Low back pain is a common clinical symptom with high incidence, long duration and easy recurrence, which can seriously affect the work and life of patients. With the development of modern society, computers and other mobile terminals are becoming more and more popular, and the reliance on these electronic devices has prompted people to work in a sitting position for a long time, coupled with modern people’s high work pressure, fast pace and few outdoor activities, the incidence of low back pain is increasing year by year and showing a trend of rejuvenation.
At present, there are many misconceptions about low back pain. Proper understanding of low back pain and reasonable choice of prevention and treatment methods are crucial to the recovery of this disease.
Is low back pain always due to cold, lumbar strain or disc herniation?
In the clinic, we often encounter such patients: “Doctor, my back is cold and I have some pain, please treat me”, “Doctor, I have lumbar muscle strain, please treat me. No need to do a test, it’s just lumbar strain”, “Doctor, I have a lumbar disc herniation, my back hurts a lot these days, you can treat it with me. I don’t need to take pictures, I know that this is the problem of herniated disc”. These patients all subjectively believe that their disease has been diagnosed clearly and no further examination is needed. Is low back pain really that simple? Do you really think your back pain must be caused by cold, lumbar muscle strain or herniated disc? There is no denying that a large proportion of low back pain is related to the above factors, but low back pain is never that simple. It should be emphasized that low back pain is only a symptom, and there are many diseases that can cause low back pain. The patient must give a detailed statement to the doctor about the location, nature and duration of low back pain, and in order to make a clear diagnosis, the doctor must also conduct a detailed physical examination and the necessary imaging examinations, otherwise it is easy to cause a missed diagnosis or misdiagnosis, and if there is a missed diagnosis or misdiagnosis of certain major diseases, the time for treatment will be missed. Therefore, for low back pain, although it is a “minor problem”, it should be “major”, and you must cooperate with the doctor to complete the necessary tests when you visit the doctor, so that you can target and prescribe the right medicine.
What are the causes of low back pain?
As we mentioned above, low back pain is only a symptom, not an independent disease. According to the statistics of clinical research, there are hundreds of diseases that cause low back pain, and in general, low back pain can be divided into six categories as follows.
The first category is low back pain caused by lesions of bones, joints and soft tissues in the lumbar region. These include congenital malformations of the lumbar region, such as: crestal cryptorchidism, lumbosacral migrating vertebrae, crestal scoliosis, congenital lumbar spinal stenosis, congenital hemivertebral malformation, congenital vertebral fusion, etc. (These types of developmental abnormalities lead to poor stability of the bony structures of the lumbar region, destroying the biomechanical stability of the lumbar region and making it more prone to low back pain.) The first category is traumatic and strain-related low back pain, such as acute lumbar sprain, lumbar spine fracture, lumbar dorsal myofasciitis, interspinous ligament injury, third lumbar transverse process syndrome, postural low back pain, etc.; degenerative lumbar pathologies, such as disc herniation, degenerative vertebral body slippage, degenerative spinal stenosis, synovial joint hyperplasia, ligamentum flavum hypertrophy, osteoporosis, etc.
The second category is immune inflammatory low back pain. Such as ankylosing crestitis. Ankylosing crestitis is an immune inflammatory disease that mainly affects the sacroiliac joint, the lumbar spine joints and the soft tissues adjacent to the crest, and can cause persistent low back pain, which is difficult to encounter and progressively worsens.
The third category is infectious low back pain. This includes tuberculous or septic infections of the lumbar spine: e.g., lumbar spine tuberculosis, brucellosis.
The fourth category is low back pain caused by crestal tumors. This includes primary and secondary crestal tumors. These diseases are difficult to detect without proper imaging because of their low incidence and atypical early symptoms, which can easily lead to misdiagnosis and underdiagnosis, delaying the best time for disease treatment and even endangering patients’ lives.
The fifth category is back pain caused by visceral diseases. Numerous pelvic and abdominal diseases can cause low back pain, such as digestive system diseases such as peptic ulcer, pancreatic cancer, colorectal cancer, etc.; genitourinary system diseases such as renal cyst, kidney stone, nephrotic syndrome, pyelonephritis, kidney tumor, gynecological inflammation, endometritis, adenomyosis, chronic prostatitis, prostate hyperplasia, pelvic tumor, etc.; vascular disorders such as aneurysm, inferior cavernous artery thrombosis, etc.
The sixth category is psychological or mental low back pain. This type of low back pain mainly refers to low back pain caused by hysteria and depression. These patients are characterized by a past history of hysteria and depression, obvious psychiatric symptoms, and complaints of low back pain closely related to changes in mental and psychological status, which are obviously inconsistent with objective examination and test results. Meanwhile, psychological or mental state plays an important role in the occurrence and development of low back pain caused by other causes. Numerous studies have shown that negative emotions such as anxiety, tension, depression, fear and frustration may indeed aggravate the low back pain in such patients.
