Do you think all back pain is the same?

Chronic low back pain is a serious medical and social problem. It is one of the most common causes of labor force loss. According to statistics, 80% of people will experience low back pain in their lifetime . Some patients will suffer from low back pain repeatedly and cannot be completely cured, turning into chronic low back pain , which seriously affects people’s normal life and work.

For many people, whenever they have low back pain, their first reaction is lumbar disc herniation, and even blindly taking low back pain relief may lead to serious consequences. In fact, this is incorrect. There are many reasons for low back pain, and different low back pain diseases have different treatment methods. To treat low back pain, it is fundamental to identify the cause, and symptomatic treatment is the best way. Today we will learn about the common low back pain diseases among different low back pain symptoms.

Acute lumbar sprain

Acute lumbar sprain is caused by improper waist force and some weight-bearing lifting activities with improper posture . The pathological anatomical basis of acute lumbar sprain is often supraspinal ligament or interspinous ligament injury , lumbar facet joint disorder or laceration injury of lumbar muscle and its fascia attachment.

Its main clinical manifestations are:

■History of acute lumbar sprain.

■The pain in the lower back is severe, the pain point is fixed and consistent with the injury site, the pain is relieved when lying flat, and there is generally no radiating pain in the lower limbs .

■The patient has a forced posture, that is, due to the spasm of the lumbar muscles on the affected side, the patient’s lumbar lordosis disappears and the patient presents a special posture of flexion toward the affected side.

■Limited waist movement, especially lateral bending, rotation and flexion to the healthy side.

Lumbar disc herniation

Lumbar disc herniation refers to a series of clinical symptoms caused by degeneration of the lumbar disc , rupture of the nucleus pulposus, protrusion (or shedding) to the back or protrusion into the vertebral lamina, which causes irritation or compression of adjacent tissues .

Its main clinical manifestations are:

■ Most patients have a history of acute lumbar trauma, such as sprain or fall from height.

■The symptoms of low back pain continue to worsen, are relieved after bed rest, and are prone to relapse after fatigue.

■ Accompanied by lower limb neurological symptoms , usually on one side, and in a few cases, on both lower limbs. In the early stage, there is lower limb soreness, which is relieved in the later stage, but the symptoms of numbness and lower limb weakness are aggravated. Some people also feel cold and frozen in their limbs.

Lumbar muscle strain

Lumbar muscle strain is a chronic damaging inflammation of the lumbar muscles and the fascia or periosteum at their attachment points. The main symptoms are swelling and pain in the lumbar or lumbosacral region , which recurs repeatedly and can change with climate change or fatigue. People who engage in physical labor or exercise are more likely to suffer from dynamic lumbar muscle strain , while people who sit or stand for long periods of time are more likely to suffer from static lumbar muscle strain.

Its main clinical manifestations are:

■Lower back pain or distension, tingling or burning pain.

■It gets worse when you are tired and gets better when you rest; it gets better with proper exercise and frequent changes of body position, but gets worse with excessive activity.

■Cannot keep bending over to work. Often forced to stretch the waist or hit the waist with fists to relieve pain.

■ There are tender points in the lower back, mostly in the sacrospinal muscles, the posterior part of the iliac spine, the insertion point of the sacrospinal muscles behind the sacrum, or the transverse processes of the lumbar vertebrae .

■There is usually no abnormality in the appearance and movement of the waist, and no obvious lumbar muscle spasm. A few patients have slightly restricted waist movement.

Ankylosing spondylitis

Ankylosing spondylitis is an invasive inflammation of the spinal joints (including sacroiliac joints , facet joints, and costovertebral joints) and the tissues surrounding the joints. More than 90% of patients have a hereditary tissue compatibility antigen HLA-B27 in their serum, and the incidence of the disease in their family is 30 times that of the normal population.

Its main clinical manifestations are:

■It is more common in young people aged 18 to 28, with more males than females, with the ratio of about 12 to 14:1.

■In the early stage, the lumbar pain is obvious, and the waist feels stiff when getting up in the morning. It gets better after activities, but the stiffness still occurs after sitting or standing for a long time.

