Low Back Pain

Low back pain is an important health problem because it is very common and causes significant financial resources, labor and time loss. It is one of the most common reasons for adults to consult a doctor. Especially in developed countries, reasons such as decrease in physical activity and increase in obesity increase the incidence. It can be seen in all ages and genders.

Causes of lower back pain

The lumbar region is the center of gravity of the body and is affected by almost all body movements. Therefore, it is a region subject to constant and repetitive stresses. The load on the waist during certain body movements is much higher than expected. For example, in bending forwards without bending the knees, the load reflected on the waist region is approximately 5-6 times more than the weight of the upper part of the body. Even while sitting, the load on the waist is several times greater than the weight of the upper body.

The formations between the vertebrae, which we call the disc, can roughly be described as the shock absorbers of the spine. These formations, which are surrounded by very solid tissue and contain a dense liquid, provide the flexibility of the spine and at the same time distribute the load. However, in order for this mechanism to work properly, the ligaments and muscles around the spine, as well as the lower back and abdominal muscles must be strong and flexible enough. Tissue aging, which becomes evident starting from middle age, will naturally also affect the discs, ligaments and muscles and cause these structures to weaken gradually, decrease their flexibility and become more vulnerable to loading. When the weakness and loss of flexibility caused by inactivity are added to these negativities brought about by aging, or when this structure, which is not strong enough, encounters excessive loads from time to time and unprepared, it is expected that damages such as herniated disc will occur.

Low back pain may occur as a result of the effects of loading and degeneration mentioned above, and may present with many diagnoses such as calcification, slipped disc, slipped disc (lumbar hernia). However, there can be many reasons for internal organs (such as kidney, pancreas), vascular structures (such as aortic aneurysm), gynecological diseases (such as uterus and ovaries), cancer or the spread of cancer to this region. Therefore, every low back pain should be carefully evaluated from the beginning.

Risk factors for low back pain

  1. Personal risk factors

    1. Posture disorders

    2. overweight

    3. muscle strength weaknesses

    4. Smoking

    5. genetic factors

    6. Presence of additional diseases such as diabetes, osteoporosis

  2. Occupational risk factors

    1. Working in jobs that require heavy lifting

    2. Working in jobs done by constantly bending over or standing still

    3. Working in jobs that require the use of a vehicle

Diagnosis in low back pain

In order to diagnose low back pain, patients’ complaints should be learned carefully. The patient’s pain that wakes him up at night, morning stiffness, and pain that increases with rest warns physicians about rheumatic and other important diseases and directs them to more detailed examinations. In addition, learning the relationship of pain with movement, in which positions it is more, in which positions it decreases, the presence of pain with coughing-sneezing, pain spread to the legs, whether there is pain and numbness in the legs provides very important data for the diagnosis. The patient’s job must also be learned.

The most important diagnostic tool to understand the root cause of low back pain is actually examination. A thorough examination is essential to locate the area where the pain originates. This examination requires joint movement of the lower back, surrounding muscles, neurological examination of the lumbar nerves, and internal organ examination. In particular, it is extremely important to determine the presence of nerve root pressures caused by a condition such as herniated disc, narrowing of the lumbar spine, slipped back, by neurological examination, in order to make the decision for surgery in case of necessity (muscle weakness-partial paralysis).

After the examination, if necessary, imaging methods such as X-ray, MRI, tomography, EMG to detect the condition of the nerves, and blood tests to differentiate rheumatic diseases can be used.

Treatment for low back pain

  1. What can be done to reduce pain

-Medicines: Medicines can be used to reduce pain in low back pain. For this purpose, analgesic/antirheumatic drugs, muscle relaxants, adjuvant drugs, weak opioids can be used. These drugs can be taken orally or used as a gel/cream applied externally.

-Rest: Another treatment method is rest. Since the waist is a load-bearing region, rest can be applied to reduce the load from the region. For this purpose, short-term bed rest and the use of a waist corset may be recommended.

Complementary medicine methods: Complementary medicine methods such as acupuncture, neural therapy, ozone therapy, mesotherapy, prolotherapy can be used to control low back pain. Among these treatments, acupuncture, neural therapy and ozone therapy are used in our clinic. These 3 methods are the methods we prefer because they allow the treatment of other systems that can cause low back pain with their low side-effect profile, ability to control pain quickly and with a holistic perspective.

-Physical therapy: Combined use of physical therapy tools in low back pain is recommended because it is one of the successful treatment methods that have been used for many years. It can control pain in the lumbar region by reducing muscle spasm, reducing edema and increasing blood flow.

  1. Reducing the load on the waist

One of the recommended methods to reduce the load on the waist in low back pain is the use of corsets and bed rest, especially in cases of acute pain.

Another important method is weight loss. In particular, it is recommended that patients who are overweight should lose weight.

  1. Exercise and waist protection techniques

Exercise in low back pain is as effective as a drug after the acute period has passed. The purpose of exercise is to strengthen the muscles around the waist, shorten the muscles that have been shortened due to spasm, and stretch the ligaments. In this way, a balanced and natural corset is formed around the waist.

In addition to exercises for the lumbar region, exercises that work large muscle groups, called aerobic exercises, and that increase the heart rate and respiratory rate, should also be performed in low back pain. These exercises also contribute to weight control. In addition, by increasing the endorphins, which are called happiness hormones, it improves the patient’s mood and reduces pain. These exercises are exercises such as running, walking, swimming, dancing. The patient should do what he likes more. Because aerobic exercises must be done for at least 8 weeks for the expected effects to occur.

Exercises such as pilates and yoga that increase body flexibility can also be done. During these exercises, it is recommended to avoid movements that cause pain and to increase the intensity of the exercise slowly. It is recommended to explain the situation to the relevant sports teacher during the exercises performed in gyms outside the doctor’s control, to increase the intensity of the exercise slowly, to avoid lifting weights inappropriately, and to avoid movements that cause pain.

Waist protection techniques should be taught to be applied both in daily life activities and in occupational activities. For this reason, when it is necessary to learn the profession of the patient and what body movements he performs while doing this profession, ergonomic arrangements should be made and the patients should be warned in this respect.

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