What treatment options are available for low back pain?
Although there are many causes of low back pain, the first category is the most common in clinical practice, and statistics show that the first category accounts for about 80% of all low back pain patients.
Due to the complex etiology of low back pain, there are certain difficulties in diagnosis and numerous clinical treatment methods. Faced with so many treatment methods, many patients with low back pain are at a loss as to how to choose the right treatment method. In fact, the treatment of low back pain can be broadly divided into three treatment methods, namely conservative treatment, surgical treatment and Chinese medicine treatment.
1.Conservative treatment
Conservative treatment mainly includes medication, physical therapy and so on.
Drug treatment: mainly analgesics, muscle relaxants and nerve-nourishing drugs. Non-steroidal anti-inflammatory and analgesic drugs are the drugs of choice for low back pain, and we commonly see acetaminophen, fenbendazole, furosemide, lexapro and so on belong to this category. These drugs have certain gastrointestinal side effects and cannot be taken for a long time, and these drugs are only effective for mild pain, more serious low back pain is often less effective. For moderate to severe low back pain, you can use weak morphine analgesics such as tramadol, etc. For more severe pain, you can use strong morphine analgesics, but these drugs only relieve the pain, not the cause of treatment, so the pain will return after stopping the drug. Myorelaxants can relax the spastic muscles and reduce muscle spasm, so it is beneficial to the recovery of low back pain, commonly used are ethylphenidate hydrochloride, but the side effects of such drugs are large, common dizziness, nausea, vomiting, weakness, etc., especially for the elderly, special attention should be paid when applying. Nutritional nerve drugs mainly include methylcobalamin, vitamin B1, etc. These drugs have certain relief and auxiliary treatment effects on low back pain.
Physiotherapy: Physiotherapy mainly works on the human body through various physical methods to improve microcirculation and eliminate inflammation and edema. Commonly used are heat conduction therapy, cold compress, infrared irradiation, ultrasound, ion introduction, magnetic therapy, etc. These treatment methods have certain effect on mild low back pain, but are not effective for more serious low back pain.
2.Surgical treatment
Surgical treatment includes minimally invasive surgical treatment and open surgical treatment. With the progress of medical technology, minimally invasive surgical methods are increasingly used in clinical practice. At present, minimally invasive surgical treatments include low-temperature plasma, radio frequency, laser, ozone, bone cement and intervertebral foramoscopy, etc. These minimally invasive surgical procedures are performed through pencil-thin surgical incisions to enter the lesion in the body, which has the advantages of small trauma, fast recovery and small interference with normal physiological functions of the body. However, there is also the disadvantage of easy recurrence. Open surgery is performed mainly through a large incision in the lower back. The advantage is that the treatment of the lesion is more thorough and adequate, and the postoperative effect is good, but the disadvantage is that there is a certain risk of surgery, the trauma of surgery and interference with the body are relatively large, and there are more complications of surgery, and there is a possibility of “crestal surgery failure syndrome However, the disadvantages of surgery are that it is more traumatic and disruptive to the body, has more surgical complications, and may result in “failed crest surgery syndrome”.
Therefore, surgery is the last choice for patients with low back pain, and everyone knows that they will not easily choose surgery as a last resort.
3.Chinese medicine treatment
Chinese medicine has a history of thousands of years in the treatment of low back pain and has accumulated rich clinical treatment experience, and there are various treatment methods, all of which have achieved certain clinical efficacy. Chinese medicine treatment methods mainly include internal use of Chinese medicine, external application of ointment, Chinese medicine acupuncture, acupuncture treatment, etc. Chinese herbal medicine is mainly used to treat patients according to their overall condition, while ointment is mainly used to dredge meridians, invigorate blood circulation, remove blood stasis, and disperse cold and dampness. Acupuncture and moxibustion are based on the patient’s symptoms and signs, and are used to identify and treat acupuncture points, so as to relax the tendons and channels and regulate the blood and Qi. Acupuncture is an innovative minimally invasive treatment method in Chinese medicine, a unique medical technology in China, which has formed a complete set of theory and treatment system after 40 years of development. The needle knife has a handle, and the needle body resembles an acupuncture needle with a slightly thicker diameter, ranging from 0.4mm-1mm, and the tip of the needle is flattened with an edge and resembles a miniature scalpel. According to clinical symptoms, signs and imaging examinations, the needle knife treatment for low back pain can reach the lesion directly through a tiny incision of less than 1mm and carry out targeted release and peeling to achieve the purpose of relieving muscle spasm, loosening soft tissue adhesions, relieving nerve stimulation and eliminating or relieving pain. As long as the indications are properly selected, acupuncture treatment has a relatively clear effect on the vast majority of low back pain. Because of its small trauma and quick repair, even if the recurrence can be done again acupuncture treatment, will not cause medical source damage to the human body, is currently one of the ideal methods of clinical treatment of low back pain.
