the beach. Crunches or partial crunches are excellent for strengthening your lower back and tightening your abs. Crunches are often rumored that crunches can actually aggravate lower back pain. This is due to improper form. To perform a crunch, lay down on your back with your knees bent and your feet planted firmly on the floor. Focus on pulling your belly button towards your spine and breathe out as you lift your shoulders off the floor. Hold the crunch for as long as it comfortable and return to the floor, keeping your abdominal muscles tucked and your movements controlled.

Wall sits are also great for toning your abs and strengthening your back and mimic proper poster to boot. Start with your back touching the wall and slowly slide down until your knees are bent in a table top position. Press your lower back into the wall and hold the pose for 10 seconds.

Another exercise to try for strengthening your back is the bird-dog stretch. In addition to strengthening your abs, this exercise will also help you tone your glutes. To do a bird-dog (also called a fire hydrant stretch), start on all fours and tuck your abs up towards your spine. Lift one of your legs and extend it, keeping your knee slightly bent as you do. For an added challenge, reach out towards the wall with your opposite arm while performing the exercise.

If you are experiencing lumbago, avoid exercises such as sit-ups, toe touches, and leg lifts. Leg lifts require you to balance on your lower back, which will aggravate the area if you are experiencing pain. Similarly, sit-ups and toe touches place strain on the discs and ligaments of the lower back.

 

Lift with Your Legs

The cliché we all heard growing up of “lifting with your legs” has been proven true. To lift a heavy object without injuring your back, start with your legs shoulder width apart and squat down. Look straight ahead and keep your shoulders back to maintain good posture while gripping the object. Straighten slowly straighten your knees and keep the object as close as to you as possible as you raise your body.

Maintain Your Health

Staying in peak physical condition and paying attention to your health is important in preventing lower back issues. If you struggle with your weight, losing even 5 pounds can great reduce strain on your lower back and spine. According to the American Obesity Association, as many as 1/3 of patients suffering from obesity report suffering from some amount of lower back pain as well. Carrying excess weight can cause the spine to become tilted and stretched unnaturally as it strains to compensate for the extra weight. This is especially apparent in patients with large waists, as the extra weight in the stomach forces the pelvis forward, pushing the spine inward. If you think your weight may be the cause of your back pain, consult your doctor to discuss your weight and overall health.

 

Save Your Lungs, Save Your Back

A study conducted on graduates of John Hopkins University concluded that smoking, a risk factor for atherosclerosis, is in turn closely related to the development of lower back pain. These findings support the hypothesis that atherosclerosis, which is caused partly by smoking, can cause lower back pain. These findings close the gap between smoking and lumbago and reveal why it is so important for athletes, especially runners who are prone to lower back issues, to quit smoking. Getting off Nicotine can be extremely difficult and potentially pose detrimental risks to your mental health. It is important to work closely with your doctor to create a personalized plan to help you quit smoking.

Conclusion

Lower back pain is an issue common in adults 30 to 60 and can be caused by both physical and psychological factors, including stress. Preventing low back pain can be possible with proper exercise and diet. Maintain correct posture is vital in limiting the strain placed on your lower back and spine and preventing the pain and symptoms associated with Lumbago. Consequently, the additional symptoms of lumbago are more prevalent in individuals who have bad posture. Whether you are an athlete or not, having regular check-ups with your doctor can help lessen the risks of lower back pain. If you are overweight, weight loss can help reduce the strain placed on your spine and prevent lower back pain. Quitting smoking is also important in preventing additional health risks such as atherosclerosis that can cause lumbago. Mild lumbago can be treated at home with specialized exercises and stretches, many of which are listed within this article. To avoid causing additional damage to stiff lower back muscles, it is important to warm up the area through heat or light movement before delving into strenuous exercise. If lower back pain persists, consult a physician and ask for a treatment plan to suit your needs and lifestyle.

Co-written by Ashley Delmar

Curated by Diana Rangaves, PharmD, RPh

Disclaimer

The references in this article are listed below and have been written by medical professionals for established medical websites and publications.  Moreover, this article aims to educate individuals on the cause of low back pain and its related symptoms. Consequently, information within the should not used in place of medical advice.  For personalized information on lumbago or other lower back issues, RunnerClick advises readers to talk to their family doctor to diagnose lower back pain and its associated symptoms.

Sources

  1. John Peloza, M.D, Lower Back Pain Symptoms, Diagnosis, and Treatment, Spine Health, Apr 20, 2017
  2. William C. Shiel Jr., M.D., FACP, FACR, Low Back Pain: What Can You Do, Web MD, May 06, 2017
  3. Goertz M, Thorson D, Bonsell J, , Adult acute and subacute low back pain, Institute for Clinical Systems Improvement, Aug 17, 2017
  4. Benjamin Ma, M.D, Low back pain – acute, Medline Plus, Aug 17, 2017
  5. Linda J. Vorvick, M.D., , Back pain - returning to work, Medline Plus, May 02, 2017
  6. Kuijer PP, Verbeek JH, Visser B, an evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain, US National Library of Medicine National Institutes of Health , May 02, 2017
  7. Stephanie Watson, , 10 Ways to Manage Low Back Pain at Home, , Web MD, Aug 17, 2017
  8. Mayo Clinic Staff, Back Pain – Treatments and drugs, Mayo Clinic, Aug 17, 2017
  9. Unknown, NINDS - Low Back Pain Fact Sheet, National Institute of Health Publications Database, Aug 17, 2017
  10. Colombini, D , Acute lumbago due to the manual lifting of patients in wards: prevalence and incidence data, Medical Journal , Mar 01, 1999
  11. Brian R. Waterman, MD , Low back pain in the United States: incidence and risk factors for presentation in the emergency setting, The Spine Journal , Jan 01, 2012
  12. Hoy, D. , The Epidemiology of low back pain, Medical Journal , Dec 01, 2010
  13. Mayo Clinic , Slide Show: Prevent Back Pain with Good Posture, Website , Apr 22, 2016
  14. WedMD, Proper Lifting Technique, Website , May 22, 2015
  15. Donald J. Frisco, MD , Weight Loss for Back Pain Relief , Website , Nov 02, 2004
  16. Donald J. Frisco, MD , Does Smoking Cause Lower Back Pain? , Website , Jul 31, 2001