Possible Causes of Lower Back Pain
Disc herniation (discus protrusion/prolapse/hernia)
What causes it?
Between two vertebrae are the intervertebral discs, which play a significant cushioning and shock-absorbing role during movements. However, around the age of 14, blood circulation in them ceases, and they only receive nutrients through the vertebral endplate. As time progresses, transverse cracks develop in them. As a result, the water content, elasticity, and load-bearing capacity of the discs decrease. Inside the disc, there is a gelatinous core surrounded by a fibrous ring. The fibrous ring always tries to keep the gelatinous core centrally located, but due to poor loading and disc degeneration, the fibrous ring weakens and the gelatinous core protrudes. This is when we talk about a herniated disc, which in most cases causes unpleasant lower back pain or pain radiating into the limbs.
There are different stages: In Discus protrusio, part of the disc bulges into the spinal canal, pushing the posterior ligament forward. It is still capable of retracting. In Discus prolapsus, the bulge is more pronounced. In Discus hernia, the protruding part can no longer retract. If the herniated part breaks off, it is called a sequestrated hernia.
Sciatica
Sciatica means pinched sciatic nerve. It is accompanied by pain in the sacral area and can also cause pain radiating to the lower limb. It is usually triggered by a sudden movement or lifting a heavy object with twisting. Every movement can be painful, and sneezing or coughing increases the pain. They are not diseases themselves but rather warning signs that the spine is being improperly loaded. Other spinal diseases, such as a hernia, may be behind them. When symptoms appear, lie on a hard surface and support your leg with a pillow. The use of muscle relaxant creams may relieve back pain due to the local increase in blood circulation.
Scoliosis (spinal curvature)
Lateral deviation of the spine is indicated. Scoliosis can be functional or structural.
Functional scoliosis can still be consciously corrected, whereas structural scoliosis involves twisting and a rib hump. Functional scoliosis can be primary or secondary. In primary scoliosis, the cause is unknown, but it can be effectively treated with muscle strengthening, posture correction, and awareness. It is advisable to stretch the spine frequently and identify any possible psychological causes. In secondary functional scoliosis, unilateral sports activity, limb length discrepancy, or other muscle tensions may be involved. After identifying the causes, significant improvement in spinal posture can also be achieved here: if necessary, with appropriate shoe inserts, balancing the load on the opposite side in unilateral sports, establishing muscle balance, followed by awareness, stretching, psychological support, and special exercises.
Structural scoliosis typically develops around the age of 10-12, and unfortunately, its cause is unknown. The earlier it appears, the more severe it usually is. Special individualized physiotherapy and possibly the use of a brace can greatly improve the condition. Specialist medical and physiotherapy assistance is very important. As parents, we can pay attention to our children's correct posture and occasionally check their spine before or after bathing. A warning sign may be if the triangle formed by the torso and the hanging arm is not symmetrical on both sides, or if one hip bone, shoulder blade, or shoulder appears higher than the other. Do not despair, but consult a specialist as soon as possible, because the earlier the correction begins, the better the results can be achieved.
Small joint pain / segmental instability
When the intervertebral discs flatten, the articular surfaces connecting the vertebrae also come closer together. Since the joint capsule is rich in nerve endings, it is very sensitive. At such times, the villi of the joint capsule can get pinched, which can cause severe pain. Typically, it hurts when walking a lot or standing in one place. The pain decreases when squatting or sitting. Nourishing the disc can help, which can be done with stretches, a bat table, or weight bath therapy.
GL5-S1 nerve root stenosis
This sentence is often read in the report. It means that the last lumbar vertebra (L5) and the sacrum disc is no longer able to absorb enough water, so they have come too close to each other. As a result, the capsule rich in sensory nerves of the small joints between the vertebrae can get pinched, which can cause severe pain. Typically, it hurts when standing in one place for a long time, but squatting or sitting down feels good.
Vertebral arch fracture (spondylolysis) and vertebral slippage (spondylolisthesis)
A vertebral arch is not fused
in vertebral arch fracture. This is most often asymptomatic and a fairly common condition, the exact causes of which are not known. However, it occurs significantly more frequently in athletes who engage in sports involving excessive stretching and frequent twisting of the spine (e.g., rhythmic gymnastics, canoeing). If spondylolysis occurs on both sides, it can happen that the vertebra, together with the spine above it, slips forward over the one below. This most commonly occurs between the last lumbar vertebra and the sacrum. This is called spondylolisthesis. Symptoms may include adolescent lower back pain, possibly radiating pain into the leg. Physical therapy usually helps relieve the pain and also strengthens the deep back muscles and abdominal muscles, which aid in stabilization.
Spondylosis
After our twenties, calcification of the small joints begins. Bone spurs often develop on the vertebrae to counteract instability. The calcium deposits can reduce the range of motion and even cause symptoms similar to a herniated disc. We can slow down the process with exercise, strengthening the deep back and abdominal muscles, and stretching.
Scheuermann's disease
This is an adolescent ossification disorder, the exact cause of which is unknown. In this condition, one or more vertebrae become deformed by narrowing into a wedge shape. It can occur in the thoracic and/or lumbar regions. In such cases, greater strain is placed on the back muscles in the affected area, which tire and tense more quickly. In most cases, it can be treated with physiotherapy and strengthening of the back muscles, and sometimes wearing a brace may become necessary. Surgical intervention is only performed in severe cases.
Piriformis syndrome
The piriformis muscle is pressing on the sciatic nerve. A characteristic symptom is pain in the buttock area when sitting with legs extended and bending forward, or when sitting with one ankle crossed over the knee and leaning the torso forward. Massage can help, as well as forcing these painful positions mentioned above, because they stretch the affected muscle. If the pain subsides, it is advisable to continue practicing these stretches, as they can prevent the recurrence of pain.
Bechterew's disease
The gradual ossification and stiffening of the spine. Symptoms include prolonged stiffness of the spine after waking, pain in the sacral area, joint pain, fatigue, nighttime back pain, and pain that decreases with movement. Early detection is important here as well, because the process can be slowed! Patients receive anti-inflammatory and pain-relieving treatment, and daily special exercises are important to maintain joint mobility and reduce spinal curvature.
Arthrosis
Degenerative disease, which primarily affects the small joints. Its symptoms are pain and restricted range of motion. It usually causes more pain in the morning because the joint fluid is even less. Mobilizing the joint, increasing muscle strength, developing proper posture, and possibly losing excess weight can help.
