Low back pain, often called back pain or lumbago, is the medical term for severe pain in the lower back, and in the lumbar vertebrae.
What are the causes? Can low back pain be prevented? How to treat it? Here are our explanations.
What is low back pain?
Low back pain: definition
Low back pain is the medical term for lower back pain in the lumbar vertebrae. This is the most common form of back pain and is most often not serious.
More than 80% of people will suffer from low back pain at some point And the prevalence of this evil continues to increase. It can occur at all ages, with peaks in adolescence and around 45 years.
Types of low back pain: acute or chronic
Low back pain is the most common form of back pain. Indeed, the lumbar vertebrae are constantly solicited and support a significant part of the body weight, which makes it a fragile region.
Acute low back pain or lumbago
Lumbago is characterized by acute pain that can last up to about 4 weeks. It is sometimes also called a kidney tower.
Acute low back pain, although short-lived, can:
- cause a lot of discomfort;
- impose a work stoppage for some time;
- significantly interfere with daily activities.
More than 90% of acute low back pain disappears or greatly improves on its own in 4 weeks or less.
Chronic low back pain
Chronic low back pain is characterized by constant pain that lasts more than 3 months.
The causes of chronic low back pain are sometimes difficult to determine. People who suffer from it often have to consider making significant lifestyle changes.
Approximately 5 to 8% of low back pain becomes chronic.
Back pain is a complex problem that conventional medicine alone cannot always relieve.
In many cases, and especially if the pain is chronic, a comprehensive approach that considers both psychological and emotional, and physical factors is necessary. In this way, we can reduce pain or, at least, learn to live better with it.
The lumbar spine
The lumbar spine consists of 5 vertebrae which are small cylindrical bones superimposed and empty in their center. The spinal cord passes through this cavity. The spinal cord consists of a bundle of motor, sensory and associative nerve fibers.
Between each vertebra is an intervertebral disc composed of flexible tissue containing a “gel”. The function of intervertebral discs is to allow the mobility of the vertebrae and to absorb shocks.
The whole is surrounded by:
- muscles;
- Tendons;
- ligaments that ensure the stability and mobility of the delicate joints of the spine.
All these structures can be responsible for lower back pain.
What causes low back pain?
Low back pain is only a symptom whose causes are very varied. In nearly 90% of cases, low back pain is benign, or “nonspecific”. This means that there is no major lesion that can explain the pain.
These can then be linked to:
- intervertebral discs;
- Vertebrae;
- muscles;
- etc.
Most of the time, it is impossible to accurately determine the origin of the pain, which disappears spontaneously within a few weeks.
For this reason, the doctor will not prescribe an imaging examination such as an X-ray, scan, or MRI, when the situation is clearly nonspecific, without any worrisome features.
In other cases, especially in the presence of neurological symptoms, imaging is indicated. In rare cases, low back pain can be a sign of a serious illness.
Here are the most common causes of pain.
An injury to a muscle, tendon, or ligament
Pain can come from:
- an effort;
- unusual twisting;
- the accumulation of microlesions caused by repetitive movements.
Those most at risk are:
- in poor physical shape;
- exercising physical trades in construction, for example, imposing the carrying of heavy loads.
Disc degeneration
With aging, the intervertebral discs lose their elasticity. Disc degeneration is observed in almost all people over the age of 60.
Some athletes also experience this problem around midlife, especially those who practice an activity that puts pressure on the spine. This degeneration is not always associated with pain, but it can be involved in some low back pain.
A herniated disc
A herniated disc occurs when part of the gel in the intervertebral disc protrudes outward and compresses the nerve roots.
The main causes of herniated discs are:
- bad postures;
- overweight;
- disc degeneration.
A gynecological problem
Many women experience back pain periodically or consistently, due to:
- painful periods;
- endometriosis;
The source of the pain is therefore not located in the lumbar region, but the pain still radiates to the lower back.
Sliding of one vertebra over another vertebra or spondylolisthesis
Spondylolisthesis can occur:
- because of congenital weakness in the vertebral structures;
- as a result of trauma.
Arthritis, osteoarthritis, or osteoporosis
Arthritis, osteoarthritis, or osteoporosis are common health problems in older adults.
If osteoporosis of the spine is significant, it can cause a vertebral fracture.
Some inflammatory rheumatism, such as ankylosing spondylitis, can also cause pain and stiffness in the lower back.