Daily preventive care for low back pain
1.Correct posture keeps you away from low back pain
Correct posture is crucial for patients with low back pain. This is because the wrong posture leads to an increase in the force on the waist or an imbalance in the force, which increases the burden on the waist and triggers low back pain. The correct posture can help us to reduce the burden on the waist, promote the recovery of low back pain and prevent the recurrence of low back pain. Therefore, patients with low back pain should learn the correct posture of sitting, standing and walking.
Sitting: Keep your back straight, head up and chest out, jaw slightly tucked, legs together and naturally flexed, feet about shoulder-width apart. If you need to work, it is recommended to use the seat with a backrest, the back of the chair with a cushion, so that the waist close to the cushion, the soles of the feet with a footstool or foot pad is raised slightly higher than the knees than the hips, which can effectively reduce the burden on the waist. Properly elevate the height of the computer, so that the computer screen and the height of the gaze directly when roughly equivalent.
Stand: keep your back and lower limbs straight, head up and chest out, jaw slightly tucked, belly, legs together, feet about the same width as the shoulders. When standing for a long time, one leg can slightly bend the knee and hip and take a small step forward, alternating between the two sides, similar to the “rest” position.
Walking: keep your back straight, head up and chest out, jaw slightly tucked, abdomen tucked, legs and hands swinging naturally and rhythmically.
2.Appropriate functional exercise, give strong protection to the waist
Proper functional exercise can make the lumbar muscles strong, and strong muscles can give strong protection to the lumbar area, which can reduce or even disappear the lumbar pain. Generally speaking, in the acute stage of low back pain, because the inflammation and edema of myofascia or nerve root is heavy, functional exercise at this time will add fuel to the fire, aggravate the inflammation and edema of myofascia or nerve root, and make the low back pain increase, so functional exercise is not recommended at this time, and bed rest is the main reason. When the lumbar pain basically disappears after treatment, the lumbar functional exercise can be carried out gradually.
The practice of small swallow flying is: the patient lying prone on the bed, the upper limbs back, the head and upper back to do their best backward, the lower limbs backward, the abdomen on the bed, so that the body is an arc, as if the swallow flying general. Hold for 5 seconds and then put down, so repeatedly, 10 times for a group, do 3-5 groups per day.
The practice of five-point support is: patients lying on their backs, with the head, elbows, feet (five points) to support the bed, hips up, so that the body is an arc, hold for 5 seconds and then put down, and so on, 10 times for a group, do 3-5 groups a day.
The above exercise should be combined with their own situation, step by step, according to their ability, and it is best to do under the guidance of a doctor.
3.Soft bed or hard bed? Low back pain patients have to know the secret
Many people like to sleep on soft beds in life, and a wide soft bed will make people feel warm and comfortable, however, for patients with low back pain, such a bed will make people feel sore in the back. Why is this so? This is because although soft beds are soft and comfortable, they make our crests lose effective support and muscle joints are more prone to strain. Therefore patients with low back pain are often advised by doctors to sleep on hard beds. But did you know? The bed is not the harder the better, sleeping directly on the board will be very uncomfortable, the bed should be moderately soft and hard is the best. Generally speaking, the hardness to our hands force down, downward pressure amplitude in 3-5cm is appropriate.
4, sleeping position is equally important for patients with low back pain
About 1/3 of a person’s life is spent in sleep, sleep can make our organs and organs get rest and functional recovery. For patients with low back pain, the lying position (including supine, lateral and prone position) is the least stress on the waist and is the best time for recovery for patients with low back pain. In supine position, as long as the bed is comfortable and the limbs remain naturally extended, the muscles of the whole body can be relaxed and the pressure of the lumbar intervertebral space can be significantly reduced to reduce the lumbar disc protrusion, which is the best position for patients suffering from lumbar disc herniation; however, it is impossible for everyone to maintain only one sleeping position during several hours of sleep, and people always have to keep turning over during sleep, because maintaining a sleeping position for a long time will Because maintaining a sleep position for a long time will make some of the muscles relaxed, while relatively make some other muscles in a state of tension, and the torso due to prolonged pressure and poor blood flow, nerve hypoxia, ischemia numbness, therefore, turning over is the body’s self-protection. However, one thing is certain, is not to promote prone position, because the prone position will make the head and neck to the side of the extreme twist, easy to cause injury to the neck muscles, ligaments, joints, but also the chest pressure, increasing the burden on the heart and lungs, so any case to avoid taking prone position sleep.
