Lumbar muscle pain

WHO statistics show that 90% of people, that is, almost every one of us, experience pain in the lower back muscles at different periods of life, to varying degrees of intensity.

Only half of those who have ever had lower back pain go to the doctor to get examined and treated, perhaps because the pain symptom is often not acute or intolerable. However, the causes of pain can be quite serious, and if they are not identified in a timely manner, the disease can become chronic and affect not only the lower back area, but also other parts of the body, internal organs and systems.

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Causes of Lower Back Muscle Pain

Pain is often one of the main symptoms, the leading clinical sign of the disease, setting the direction for all diagnostic measures. However, the causes of pain in the lumbar muscles are not easy to recognize and determine. It is believed that the primary cause of the pain symptom is mostly degenerative pathology of the spinal column - osteochondrosis, in fact, diseases of the spine make up no more than 25% of the total number of factors causing pain in the lumbosacral zone. Basically, this is the displacement of intervertebral discs and pinching of nerve endings. The remaining number of causes consists of many different diseases, which include nephropathologies, diseases of the pelvic organs in women, muscle hypertonicity after intense training, diseases of the digestive tract, neurological conditions and many others. Actually, all organs and systems that innervate the lumbar region can provoke pain in the lumbar muscles.

Statistics on factors that induce lower back pain:

• Inflammation, hypertonicity, spasm of muscles and soft tissues – 70%.
• Degenerative diseases associated with the spine – no more than 12%.
• Intervertebral disc herniation – 4%.
• Spondylolisthesis (lumbosacral instability) – 4%.
• Injuries – 1%.
• Congenital anatomical anomalies of the spine - 1%.
• Osteoporosis, compression fractures – 4%.
• Spinal stenosis – 2%.
• Tumor processes – 1%.
• Reflected pain symptom – 1%.

Pathological causes of pain in the lower back muscles:

• Osteochondrosis, deformation of the spine, both in the chest area and in the lumbosacral zone.
• Myofascial syndrome.
• Fibromyalgia.
• Pathological changes in the abdominal organs.
• Neuropathies.
• Diseases of the pelvic organs.

Factors that can trigger muscle pain in the lumbar region:

• Muscle strain as a result of physical exertion or training.
• Static tension of the muscles located in the lumbar region when working while sitting, standing, or bending.
• Exposure to constant vibration is a professional cost of work for drivers of agricultural and construction vehicles (tractors, combines, stackers, loaders, etc.).
• Spinal cord injury, hip joint injury, lumbar spine injury, coccyx injury.
• Hypothermia.
• Psychogenic factors (stress, depression).

A more specific description of the etiological factors will help determine what hurts in the lower back - the muscles themselves or is it reflected pain? The causes of muscle spinal pain in medical practice are divided into primary and secondary

1. Primary pain syndrome is a morphofunctional change in the skeletal muscles located in the lumbar region, such a syndrome is also called muscular-tonic. As a rule, the cause of the syndrome is dystrophic damage to the spine:

• Osteochondrosis, most often of the lumbosacral zone. Dystrophic, degenerative changes in the intervertebral discs lead to the development of spondylosis, this process is inevitably accompanied by lumbar pain.
• The facet form of osteochondrosis is spondyloarthrosis, when degeneration penetrates into the intervertebral structures – facet or synovial.

2. Secondary pain syndrome in the lower back has more diverse causes, some of them are also caused by functional disorders of the spine, but often they are not associated with it at all:

• Fixed or non-fixed deviation of the spine, curvature in the frontal plane or scoliosis.
• Osteoporosis, osteomalacia.
• Non-infectious diseases of the musculoskeletal system – RA (rheumatoid arthritis), Reiter's syndrome, Bechterew's disease, rheumatic polymyalgia.
• Spinal injury - crack, fracture of a vertebra.
• Tumor process in the spine.
• Infectious diseases – epidural abscess, brucellosis, tuberculosis.
• Diseases of the gastrointestinal tract.
• Myofascial syndrome.
• Myositis is an inflammatory process in the muscles of the lumbar region of an infectious nature.
• Sciatic bursitis.
• Lower back pain during pregnancy.
• Some types of stroke when acute cerebrospinal blood flow disorder is diagnosed.
• Lumbago (lumbago).
• Reflected pain in the lower back, including in the muscles, can be caused by renal colic, gynecological diseases and some types of STIs - gonorrhea, ureaplasmosis, chlamydia, trichomoniasis.

