Low back pain (LBP) is one of the most common health problems of our time, and it is estimated that 80% of the population experience pain in the lower back or lumbar, lower part of the spine at least once during the lifetime.

Thus, low back pain has become a major public health problem because it is the most common cause of a large number of missed work days. It is known by many names, one of which is lumbago, and the popular title Hexenschuss or witch stab explains the sudden emergence and character of the disease.

What is it?

Degenerative changes most commonly occur between the connected parts of the spine, which are a source of pain.

Spine is complicated anatomical set of vertebrae (of which 7 cervical, 12 thoracic and 5 lumbar mobile), intervertebral  fibrocartilages that allow the movement of the vertebrae, and are associated with a number of muscles, nerves, blood vessels and ligaments, forming the main bearing assembly of the body . It allows us to reach upright posture, and vertebrae forming a tube create a shielding canal for the spinal cord and nerve roots of the arms and legs. Therefore, because of its multiple functions, the spine is exposed to constant mechanical effects of burden (pressure, tension, shear, bending, twisting, torsion), which can cause overstrain and wear. Some parts of the spine (cervical, thoracic and lumbar) have different scope of mobility, of which the neck is extremely mobile and the breasts are very poorly mobile.

Degenerative changes most commonly occur between the connected parts of the spine, which are a source of pain. Thus, the pain may occur at the breast-lumbar transition, in the lumbar part, and most often in the lumbar-spinal transition between a moving and burdened back lumbar vertebra and very poorly mobile sacrum.

Cause

There are more than one hundred different causes of back pain. The most common cause is improper and excessive physical strain that exceeds the strength of the back muscles, interspinal ligaments. Other causes are hard physical work, many hours of irregular body posture (eg. sitting in the car), and the problems are regularly caused by relaxed or strained muscles.

Tissues that are too tight can in an instant shrivel and turn into extremely hard and painful area with sudden fierce and severe pain. Low back pain may occur gradually and with a sense of discomfort that gradually gets stronger.

In older people, low back pain is often caused by degenerative changes in the vertebrae and intervertebral discs (spondylosis, spondylarthrosis). It is also common in inflammatory rheumatic diseases (ankylosing spondylitis, psoriatic arthritis, gout ...). It can be developed together with congenital curvature of the spine (kyphosis, scoliosis), congenital developmental disorders of the vertebrae (spondylolisthesis, sacralization, lumbarization of vertebrae, Spina bifida, etc.), after injury, inflammation (tuberculosis, infectious spondylitis), and particularly in osteoporosis - brittle bone disease.

It is not rare in other metabolic bone diseases, and we find it with primary diseases of other joints (usually the hip, and the knee) when a man unconsciously, because of pain in the legs, changes mechanism of walking, so the low back pain occurs.

Pain transferred to the back occurs in some diseases within the abdominal cavity: genitourinary tract, especially woman's reproductive organs (in some women it occurs regularly during or prior to menstrual period), kidneys, tumors, which can be developed on the bones of the spine. The cause of back pain can be a lack of physical activity. Excessive body weight, improper shoes with too high heels, flat feet, excessive mental tension and chronic stress can also cause back pain.

Risk group

These are all people who work hard physical work or are faced with irregular body posture for several hours, mainly jobs performed while sitting, older people in whom a degenerative process occurred, people with osteoporosis or some congenital anomalies of the spine after injuries and operations of the spine.

Symptoms

The symptom is a pain in the lumbar spine that can occur suddenly or gradually, be localized in the lower part of the spine or expand to one or both legs. We must pay attention to the onset of illness (sudden, gradual), injuries and duration of symptoms.

Every information about the existence of similar problems and other health disorders of the spine, general health, and characteristics of pain (place of severest pain, spreading of pain in the legs, pain during any kind of straining - coughing, sneezing, laughing , exertion; changes in skin sensitivity, periods of soreness and pain reduction) is important.

Treatment and Prevention

An indispensable part of treatment is adequate exercise, preferably in the water, and various forms of traction (stretching withered muscle structures on specially designed beds).

Low back pain requires prompt medical attention. The treatment can be time-consuming, requires participation of several specialists, but also requires a change of lifestyle. The purpose is to eliminate the cause of the disease - the surrounding harmful stimuli, suppress pain and prevent recurrence of the disease. It would be best to discover the cause of back pain before treatment, but often it is not possible because of very severe pain. Treatment in the initial and prolonged stage may be sparing and operational. The most important thing is to remove patients from the influence of provoking factors that cause pain. 

Various types of non-steroidal anti-inflammatory antirheumatic drugs and analgesics in the form of preparations for oral administration, suppositories, creams or injections are applied, and in case these do not work there are very strong opioid analgesics in the form of patches. Usually in the first 7 days until the pain settles doctors do not undertake diagnostic tests, but recommend bed rest in the most favorable position.

The rule is that the severe pain should be significantly reduced, but not completely, because the pain is a warning sign. It may be a sign of some serious disease, so if the pain completely disappears before determination of causes, the condition may even worsen. After establishing the cause of pain, the treatment is determined according to the type of disease. Mostly it is physical therapy, which in many patients significantly reduces the symptoms (ice massage, manual and underwater massage, warm compresses, infrared and ultraviolet lamp, various types of electroprocedures, magnetic therapy, ultrasound, laser, etc.).

The treatment is applied according to doctor`s advice, and not according to the opinion of patients, because there are large number of causes of back pain, and even different treatments that may be used with certain diseases.

In case of a severe mechanical damage (slippage of the vertebrae, narrowing of the spinal canal, spinal disc herniation) one should consult a neurosurgeon and consider a surgical treatment. In chronic degenerative changes and a variety of causes of instability of the spine there is an option for the use of orthotic devices - different types of corsets and orthopedic devices that stabilize the spine. However, in the long run, corsets weaken the natural muscular corset torso (back muscles and abdominal muscles), so it is recommended to avoid them, and strengthen the muscles instead.

Sometimes chiropractic is applied, spinal manual therapy intervention, which requires a lot of medical knowledge and may be performed only by a doctor. It is necessary to correct the static of the foot, regulate body weight, reduce stress and cause of psychological tension.

Prognosis

Prognosis depends on the cause. Low back pain can be avoided by observance of the simple rules of conduct: proper posture, moderate regular physical activity, strengthening of the muscles that form the natural protective pillar around the spine, periodic physical therapy. When performing the tasks it is necessary to use protective positions for the spine, avoid sitting, excessive physical labor. It is advisable to reduce body weight to optimum, wear appropriate footwear, and correct low arches of the foot, if necessary.

From an early age, children should be encouraged to do sports, and it is necessary to monitor the development of congenital malformations and deformations of the musculoskeletal system. This way one can prevent many harmful and undesirable consequences, and preserve their spine.