Abdominal aortic aneurysm
In rare cases, low back pain can be caused by:
- an abdominal aortic aneurysm
- a tumor
- an osteoporosis-related fracture or infection.
Regardless of the origin of back pain, there is often a contraction of the muscles located near the sore area. This is a protective reflex.
This contraction can itself lead to pain. A vicious circle can then be set in motion and contribute to chronic pain.
The symptoms accompanying low back pain can vary greatly from person to person.
What are the symptoms of low back pain?
In reality, low back pain is not a disease, but a symptom.
Due to the complex anatomy of the lumbar spine and the multiple causes of lower back pain, the symptoms accompanying low back pain can vary greatly from person to person. For the same condition, two people can describe their pain very differently.
If the pain in the lower back occurs suddenly and is manifested by a sudden and intense contraction of the muscles, this is usually a sign:
- a muscle injury;
- a ligament sprain;
- the rupture or displacement of a disc.
This type of pain typically occurs:
- after a “false movement”;
- after carrying a heavy load.
When the pain goes down the posterior part of one or both legs, it may be sciatic neuralgia, which is a “pinching” of the sciatic nerve. The pain is then exacerbated by:
- cough;
- sneezing;
- effort.
This type of pain can also be a sign of a herniated disc.
If the pain in the lower back is more intense at night, it may be caused by pressure exerted by:
- inflammation
- a diseased organ;
- a tumor
Low back pain: when to consult?
In some cases, low back pain is caused by a serious illness, such as:
- cancer;
- infection
- vertebral fracture.
It is therefore imperative to consult a doctor without delay when low back pain:
- occur after trauma such as a fall or a blow to the back for example;
- are constant and intensify, mainly at night;
- occur after prolonged use of corticosteroids;
- radiate into one or both legs;
- cause weakness, numbness, or tingling in one or both legs
- coincide with the appearance of intestinal or urinary problems;
- are accompanied by chest or abdominal pain;
- are associated with urinary incontinence or loss of sensation in the perineum area;
- are accompanied by unexplained weight loss, chills, or fever;
- occur in people under 20 years of age or over 55 years of age;
- occur in a person with cancer, osteoporosis, or HIV infection;
- occur in an intravenous drug user.
If there are no warning signs mentioned above, but the pain remains present a few days after its appearance, despite the self-treatment provided, it is also important to consult.
Some people are at higher risk of developing low back pain.
Low back pain: people at risk
Workers
The following people are at higher risk of developing low back pain:
- people whose work requires spending long hours sitting or standing;
- persons called upon to lift or pull heavy loads;
- people who frequently have to lean forward or twist the torso sideways.
Pregnant women
Pregnant women are also at risk of low back pain. Indeed, pregnant women bear an additional weight of 9 to 12 kg. In addition, their hormones control the relaxation of muscle tissue, mainly in the pelvic area, to facilitate childbirth, but also near the spine.
Other people at risk
People whose parent has suffered from disc degeneration, osteoarthritis, or osteoporosis are also considered to be at risk for low back pain.
What are the risk factors for low back pain?
Risk factors for low back pain include:
- Lack of physical training;
- overtraining;
- overweight;
- bad postures;
- wearing high-heeled shoes;
- smoking;
- depression, which can be both a cause and a consequence of chronic back pain;
- prolonged stress.
Repressed emotions or an unsatisfactory work situation contribute to low back pain. Stress increases muscle tension in the back.
Risk factors for chronicity of low back pain
In about 5-8% of cases, low back pain becomes chronic. Certain factors are known to cause this chronic condition:45
- be a woman;
- belong to a low social class;
- being depressed;
- have had back surgery.
In addition, job dissatisfaction has a strong impact on the transition to chronicity.
Finally, having imaging tests and discovering the presence of lesions, even if they are normal age-related lesions, contributes to worsening the prognosis, worrying the person and preventing him from having faith in his recovery.
In order to prevent low back pain, it is essential to adopt a healthy lifestyle. Here are some key recommendations to avoid low back pain.
Low back pain: prevention measures
Basic preventive measures
It is recommended to adopt some good habits to reduce muscle tension in the back and reduce the risk of low back pain.
A healthy lifestyle
It is advisable to:
- maintain a healthy weight;
- lose weight when you are overweight;
- exercise regularly and warm up before engaging in physical activity. This is the best way to maintain the strength and flexibility of the back;
- Pay special attention to the musculature of the abdomen and back, which is a natural corset of the spine while protecting it from shocks. It is important to learn the exercises under the supervision of a qualified instructor. Poorly executed, exercises can trigger or aggravate low back pain;
- reserve moments of relaxation.
