Low back pain

The causes of 50% of lumbago are usually contractures or degenerative alterations of the lumbar spine, and they subside in approximately 7-10 days. This type of low back pain lasting less than 6 weeks is called acute low back pain.

We speak of subacute low back pain when the evolution time is 6-12 weeks and chronic low back pain when the duration is more than 12 weeks. In these cases, a detailed study with complementary tests is required to help us find the reasons for the pathology.

Likewise, low back pain can be triggered by alterations in different anatomical structures of this region of the spine: intervertebral discs, vertebrae, ligaments, muscles, facet joints, sacroiliac joints, etc.

To learn more about the origin of low back pain, we classify it into mechanical (90%) and non-mechanical (10%).

Mechanical low back pain comes from an osteomuscular dysfunction in the lumbosacral spine, which generates structural/functional alterations:

• Traumatic or pathological vertebral fractures (osteoporosis, metastasis). 
• herniated disc. 
• Deep Gluteal Space Syndrome (Pyramidal Syndrome).
• Segmental instability Spondylarthrosis.
• Spinal stenosis. Foraminal stenosis. 
• Spondylolysis / Spondylolisthesis. 
• Scoliosis.

On the other hand, non-mechanical low back pain is notably less frequent and its origin lies in:

• inflammatory diseases (Sacroiliitis, Rheumatoid Arthritis, Psoriasis, Ankylosing Spondylitis, Crohn's Disease).
• infectious Spondylitis (Ankylosing Brucelosic Spondylitis, Spondylodiscitis, Tuberculosis, Osteomyelitis).
• tumors ( Primary Bone, Metastasis, Retroperitoneal Tumors, Myeloma).
• visceral (Gastrointestinal, Renal, Gynecological Referred Pain).
• bone diseases (Paget's Disease, Osteomalacia).
• neuropathic pain (Fibromyalgia, Diabetic Neuropathy).
• circulatory disorders (Aortic Aneurysm, Vasculitis). 

The main symptom of low back pain is pain. When this, focused on the lumbar region, is of mechanical origin, it is characterized by increasing with physical activity and improving with rest, analgesic-anti-inflammatory treatment, and progressive increase in activity. It is not usual for it to cause nocturnal disturbance but, in some cases, it can make it difficult to completely sleep comfortably.

In the case of 10% of non-mechanical low back pain, there is morning pain and a clear sleep disorder. Rest is usually insufficient for the patient's improvement, and diagnosis is essential for the correct treatment of the injury.

To carry out a correct diagnosis of low back pain, it is necessary to have a detailed clinical history with a complete physical examination:

In the clinical history, we investigate the personal history and ongoing pathologies. Likewise, we identify the causes of pain (mechanical or inflammatory), we discriminate between low back pain and lumbosciatica, and we contrast different variables such as the evolution of pain. 

During the physical examination, we examine the patient from the moment he enters the office door. The type of gait, the postural attitude and the functional limitations in the examination positions are determining factors in the diagnosis. We must assess active mobility in all planes (Toe-Ground Distance, Schöber test, lateralizations, and rotations), evaluate possible root affectations in the hip and sacroiliac joints, and perform root elongation tests (Lasègue, Bragard, toe, and heel walking) and explore strength alterations, atrophies or alterations in reflexes.

We support this diagnosis with the following complementary tests:

The radiological study is an essential test that, in addition, must be the first to be performed on the patient. 

Magnetic resonance imaging (MRI) is the best test to identify soft tissue injuries. It is essential in the diagnosis of sciatica, suspicion of malignancy, infection, or neurological deficits. 

The CT scan is a very useful test in the structural bone assessment of the vertebra and the result can help us identify spinal stenosis or vertebral malformations. 

To diagnose tumors, inflammations or infections, the complementary GGO test is used.  

Lastly, neurophysiology studies (electromyograms/electroneurograms) are useful for evaluating neuromyopathic alterations that contribute to lumbocytalgia.

Low back pain treatment can be conservative or surgical. The pathology that triggers low back pain or sciatica and the intensity and duration of the pain are decisive for choosing one or the other, since the surgical operation is performed when the pathology is sciatica or spinal disc herniation.

Low back pain is usually initially treated with analgesics, anti-inflammatories, and muscle relaxants supported by active physical rehabilitation. Bed rest and passive maneuvers, poor postural habits, loss of body weight, and smoking should be avoided. Likewise, maintaining an effective dorso-lumbar and abdominal muscle tone is important to avoid or reduce relapses.

Depending on the intensity and duration of the process, the recurrence, and the failure of the conservative treatment, we consider performing a surgical treatment.

There are several recommended sports for low back pain: walking is good for low back pain, as well as swimming and yoga. It is advisable to go to our traumatologists specializing in low back pain in Madrid to treat the pathology in a particular and personalized way, as well as agree on a series of exercises at home for low back pain, or the use of lumbar belts.