Summarizing the wide variety of causes that provoke muscle pain syndrome in the lumbar region, they can be systematized as follows:

• 70-75% of the causes of pain in the lower back muscles are associated with the degenerative-dystrophic process in the spine.
• 10-15% - myofascial syndrome.
• 10-15% of diseases of the abdominal cavity and pelvic organs.
• 5-10% neuropathy.

How does lower back muscle pain manifest itself?

Like other pain symptoms, symptoms of lower back muscle pain are classified according to the degree of intensity and nature of the sensations:

• Acute pain symptom. Duration from 1 day to one and a half months.
• Subacute pain symptom. Duration from one and a half months to 3 months.
• Chronic pain symptom. Duration of pain is more than 3 months or more.
• Recurring pain.

Symptoms of pain in the muscles of the lower back are directly related to the disease, condition, factor that provokes the pain:

1. Lumbago is a disease that has many causes, most of which are related to overexertion, physical overload and hypothermia. The pain is localized in the back, in the lower back, spreads towards the hip, along the surface of the leg. The pain appears during physical exertion, intensifies with sudden movements, turns. Lumbago can recur and be provoked by hypothermia. The pain symptom is localized in the paravertebral muscles, at the very beginning it has a shooting, sharp character, then turns into aching pain, radiating to the buttock, limiting motor activity.
2. Lumbosciatica is a type of lumbago that is directly related to the spine, of vertebrogenic origin. The syndrome is most often provoked by compression or herniation of the intervertebral disc (L5-S1 or L4-L5). It should be noted that compression pain is rare, more often the symptom indicates irritation of nearby muscles and ligaments. The pain is symmetrical, diffuse, poorly defined by localization, felt deep in the lower back, rarely radiating below the hip. If lumbosciatica is provoked by a hernia, then the pain is felt more acutely, depends on movements, static posture, bending, and can intensify with the slightest tension (coughing, sneezing).
3. Myofascial syndrome. This complex polysymptomatic disease can provoke muscle pain on its own, but can complicate the symptoms of vertebrogenic pathologies. The nature of the pain depends on the prevalence of the process, most often it is aching and intensifies with movement. The pain is localized in the piriformis muscle, as well as in the middle gluteal and paravertebral muscles of the lumbar region. Small painful seals are palpated in the muscle tissue, which are diagnostic criteria. Myofascial pain syndrome is observed in 80% of patients complaining of pain in the lumbar muscles.

There are symptoms of lower back muscle pain that require immediate diagnosis and medical attention, regardless of the suspected cause:

• Severe pain in the lumbar region for 1.5-2 days, not subsiding in a horizontal position and intensifying at night.
• Pain in the lumbar muscles radiating below the knee.
• A painful symptom that causes numbness in one or both legs.
• Low back pain accompanied by pelvic disorders (intestines, bladder).
• Pain caused by a severe bruise to the lower back, trauma.
• Chronic pain in the lower back muscles, accompanied by steady weight loss.

Diagnosis of lower back muscle pain

The specificity of the diagnosis of pain in the lumbar muscles is the subjectivity of the complaints presented by the patient. They are considered significant in the first place, although no symptom of lumbar pain can be pathognomic, moreover, quite often the examination does not reveal any serious anatomical or degenerative changes in the musculoskeletal system. Therefore, the initial stage of diagnosis is the exclusion of threatening conditions and diseases of the spine. Then follow neurological and instrumental examinations, clarifying the diagnostic direction.

Diagnosis of pain in the muscles of the lower back, algorithm:

1. Exclusion of serious pathologies (the “red flag” system):

• Oncoprocess.
• Unexplained weight loss.
• Decreased immunity (possible long-term use of glucocorticosteroids).
• Infectious diseases of the urinary system.
• Thrombocytopenia, long-term use of anticoagulants and the possibility of retroperitoneal hematoma.
• Osteoporosis in people over 50 years of age.
• Serious injury, including a fall from standing height.
• Cauda equina syndrome, other neurological pathologies, including those that require surgical treatment.
• Dependence of pain symptoms on diseases of internal organs.
• Clearly expressed deformation of the spinal column.

2. Determining the localization, nature and other parameters of pain by questioning the patient:

• In what position or body posture does the pain increase?
• At what time of day does the pain become most intense?
• What position can reduce pain symptoms?
• What body movements are associated with pain?
• How did the pain arise – spontaneously or did it intensify gradually?
• The presence or absence of traumatic injury to the lumbar region, hypothermia, overexertion.

3. External visual examination of the lumbar region and palpation:

• Presence or absence of scoliosis.
• Determination of spasmodic areas of the body – trigger points.
• Identification of areas of muscle hypotrophy.