Good posture
It is necessary to:
- remain aware of posture at all times;
- keep your back straight, looking forward, shoulders back;
- to lift a heavy object, squat by bending your knees while keeping your back straight, and stand up by unfolding your legs while holding the object close to your body;
- avoid twisting movements;
- To shovel snow, keep your back as straight as possible. To do this, place your hand as low as possible on the handle, bend your knees to collect snow, use the knee as a lever when the load is heavy, and avoid twisting your back when throwing snow away.
Get to work
If you have to stand for a long time
It is advisable to use a low stool on which the feet will be placed in turn, alternating every 5 to 10 minutes.
If you have to sit for long hours at the desk or behind the wheel of a vehicle
It is recommended to:
- make stops to stretch and stretch;
- use straight-backed chairs that support the lower back well;
- use a swivel chair to minimize twisting movements;
- adjust the height of the chair;
- Put your feet on a small stool so that the knees are a little higher than the hips.
For work in front of a computer
The height of the screen must be adjusted so that the eyes are fixed straight ahead and the head relatively straight.
Think!
It is recommended to:
- prefer backpacks to handbags and use both shoulders to carry the backpack;
- pushing heavy objects rather than pulling them;
- avoid wearing high-heeled shoes larger than 5 cm;
- Instead, wear well-fitting shoes, which provide good support.
What are the treatments to adopt to relieve pain and back pain? Check them out.
Low back pain: treatments
There are different ways to treat low back pain.
Rest the back
In the acute pain phase, we try to control the pain. It is important to avoid sudden movements and rest the back. A rest of 48 hours is recommended.
Afterward, it is imperative to mobilize, even if the pain is still present. The strict bed rest that was prescribed in the past is proven ineffective and even deleterious.
The positions that best rest the lumbar spine are:
- lying on his side, knees bent, one pillow under his head and another between his knees; pregnant women can add a pillow under their belly;
- lying on your back, without a pillow under your head, with one or more pillows below your knees and a rolled towel or a small cushion in the crook of your lower back.
The application of a hot water bottle or a heated lumbar belt reduces pain. Some people prefer to apply ice, but studies have shown that the effect on pain is less important.46.
| Note: It is important not to unduly extend the rest period beyond 1 or 2 days and to resume activities as soon as possible. As a general rule, bed rest should be avoided or be as short as possible, as this is a factor that contributes to chronic low back pain. Inaction and immobility contribute to the atrophy and weakening of the back muscles. They can compromise the normal mobility of the lumbar spine joints. |
Medicines for low back pain
Acute low back pain
To control pain temporarily and over a short period of time, it is advisable to take paracetamol such as Tylenol®. Nonsteroidal anti-inflammatory drugs or NSAIDs (such as aspirin, ibuprofen, including Advil®, Motrin®, or muscle relaxants, such as Robaxacet® or Robaxisal®) over-the-counter can also relieve pain.
If the pain is severe and stubborn, the doctor may prescribe stronger painkillers, such as opiates. It is important to get effective pain relief, as suffering can lead to a fear of movement, which contributes to the chronicization of pain.
Chronic low back pain
Cortisone injections near the painful area are sometimes given in case of chronic pain.
Tricyclic antidepressants may also be prescribed to relieve some chronic back pain. Indeed, they have an analgesic effect. If necessary, they can also be used to treat the depressive syndrome, which can contribute to increased pain.
Physiotherapy and exercise
Exercises and physiotherapy are not useful against pain in acute low back pain.
In contrast, people with subacute or chronic low back pain who maintain physical activity, such as stretching and strengthening exercises, or walking, heal faster.
A physiotherapy program is therefore often recommended in case of subacute low back pain lasting more than 4 weeks.
At first, sessions may be limited to gentle movements and the application of heat in the lumbar region.
Gradually, the patient will learn a series of exercises that he will be called upon to repeat daily at home in order to rehabilitate and rehabilitate the muscles and joints of the lumbar spine. Massage therapy can be helpful.
Subsequently, gentle sports for the back are recommended such as:
- walking;
- swimming;
- Road cycling with a bicycle that fits snugly to your size.
Yoga is also effective in calming low back pain in the long run.
