Low Back Pain

Anatomy of the Waist

Our waist is a structure that carries the weight of our body, transfers the load from the hips to the legs and also allows our body to be mobile during our daily activities. Our waist has 5 vertebrae and cartilage pads (discs) connecting these vertebrae, joint structures and soft tissues that support them. In addition to contributing to movement and carrying loads, the lumbar vertebrae, like the other parts of the spine, serve as protection for the spinal cord and nerve roots. The nerves that provide muscle control of the legs, carry the sensation of the legs and control urinary, fecal and sexual functions pass through the lumbar vertebrae.

Causes of Lower Back Pain

Any event that develops in the vertebrae, discs and soft tissues in the waist can cause back pain.

Back pain is one of the most important reasons that restricts the daily activities of the individual today. It is known that approximately 80% of the population worldwide has at least one back pain attack at some point in their lives. Back pain ranks second after heart diseases among chronic diseases seen in developed societies and ranks fifth among diseases that require surgical treatment. Back pain is most commonly seen in people between the ages of 20-40. We can divide back pain into 2 groups: acute and chronic. In acute back pain, the pain usually decreases within a few days and completely disappears after a few weeks. If the pain lasts more than 3 months, this pain is called chronic back pain. While the complaints of 90% of patients with back pain go away on their own within the first 4 weeks, only 5% become chronic. In most cases, the cause of the pain is diagnosed with history and clinical examination, and nothing can be found in auxiliary examinations and radiological examinations.

We generally call this type of pain "Mechanical low back pain".

We can group the causes of back pain into 2 major groups.

1. Musculoskeletal system diseases
2. Spinal diseases

1-Musculoskeletal System Diseases

The vast majority of back pain falls into this group. It mostly occurs due to minor damage to the muscles, connective tissue or joints. The term "myofascial pain syndrome" is used for the clinical picture caused by excessive tension and injury to the muscles and soft tissues. Other musculoskeletal system problems that cause back pain include poor and incorrect body posture, shortness of one leg, smoking as it causes low oxygenation of the vertebrae and cartilages in the back, and psychosocial factors such as stress.

2-Spinal Diseases

Diseases in this group are proportionally less common than musculoskeletal diseases. The most common diseases that cause back pain in this group are: herniated discs (lumbar disc herniations), deterioration of the disc tissue (degenerative disc disease), lumbar spondylolisthesis, narrowing of the lumbar spinal canal (lumbar stenosis). Other than these, there are much less common but serious diseases of the spine such as tumors, infections, trauma, and collapses due to osteoporosis.

Evaluation and Diagnosis of Patients with Low Back Pain

The cause of most back pain is, as mentioned above, excessive stretching or minor injuries of the muscles and soft tissues. Since the pain complaints in these patients will subside on their own within a few days, they usually do not need to be examined. However, the following reasons require immediate medical attention.

1. Recurrent back pain attacks
2. Chronic back pain
3. Gradually increasing pain intensity
4. Symptoms such as pain in the thighs and legs, numbness, weakness, inability to urinate or defecate voluntarily, and sexual dysfunction accompanying back pain
5. Back pain that does not go away with rest
6. Excessive weight loss, fever, chills and shivering accompanied by back pain
7. When investigating the causes of back pain, the patient's history should be taken and the necessary examination should be performed, and tests should be performed in line with the preliminary diagnosis determined.

a) If a herniated disc, excessive stretching of the muscles and soft tissues are considered as the cause of acute back pain, bed rest (not exceeding 5 days) and drug therapy are recommended for these patients.

b) In cases with chronic back pain, acute back pain that has been treated with rest and medical treatment but the pain does not go away, and in cases where a spinal tumor or spinal infection is suspected, we should start our examination with direct radiography and follow-up to determine the level of the lesion and diagnose the disease with Magnetic Resonance Imaging (MRI). In addition to these examinations, if an infection or tumor is suspected in the patient, blood tests and bone scintigraphy should be performed.

Treatment for Low Back Pain

The treatment for low back pain should be determined according to the cause of the pain and the location of the disease.

Treatment of Acute Low Back Pain

* In low back pain caused by excessive tension of muscles and soft tissues or minor injuries

(Mechanical low back pain) painkillers, muscle relaxants and short-term bed rest alone are sufficient in most cases.

Low back pain caused by trauma and infection: if there is weakness in the legs due to pressure on nerves and/or inability to urinate and defecate voluntarily, instability (abnormal mobility) in the spine, surgical intervention should be performed, and if the cause is infection, additional antibiotic treatment should be given.

Tumor-Related Low Back Pain:

If there are complaints of weakness in the legs and/or inability to urinate and defecate voluntarily due to pressure on the nerves, or if it has caused instability (abnormal mobility) in the spine, surgical intervention may be performed and radiotherapy-chemotherapy is recommended according to tissue diagnosis.

If there is no sign of pressure on the nerves, first the type of tumor should be determined by biopsy, then surgical intervention and/or radiation therapy, chemotherapy should be performed depending on the situation.

Lumbar Pain Due to Herniated Disc, Lumbar Slippage, Spinal Stenosis:

If there are complaints of weakness in the legs due to pressure on the nerves and/or inability to urinate and defecate voluntarily, if there is instability (abnormal mobility) in the spine, surgical intervention is absolutely necessary. If the quality of life of the patients is affected due to long-term pain despite the absence of neurological findings such as loss of strength, pain alone may be the reason for surgical intervention. When choosing the surgical intervention method, each patient should be evaluated individually and the appropriate technique should be selected for that patient.

If there are no signs of pressure on the nerves, painkillers, muscle relaxants and bed rest (not exceeding 5 days) are recommended.

In cases of chronic low back pain, if the cause is a herniated disc, lumbar spondylolisthesis, narrowing of the spinal canal, or deterioration of the disc tissue, if there are progressive neurological findings (muscle weakness, inability to defecate and urinate voluntarily), surgical intervention is recommended; if not, painkillers, muscle relaxants and short-term bed rest followed by physical therapy and muscle exercises are recommended.

Preventing Back Pain

In order to prevent recurring back pain, the patient must lose weight, quit smoking if he/she has any, do regular and continuous muscle exercises for the waist, back and abdominal muscles, and correct improper posture, sitting and lying positions.