4. Determination and clarification of the range of motion, clarification of the neurological status:

• Tension symptom (Lassegue-Wasserman test, Neri test, symptom of sitting, tilting).
• Examination to determine sensitivity, reflexes and sufficient muscle tone.
• Presence or absence of swelling.
• Condition of the skin of the lower back (temperature, color, humidity, etc.).

5. Instrumental types of examination:

• X-ray of the spine.
• CT and MRI.
• Ultrasound of the pelvic organs in women.
• Rectomanoscopy as indicated.
• Gynecological examination as indicated.
• Gastroscopy as indicated.
• Laboratory tests of blood and urine to differentiate possible inflammatory infectious pathologies that provoke pain in the lower back.

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Treatment of lower back muscle pain

The main task that the treatment of pain in the lower back muscles solves is the relief of pain using accessible and adequate methods.

Treatment of lower back pain – general recommendations:

• Anesthesia.
• Maintaining a gentle bed rest, but no more than 3 days in the absence of serious spinal pathologies.
• Avoid overexertion and physical exertion.
• Partial immobilization of the lumbar region is possible with the help of corsets and fixing belts.
• The rehabilitation period is strengthening the lumbar muscles.
• Prevention of relapses.

The following groups of drugs are used as drug treatment methods:

• Analgesics (drug blockade).
• Nonsteroidal anti-inflammatory drugs.
• Muscle relaxants.
• Diuretics to reduce swelling.
• Tranquilizers, antidepressants for fibromyalgia, depressive states, psychogenic factors that provoke pain.
• Chondroprotectors.
• Preparations that improve metabolic processes and blood microcirculation.
• B vitamins.

Non-drug treatment for lower back muscle pain:

• Vacuum therapy.
• Compresses for myofascial syndrome.
• Acupuncture.
• Post-isometric manual relaxation.
• Magnetopuncture.
• Massage.
• Physiotherapy exercises.

Prevention of lower back muscle pain

Preventive measures aimed at preventing relapses of lumbar pain include eliminating the root cause of the symptom, correcting the condition of the spinal column, correcting possible incorrect motor stereotypes, but most importantly, strengthening the muscles and creating the so-called muscle corset. In essence, prevention is following simple recommendations:

• You need to learn to maintain physiologically correct body posture.
• It is necessary to sit and stand correctly.
• For people suffering from lower back pain, it is very important to learn how to get up from a lying position correctly.
• You need to learn to distribute the load on the spine when moving and lifting heavy objects.
• It is necessary to follow a diet that includes foods rich in calcium, phosphorus, and B vitamins.
• It is necessary to regularly strengthen the muscular corset, especially in the lumbar region.

A little more detail about each point:

1. Walking and standing. When walking, you should watch your posture and straighten your back to reduce the load on the lumbosacral spine. If a person has to stand a lot due to their job, they should try to move periodically, change their posture, and shift their body weight from one leg to the other. It is also useful to do small bends to relieve fatigue in the lower back and back muscles in general.
2. If a person sits for a long time, it is also necessary to watch your posture, keeping your back straight if possible. After 10-15 minutes, you should warm up - stretch, change the position of your legs. It is very important what a person sits on, a chair, an armchair, etc. should be comfortable, with a high back and a fairly soft seat.
3. Horizontal posture and getting up in the morning. The bed should be quite hard to maintain the physiological curve of the spine. Too soft a bed develops a pathological deflection, "sagging" of the back. Getting up in the morning should begin with a warm-up in bed, then you can get up, turning sideways, first lowering one leg, then the other.
4. Moving heavy objects. There are certain weight standards: children under 16 years old - no more than 10 kg, women - also, men can lift loads from 25 to 50 kg, but alternating with lighter work. If the work involves systematically moving heavy objects, you need to strengthen your lower back with a special belt or corset. In addition, when moving loads, you should not bend your spine, but bend your legs at the knees (squat with a straight back). This is how weightlifters lift loads, keeping their back as straight as possible. You cannot carry a heavy load in one hand for a long time to avoid overloading the left or right side of the body. If you have to carry a load, you need to bring it as close to you as possible so as not to bend over and eliminate turns (twists) of the body.

Experts say that lower back muscle pain can be prevented if you systematically strengthen your muscular corset and sensibly assess your physical capabilities when playing sports or moving loads. Minimal knowledge of the structure of the spine, muscles and all the features of static and dynamic loads will also not hurt. In addition, an old, time-tested method allows you to avoid pain in the back, in the lower back - regular physical activity, this is especially relevant in our time - the era of physical inactivity.