Mind-body approaches
When pain is chronic, you often have to make major lifestyle changes:
- change of job;
- renunciation of certain activities;
- learning new postures;
- adherence to an exercise program;
In addition, the link between emotions and low back pain seems increasingly clear to back specialists. Thus, believing in one’s healing and giving less importance to pain, by learning how to manage it as well as possible, increases the chances of recovery.
Mind-body approaches can help make this important shift. The author of a review of studies on pain control mentions that these approaches are valid complementary treatments for chronic low back pain.
In addition to reducing the intensity of pain, they make it possible to:
- better manage stress;
- learn to relax;
- have a more positive attitude.
Cognitive behavioral therapy appears to be effective.
Lumbar belt
There are no clear recommendations for lumbar belts, i.e. the wide belts that wrap around the lower back because data on their effectiveness are contradictory.
In some cases, a lumbar belt can help relieve pain and help the person resume normal activity quickly. It also reduces the use of medication and limits recurrence through a reminder action to avoid “false movements”.
In the case of chronic low back pain, wearing a lumbar belt is also controversial.
It is generally recommended only for certain situations that may revive the pain such as:
- long sit-down journeys;
- shopping;
Surgery
When a nerve is compressed, it may be decompressed with surgery. The operation will be done acutely if a nerve related to the sphincter of the bladder or anus is affected.
Alternatively, if the affected nerve causes muscle weakness in the legs or feet, doctors usually only consider surgery when the situation does not improve with time and other treatments.
In general, it is decided to give up surgery if the compression causes pain exclusively, without muscle weakness. According to studies, this type of surgery does not effectively relieve pain in the long term.
Research is currently underway on replacement discs.
Reintegration into work
If low back pain has caused a prolonged absence from work, help can be obtained from organizations that facilitate reintegration into work.
This will include ensuring that job requirements are tailored to the person’s physical abilities. They can also offer ergonomics advice. Ask your doctor.
Some complementary approaches make it possible to treat low back pain in a more natural way.
Low back pain: complementary approaches
| Note: In case of persistent pain, consult a doctor first to find out if it is possible to discover a specific cause of back pain. The following unconventional treatments have been tested in people with low back pain that was not related to a specific disease. |
Back pain tops the list of conditions for which people use alternative and complementary medicine. The most popular therapies include:
- acupuncture;
- herbal medicine;
- massage therapy;
- manipulations of the spine by chiropractic or osteopathy.
Increasingly, doctors are encouraging people with chronic low back pain to experiment with complementary approaches, as conventional treatments alone are often not enough to make the pain go away.
Any of the plants mentioned below can also be used to relieve pain and decrease inflammation.
Chiropractic
The effectiveness of chiropractic, particularly spinal manipulations, in treating low back pain has been the subject of several systematic reviews.
Among these, a very comprehensive review, including randomized clinical studies, systematic reviews, meta-analyses, and cohort studies, compared chiropractic with conventional treatments or placebos.
Whether for acute or chronic low back pain, the spinal manipulation technique seems to be more effective than placebo or inactive treatments in relieving pain and improving patients’ functional status.
In addition, the addition of a specific exercise program seems to:
- accelerate and improve results;
- reduce the periodic recurrence of pain.
Contraindications
Chiropractic is generally considered safe to treat lower back pain. However, it is contraindicated in the case of:
- cauda equina syndrome, a severe form of sciatica;
- vertebral fracture.
Osteopathy
Osteopathy is a manual medicine that aims to balance internal structures using a touch of great finesse. Several meta-analyses have concluded that this approach reduces low back pain more effectively than placebo treatment.
In addition, there are several studies in which osteopathy has been shown to be more effective than conventional treatments. It can sometimes reduce the dose of pain medication.
In addition, it seems that this effect would be significant in the short to medium term, as research has shown beneficial effects that last beyond 3 months.
| Note: Doctors generally advise against spinal manipulations, whether osteopathic or chiropractic, during the acute phase. However, they can be recommended in the subacute phase, from 4 to 12 weeks. |
Acupuncture
Acupuncture is a treatment increasingly used to relieve the pain of all kinds. In particular, it would stimulate the production of endorphins, substances with calming and pain-relieving properties.
A meta-analysis of 22 randomized clinical studies compared the effect of acupuncture with other treatments or placebos. It appears that acupuncture would be as effective in relieving chronic low back pain as the therapies usually used.
