Pain in the lumbar muscles

WHO statistics show that pain in the lumbar muscles at different periods of life, in varying degrees of intensity, is experienced by 90% of people, that is, practically every one of us.

Only half of those who have ever had a lower back, turn to a doctor to examine and treat the ailment, perhaps this is due to the fact that the pain symptom is not usually acute, intolerant. However, the causes of pain are serious enough, if they are not detected in time, the disease can go on into chronic form and affect the complications not only of the lumbar region, but also of other parts of the body, internal organs and systems.

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Causes of pain in the muscles of the lower back

Pain is often one of the main symptoms, the leading clinical sign of the disease, which directs all diagnostic activities. However, the causes of pain in the lumbar muscles are recognized and are not easily determined. It is believed that the root cause of the pain symptom is, for the most part, degenerative pathology of the spinal column - osteochondrosis, in fact, spinal diseases account for 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 infringement of nerve endings. The remaining number of causes consists of a variety of diseases, including nephropathy, pelvic organs in women, hypertension of muscles after intensive 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 muscles of the waist.

Statistics on the factors inducing lower back pain: 

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

Pathological causes of pain in the muscles of the waist:

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

Factors that can provoke muscle pain in the lumbar region: 

• Overexertion of muscles as a result of physical activity, training.
• Static tension of the muscles located in the zone of the waist, while sitting, standing, tilted.
• The impact of constant vibration - the professional costs of the work of drivers of agricultural, construction transport (tractor, combine harvester, car loaders, forklifts and so on).
• Injury of the spine, hip joints, contusion of the lower back, coccyx.
• Subcooling.
• Psychogenic factors (stress, depressive state).

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

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

• Osteochondrosis, more often the lumbosacral zone. Dystrophic, degenerative changes in the intervertebral disc lead to the development of spondylosis, this process is inevitably accompanied by lumbar pain.
• The faceted 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 also caused by functional disorders of the spine, but often they are not associated with it: 

• Fixed or non-fixed spinal deviation, 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.
• Injury of the spine is a crack, fracture of the 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 zone of an infectious nature.
• The ischium bursitis.
• Low back pain during pregnancy.
• Some variants of a stroke, when an acute disorder of cerebrospinal blood flow is diagnosed.
• Lumbago (chamber).
• Reflex pains in the lower back, including in the muscles, can be caused by renal colic, gynecological diseases and some types of STDs - gonorrhea, ureaplasmosis, chlamydia, trichomoniasis.

Summarizing a wide variety of causes provoking painful muscular syndrome in the lumbar region, we can systematize them in this way: 

• 70-75% - causes pain in the lower back muscles, associated with a degenerative-dystrophic process in the spine.
• 10-15% - myofascial syndrome.
• 10-15% of diseases of the abdominal cavity, small pelvis.
• 5-10% of neuropathy.

How does the pain in the muscles of the lower back?

Like other pain symptoms, the symptoms of pain in the muscles of the waist are divided according to the degree of intensity and nature of the sensations: 

• Acute pain symptom. Duration from the 1st day to the month and a half.
• Subacute pain symptom. Duration from one and a half months to 3 months.
• Chronic pain symptom. Duration of pain more than 3 months or more.
• Recurrent pain.

Symptoms of pain in the lumbar muscles are directly related to the disease, condition, factor, which provoke a painful feeling: 

1. Lumbalia is a disease that has many causes, most of which relate to overexertion, physical overload and hypothermia. The pain is localized in the back, in the waist, poured into the side of the thigh, over the surface of the leg. The pain appears with physical exertion, amplified by sharp movements, turns. Lumbago can recur and be provoked by hypothermia. The pain symptom is localized in the paravertebral muscles, at the outset it has a shooting, sharp character, then passes into a aching pain radiating into the buttock, limiting the motor activity.
2. Lumboschialgia is a variant of lumbago, which is directly connected with the spine, of vertebrogenic origin. The syndrome is most often provoked by compression infringement or a hernia of the intervertebral disc (L5-S1 or L4-L5). It should be noted that compression pains are rare, often a symptom means irritation of nearby muscles and ligaments. The pain is symmetrical, diffuse, poorly defined by localization, felt deep inside the waist, rarely radiates below the hip. If lumboscialgia is provoked by a hernia, the pain is felt more sharply, depends on movements, static posture, slopes, can be amplified at the slightest stress (coughing, sneezing). 
3. Myofascial syndrome. This complex polysymptomatic disease can provoke muscle pain on its own, but it 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 intensified in motion. The pain is localized in the pear-shaped muscle, as well as in the middle gluteal and paravertebral muscles of the waist. In the muscle tissue palpation there are small painful seals, which are diagnostic criteria. Myofascial pain syndrome is noted in 80% of patients with complaints of pain in the muscles of the waist.

There are symptoms of pain in the muscles of the lower back, which require immediate diagnosis and medical care, regardless of the reason: 

• Severe pain in the lumbar region for 1.5-2 days, not abating in a horizontal position and worse at night.
• Pain in the muscles of the waist, radiating below the knee.
• Pain symptom causing numbness in one or both legs.
• Back pain, accompanied by pelvic disorders (intestines, bladder).
• Pain, provoked by a strong back injury, an injury.
• Chronic pain in the muscles of the waist, accompanied by a steady loss of weight.

Diagnosis of pain in the lumbar muscles

Specificity, which has a diagnosis of pain in the muscles of the waist, is the subjectivity of the complaints made by the patient. They are considered to be significant in the first place, although no symptom of lumbar pain can not be pathogenic, moreover, quite often in the examination there is no serious anatomical or degenerative change in the musculoskeletal system. Therefore, the initial stage of diagnosis is the elimination of threatening conditions and diseases of the spine. Followed by neurological and instrumental examinations, specifying the diagnostic direction.