■When the lesion invades the costovertebral joints, the patient often feels shortness of breath or chest tightness in addition to chest pain.

■ Patients in the late stage of the disease often have kyphosis deformity.

Osteoporosis

Osteoporosis is a systemic metabolic disease characterized by decreased bone mass and destruction of bone microstructure, which leads to decreased bone strength and increased risk of fractures. It is a long-term, hidden disease, also known as the “silent killer.”

Its main clinical manifestations are:

■Mainly pain in the waist and back + pain in bones all over the body, aggravated by holding heavy objects, difficulty turning over, sitting up and walking.

■Fractures (hip, spine, distal forearm, proximal upper arm, etc.).

■ Shortened stature, hunchback, spinal deformity , and limited extension.

■It is more common in postmenopausal women (ovarian dysfunction, low estrogen levels, bone absorption greater than bone formation, rapid bone loss); people who are dieting, losing weight, and have a thin body (androstenedione contained in fat can synthesize estrogen); people with whitening skin (skin + sunlight = D3 absorbs calcium and deposits it in the bone marrow).

Lumbar spinal stenosis

Lumbar spinal stenosis refers to a disease in which the morphology and tissue structure of the lumbar vertebrae and soft tissues (facet joints, lamina, ligamentum flavum, intervertebral disc, etc.) change due to various reasons, leading to stenosis of the central spinal canal, nerve root canal , and intervertebral foramen, causing compression of nerve roots and (or) cauda equina , and causing a series of clinical symptoms. Clinically, degenerative lumbar spinal stenosis is the main disease, which is more common in the elderly.

Its main clinical manifestations are:

■ Intermittent claudication : stop-and-go walking. Symptoms include back pain, leg pain, numbness, and weakness on one or both sides after walking a certain distance. The patient needs to squat or sit down to rest for a while before continuing to walk.

■The symptoms described by the patient are severe, but the doctor cannot find any obvious positive signs when examining the patient. The symptoms described do not match the doctor’s findings.

■ Lumbar extension will cause the space in the spinal canal to become smaller, aggravating the symptoms of nerve compression, resulting in numbness and increased pain in the lower limbs.

In addition to the three characteristic manifestations mentioned above, the following manifestations may also exist:

■ Lumbar symptoms: Mainly manifested as weakness, soreness, and easy fatigue.

■Symptoms of pain in lower limbs: This is similar to lumbar disc herniation, and is especially aggravated when walking.

■Changes in lower limb sensation and muscle strength: Some patients may experience weakened lower limb strength and sensory dysfunction , such as numbness, decreased sensation, or allergy.

Discogenic low back pain

Discogenic low back pain is a very common syndrome in clinical practice, also known as disc derangement. It is a chronic low back pain cause by stimulation of pain receptors in the disc, such as degeneration, annular fibrosis, and discitis, without radicular symptoms , and without radiological evidence of nerve root compression or excessive displacement of vertebral segments.

Its main clinical manifestations are:

■ The tolerance to sitting decreases, and the pain often intensifies when sitting. Patients can usually only sit for about 20 minutes. The reason is that the pressure in the intervertebral disc is the highest when sitting, especially when sitting forward.

■The pain is often sore and swollen. The symptoms worsen after activities, especially when the vertical stress of the spine increases. You cannot sit or stand for a long time.

■Symptoms are more severe when sitting than when standing . Coughing, sneezing, etc. can aggravate the pain, which can recur and last for a long time (up to several months or more).

■The most common aggravating factor is after exertion.

In recent years, back pain is no longer exclusive to the elderly. Not only office workers, but even some students often complain of back pain. Back pain has become a common phenomenon in modern life , and it is gradually becoming younger.

Regardless of the cause of lumbago, most patients are treat conservatively in the early stages, and in the acute stage they are mainly treat with bed rest and physical therapy (massage, hot bath, physical therapy, traction, acupuncture, cupping, etc.). Platinum Pain Diagnosis and Treatment Center would like to remind everyone that early diagnosis of lumbago is critical. It is often because we do not understand or pay enough attention to lumbago that lumbago worsens. Therefore,