5, exercise should be gradual
Patients with low back pain should do sports gradually, not strenuous confrontational, competitive sports or sports that increase the burden on the back, such as basketball, soccer, golf, weightlifting, etc.. Brisk walking, jogging, cycling and swimming are good exercises for people with low back pain, and about 30 minutes a day is appropriate. Some stretching exercises can help us to improve the flexibility and elasticity of our muscles, such as yoga, etc., but they must be done according to our ability. For patients with low back pain, because of the complex causes of low back pain, it is best to consult a professional doctor before carrying out a certain exercise to see if it is suitable for you.
6.There are rules for lifting heavy objects
Patients with low back pain should avoid lifting heavy objects as much as possible, and try to seek help from others when they need to lift heavy objects. When you have to lift heavy objects or cannot get help from others, you should be prepared, feet shoulder-width apart, knees bent and squatting, try not to bend, lifting heavy objects should be carried as close to yourself as possible, and try not to suddenly twist your body during the march to minimize its impact on the waist and reduce the burden on the waist.
7, back pain, and workaholism? You need an intermission.
You already suffer from low back pain, but, you are a workaholic, working more than eight hours a day, every day on the computer, your back suffering, how to do? Suggest an intermission! We generally think that sitting is a more comfortable position, in the impression of most people, sitting for the waist is less than the impact of standing position. In fact, it is not, research shows that the pressure on the waist in the sitting position is 140%-200% of that in the standing position. Long-term sitting work, not only significantly increased the burden on the waist, accelerating lumbar degeneration, but also make the waist muscle tension contraction for a long time, while generating static residual tension, so even after the work, but also on our waist continued to have a negative impact. To change this adverse effect, in fact, only need a small change, that is, the intermission! We recommend not working for 30 minutes, stand to move 2-3 minutes, you can stretch, do chest expansion exercises, etc.. Such a simple change can significantly reduce the back pain, bringing you unexpected results.
8, high heels, is also a big taboo for people with low back pain
High-heeled shoes make many beautiful ladies look more elegant, but also bring many adverse effects to our body. After wearing high heels (greater than 4 cm), will make the pelvis tilt forward to increase, the waist muscles will compensatory tension to maintain the upright posture of the body, which will certainly increase the burden on the waist, and with the increase in the heel, the burden on the waist will increase exponentially, thus with the triggering of low back pain. Therefore, choosing the right shoes is also very important for patients with low back pain. We recommend choosing shoes with a low heel, comfortable and good fit to the bottom of the foot, such as sports shoes, which can effectively reduce the burden on the waist.
9. Weight loss is vital for overweight low back pain patients
Obesity is a common problem in society, obesity can not only cause cardiovascular diseases, endocrine metabolic diseases and malignant tumors, but also play a vital role in the occurrence and development of low back pain. Obesity, especially abdominal obesity, can significantly increase the burden of the waist, cause changes in the structure and function of the waist, accelerate the degeneration of the lumbar spine, and thus cause low back pain. Once low back pain occurs, overweight patients require longer and worse relief from low back pain compared to normal weight patients. Therefore, patients with low back pain must pay attention to weight reduction and control.
10. what?! Smoking can also cause low back pain
Studies have shown that smoking is closely related to low back pain. Smoking can affect the microcirculation of the tissue around the disc, interfere with the metabolism of bone, accelerate the degeneration of the disc and the vertebral body, while the chronic cough caused by smoking can increase the burden on the disc and trigger or aggravate low back pain. Therefore quit smoking is also very important for patients with low back pain.
11, pay attention to the cold and warm, cold and damp should not be
Cold and humid environment is an important trigger for low back pain attacks. Many patients with low back pain will have the experience that once the weather becomes cool or it is going to rain, there will be low back pain or low back pain aggravation, just like the weather forecast. This is because cold and damp invade the body, can make the body vasoconstriction, muscle spasm, waist circulation and metabolic disorders, thus triggering low back pain. Therefore, for patients with low back pain, it is vital to prevent cold and keep warm, which can effectively prevent the onset or aggravation of low back pain.
12, low back pain also need to have a good state of mind
Studies have shown that psychological state is closely related to low back pain. Most of the low back pain is related to the degeneration of various tissues and structures in the lumbar region, such as muscle strain, decreased muscle compliance, decreased muscle strength, hypertrophy of fascia, osteophytes, herniated discs, hypertrophy of ligamentum flavum and so on. Therefore, as a degenerative disease, it is a natural manifestation of the aging of the organism and cannot be completely reversed by any method. Moreover, poor posture and lack of exercise can make the back pain linger and hard to heal. Patients often hope that the doctor can solve the problem of low back pain with one method once and for all when they visit the doctor. Once the treatment effect is not as ideal as imagined, pessimism and fear can be generated, resulting in increased feelings of low back pain and forming a vicious circle. Therefore, a correct understanding of these characteristics of low back pain and a positive attitude can help patients with low back pain recover as soon as possible.