This is also the conclusion of a review of the scientific literature on 4 randomized studies. When it comes to acute low back pain, however, the results are scarce and inconclusive.
Hydrotherapy or thermal cures
The authors of a meta-analysis looked at 5 clinical trials investigating the effects of balneotherapy and spa treatments for the relief of low back pain. The results of these studies show that the 2 types of therapies reduce pain.
A clinical trial has also shown that balneotherapy is more effective if the water used is rich in sulfur. The European League Against Rheumatism or EULAR analyzed 19 clinical trials of balneotherapy and confirmed its usefulness for chronic low back pain.
Cayenne or Capsicum frutescens
Local application of capsaicin, one of the active ingredients in cayenne cheese, helps relieve low back pain, according to a few studies. It should be noted, however, that according to the authors of a meta-analysis, capsaicin has only low to moderate efficacy against musculoskeletal pain.
These researchers point out, however, that it may be useful as an adjuvant or as the only treatment for people who do not respond or are intolerant to other treatments.
Commission E recognizes the external use of Cayenne to relieve muscle pain in the:
- shoulders;
- arm;
- spine.
Dosage
Apply a cream, lotion, or ointment containing 0.025 to 0.075% capsaicin.
In Chinese shops, capsicum plasters can also be found that are applied to joints or painful muscles.
Note that
It often takes 14 days of treatment before the full therapeutic effect is felt.
Sometimes the first application causes a sharp sensation of pain that later fades. Applications should be discontinued if this sensation persists after 2 treatments or if redness appears.
Wash hands thoroughly after use. Since the irritating substance is poorly soluble in water, soap or a little vinegar is needed to cleanse the skin.
Devil’s claw or Harpagophytum procumbens
Results from several clinical trials, with or without placebo groups, indicate that devil’s claw root may improve mobility and relieve pain in musculoskeletal disorders, including osteoarthritis and back pain.
It would have an anti-inflammatory action and promote muscle relaxation.
Commission E and ESCOP have recognized the effectiveness of this African plant to relieve arthritic and musculoskeletal pain.
Dosage
1 or 2 tablets of 500 mg are usually taken 3 times daily, or 1.5 to 3 g per day. Dosages may vary depending on the type of extract. Follow the manufacturer’s instructions.
Note
It is recommended to follow this treatment for at least 2 or 3 months in order to take full advantage of its effects.
White willow or Salix alba
The bark of the white willow contains salicin, the molecule that causes acetylsalicylic acid or aspirin®. It has analgesic and anti-inflammatory properties.
Clinical trials indicate that willow bark helps soothe low back pain. The pain-relieving effects of white willow have sometimes been similar to those of synthetic drugs.
Commission E and ESCOP recognize its usefulness in lowering fever and relieving rheumatic pain and headache.
Massage therapy
Several researchers have studied the therapeutic effects of massage in the treatment of low back pain. The results do not allow them to reach a consensus on the effectiveness of massage therapy, given the variability in the quality of the studies conducted to date.
It still seems that massage relieves subacute and chronic low back pain, especially if combined with physical activities and educational information on the prevention of back pain.
Massage helps to release muscle tension and improves blood circulation, which would partly explain its pain-relieving effect. There are several types of therapeutic massages.
Technique Alexander
The Alexander Technique is a somatic education technique that aims to unlearn certain posture habits to:
- reduce muscle tension;
- improve balance;
- reduce fatigue and pain.
Even if the effectiveness of the Alexander technique is still far from being demonstrated for the relief of low back pain, it is successfully integrated into multidisciplinary protocols to reduce discomfort for people with this condition.
Transcutaneous electrical nerve stimulation or TENS
TENS involves stimulating the nerves with a gentle electrical current to relieve pain. Although widely used in the treatment of low back pain, this method has not proven its effectiveness. At least that’s what the authors of an analysis concluded.
Back schools
We must highlight the success observed with what is now known as the “back schools”: these are programs for the care and support of patients suffering from low back pain.
It teaches:
- how to take care of your back;
- what movements to avoid;
Body disciplines
Although their effectiveness has not been demonstrated during clinical trials, several body disciplines provide relief for people with low back pain. Among the most popular are tai chi and yoga.
A randomized study showed that yoga improved the quality of life of people with chronic low back pain while providing greater spine flexibility than conventional physiotherapy exercises.
Studies to better assess the effect of yoga and tai chi on chronic low back pain are ongoing.
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