Where does back pain come from?
The spine is a complex structure of vertebrae, discs, joints, ligaments and muscles, and any of these structures can hurt. The most common situation is nonspecific pain, when the exact source is impossible and unnecessary to determine: the prognosis is good regardless of whether it is a muscle or a facet joint. Less commonly, the pain is caused by compression of the nerve root by a herniated disc, and then it radiates down the leg below the knee with numbness. Specific causes such as fracture, infection or tumor are rare but require exclusion.
- Nonspecific musculoskeletal pain
- Intervertebral disc herniation with radiculopathy
- Facet syndrome and arthrosis of small joints
- Spinal stenosis
- Compression fracture due to osteoporosis
- Spondyloarthritis
- Referred pain in diseases of the kidneys, pancreas, aorta
What provokes an exacerbation
Often an exacerbation begins after an unsuccessful movement, lifting a heavy object from an incline, a long trip or hypothermia. But the background plays a key role: a sedentary lifestyle, weak trunk muscles, prolonged sitting in one position. There is a separate psychological factor: anxiety, depression, fear of movement and the belief that the back is “worn out” significantly lengthen the period of pain. Smoking and excess weight worsen the nutrition of the discs and increase the risk of chronicity.
- Lifting weights from a bend and with a turn
- Sitting for long periods without breaks
- Weakness of the back and abdominal muscles
- A sharp increase in physical activity
- Excess weight and smoking
- Stress, anxiety, sleep disturbance
- Osteoporosis in older people
When do you need pictures?
Contrary to popular belief, doing an MRI for every back pain is not necessary and even harmful: in most healthy adults, protrusions and age-related changes not associated with pain are found in the images, and such findings increase anxiety. Imaging is indicated if there are warning signs, if pain radiates along with neurological impairment, if complaints persist longer than 4-6 weeks, or if surgery is being discussed. In these cases, snapshots really change tactics.
- Warning signs from the list above
- Leg pain below the knee with weakness and numbness
- Pain does not improve after 4–6 weeks of treatment
- Suspicion of fracture, infection or tumor
- Planned surgical treatment
- Age over 50 years with new onset of severe pain
What helps with exacerbation
The main rule of modern recommendations is not to lie down for a long time. Bed rest for more than 1–2 days slows recovery. Keep as active as possible, walk, change your position every 30–40 minutes. Heat on the lower back in the first days reduces muscle spasms. Painkillers are taken in a short course as prescribed by a doctor. As the pain subsides, therapeutic exercises are added, which remains the main means of preventing recurrent episodes.
- Stay active and avoid lying down for long periods of time
- Heat on the lower back for muscle spasms
- Short course pain relief as prescribed by a doctor
- Regular breaks during sedentary work
- Therapeutic exercises after acute pain subsides
- Massage and physiotherapy as an addition
- Dealing with stress and normalizing sleep
Treatment and prevention of recurrences
For chronic pain, the basis is regular physical activity, selected with a rehabilitation specialist: exercises for the core muscles, walking, swimming. The effect does not come from a one-time course, but from consistency. Physiotherapy, massage and traction provide relief, but are used as an adjunct. For radicular syndrome, the doctor may prescribe special medications and blockades. Surgery is required for a small proportion of patients: for persistent compression of the root with weakness in the leg or for cauda equina syndrome, when the intervention is performed urgently.
- Regular exercises for the back and abdominal muscles
- Walking and swimming
- Ergonomics of the workplace
- Proper lifting technique: Bend your knees, not your back.
- Physiotherapy, massage, traction as an addition
- Losing weight and quitting smoking
- Surgical treatment for persistent radiculopathy