Diagnosis of pain in the lumbar muscles, algorithm: 

1. Exclusion of serious pathologies (the system of "red flags"): 

• Oncoprocess.
• Unexplained weight loss.
• Decreased immunity (possible long-term use of glucocorticosteroids).
• Infectious diseases of the urinary system.
• Thrombocytopenia, prolonged use of anticoagulants and the possibility of retroperitoneal hematoma.
• Osteoporosis at the age of more than 50 years.
• Serious injury, including a fall from the height of its growth.
• Ponytail syndrome, another neurological pathology, including one that requires surgical treatment.
• Dependence of pain symptom with diseases of internal organs.
• Pronounced deformity of the spinal column.

2. Elucidation of localization, character and other parameters of pain with the help of a patient's questionnaire: 

• At what position, the posture of the body pain intensifies.
• At what time of day the pain becomes most intense.
• What posture can reduce the pain symptom.
• With what movements of the body is the pain.
• As the pain arose - spontaneously or gradually increased.
• Presence or absence of traumatic injury of the waist, hypothermia, overexertion.

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

• Presence or absence of scoliosis.
• Identification of body spasms - trigger points.
• Identification of areas of muscle hypotrophy.

4. Definition and clarification of the volume of movements, clarification of the neurological status: 

• Symptom of tension (Lassega-Wasserman test, Neri test, symptom of planting, tilt).
• Examination for the determination of sensitivity, reflexes and sufficient muscle tone.
• Presence or absence of puffiness.
• Condition of the skin of the waist (temperature, color, humidity and so on).

5. Instrumental types of examination: 

• Radiography of the spine.
• CT and MRI.
• Ultrasound of the pelvic organs in women.
• Recto-manoscopy according to indications.
• Gynecological examination according to indications.
• Gastroscopy according to indications.
• Laboratory tests of blood, urine for differentiation of possible inflammatory infectious pathologies, provoking a pain symptom in the lower back.

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Treatment of pain in the muscles of the waist

The main task that is solved by the treatment of pain in the muscles of the waist is to stop the pain sensation with accessible and adequate methods.

Treatment of low back pain - general recommendations: 

• Anesthesia.
• Observance of sparing bed rest, but no more than 3 days in the absence of serious pathologies of the spine.
• Avoidance of overexertion, physical activity.
• Partial immobilization of the waist is possible with the help of corsets, fixing belts.
• Rehabilitation period - strengthening the muscles of the waist.
• Relapse prevention.

As medicamental methods of treatment, such groups of drugs are used: 

• Analgesics (drug blockade).
• Non-steroidal anti-inflammatory drugs.
• Mielorelaksanty.
• Diuretics for reducing edema.
• Tranquilizers, antidepressants in fibromyalgia, depressive states, psychogenic factor provoking pain.
• Chondroprotectors.
• Drugs that improve metabolic processes and blood microcirculation.
• Vitamins of group B.

Non-drug treatment of pain in the muscles of the waist: 

• Vacuum therapy.
• Compresses with myofascial syndrome.
• Acupuncture.
• Postisometric manual relaxation.
• Magnetopuncture.
• Massage.
• Physiotherapy.

Prevention of pain in the lumbar muscles

Preventive measures aimed at preventing relapses of lumbar pains, provide for the elimination of the root cause of the symptom, correction of the spinal column, correcting possible motor wrong stereotypes, but most importantly - strengthening the muscles and creating the so-called muscle corset. In fact, prevention is the implementation of simple recommendations: 

• You need to learn how to maintain a physiologically correct body posture.
• It is necessary to sit and stand properly.
• People suffering from low back pain, it is very important to learn how to get up correctly from a prone position.
• It is necessary to learn to distribute the load on the spine when moving and lifting weights.
• It is necessary to observe a diet that includes food rich in calcium, phosphorus, B vitamins.
• It is necessary to strengthen the muscular corset regularly, especially in the lumbar region.

A little more about each point: 

1. Walk and stand. When walking, follow the posture and straighten the back to reduce the burden on the lumbosacral spine. If a person has to stand up for a long time, you need to try to move periodically, change the position, move the weight of the body from one leg to the other. It is also useful to make small inclines to relieve fatigue of the muscles of the waist and back in general. 
2. If a person sits for a long time, it is also necessary to follow the posture, as far as possible keeping a straight back. After 10-15 minutes, you should warm up - stretch, change the position of the legs. It is very important what a person sits on, a chair, an armchair and so on, you need to choose a comfortable one, with a high back and a fairly soft seat. 
3. Horizontal posture and rise in the morning. The bed should be quite rigid to maintain the physiological bending of the spine. Too soft bed develops a pathological deflection, a "sagging" of the back. Rise in the morning should begin with a warm-up in bed, then you can get up, turning sideways, first dropping one leg, then the other.
4. Moving weights. There are certain weight norms: children under 16 do not exceed 10 kg, women - also, men can lift loads from 25 to 50 kg, but alternating with easier work. If the work involves the systematic movement of gravity, you need to strengthen the lower back with a special belt, corset. In addition, when moving loads, you should not tilt the spine, but flex your legs in your knees (crouch down with your back straight). So lift loads weightlifters, maximally keeping the evenness of the back. You can not 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 closer to yourself as much as possible, so as not to bend over and eliminate twists (twisting) of the body.

Experts argue that pain in the muscles of the waist can be prevented if you systematically engage in strengthening the muscular corset and reasonably assess their physical abilities in sports or moving loads. Nor will minimal knowledge of the structure of the spine, muscles, and all the features of static and dynamic load also interfere. In addition, to avoid pain in the back, the back allows an old, proven way for centuries - regular motor activity, this is especially true in our time - the era of hypodynamia.