Low back pain is an important health problem because it is very common and causes significant loss of financial resources, labor and time. It is one of the most common reasons why adults consult a doctor. Especially in developed countries, reasons such as decreased physical activity and increased obesity increase the incidence. It can be seen at any age and gender.
Causes of lower back pain
The waist area 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 recurring stresses. The load on the waist during certain body movements is much higher than expected. For example, when bending forward without bending the knees, the load reflected on the waist area is approximately 5-6 times greater than the weight of the body above the waist. Even while sitting, the load on the waist is several times greater than the weight of the upper body.
The formations located between the vertebrae, which we call discs, can be roughly described as shock absorbers of the spine. These formations, which are surrounded by very solid tissue and contain a dense fluid, provide the flexibility of the spine and at the same time distribute the load. However, for this mechanism to work properly, the ligaments and muscles around the spine, waist and abdominal muscles must be strong and flexible enough. Tissue aging, which becomes evident starting from middle age, will naturally affect the discs, ligaments and muscles, causing these structures to gradually weaken, decrease in flexibility and become less resistant to load. When the weakness and loss of flexibility caused by inactivity are added to these negativities brought about by aging, or if this structure, which is not strong enough, encounters excessive loads from time to time and unpreparedly, it is expected that damage such as herniated disc will occur.
Lower back pain is due to the load and degeneration mentioned above. It can occur as a result of related effects and can be encountered with many diagnoses such as calcification, lumbar slip, slipped disc (herniated disc). However, it can be caused by internal organs (such as kidney, pancreas), vascular structures (such as aortic aneurysm), gynecological diseases (uterus and ovaries). an), there may be many reasons for cancer or the spread of cancer to this area. For this reason, every low back pain needs to be evaluated carefully from the beginning.
Risk factors for low back pain
Personal risk factors
Posture disorders
Overweight
Muscle strength weaknesses
Smoking
Genetic factors
Presence of additional diseases such as diabetes and osteoporosis
Occupational risk factors
Working in jobs that require heavy lifting
Continuous bending or standing still Working in jobs that require the use of vehicles
Working in jobs that require driving a vehicle
Diagnosis of low back pain
To diagnose low back pain, patients' complaints must be learned carefully. The presence of pain that wakes the patient up at night, morning stiffness, and pain that increases with rest alerts physicians to rheumatic and other important diseases and directs them to more detailed examinations. In addition, finding out the relationship between pain and movement, in which positions it is greater, in which positions it decreases, the presence of pain with coughing and sneezing, pain radiating to the legs, and whether there is pain and numbness in the legs provides very important data for diagnosis. The patient's work must also be learned.
The most important diagnostic tool to understand the root cause of low back pain is actually examination. A comprehensive examination is essential to find the area where the pain originates. This examination requires joint movement of the waist, surrounding muscles, neurological examination of the nerves originating from the waist, and internal organ examination. Especially through neurological examination, accurate detection of the presence of nerve root pressures resulting from a condition such as a herniated disc, canal narrowing, or lumbar slippage is extremely important in terms of making a decision for surgery in case of necessity (muscle weakness-partial paralysis).
Examination. Afterwards, if necessary, imaging methods such as radiography, MRI and tomography can be used to examine the nerves. EMG can be used to detect the condition and blood tests can be used to differentiate rheumatic diseases.
Treatment for lower back pain
What can be done to reduce pain
-Medications: To reduce pain in lower back pain medications can be used. For this purpose, painkillers/antirheumatic drugs, muscle relaxants, adjuvant drugs, weak opioids can be used. These medications can be taken orally or applied externally as a gel/cream.
-Rest: Another treatment method is rest. Since the waist is a load-bearing area, rest can be applied to reduce the load on the area. 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 and 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 have a low side effect profile, the ability to control pain quickly, and a holistic perspective that also allows the treatment of other systems that may cause low back pain.
-Physical therapy: The combined use of physical therapy tools for low back pain is recommended as it has been one of the successful treatment methods that have been used for many years. It can control the pain in the waist area by reducing muscle spasm, reducing edema, and increasing blood flow.
Reducing the load on the waist
To reduce the load on the waist in cases of low back pain. One of the recommended methods is the use of a corset and bed rest, especially in cases of acute pain.
Another important method is weight loss. It is recommended that patients, especially those who are overweight, lose weight.
Exercise and waist protection techniques
Exercise in low back pain is as effective as a medicine after the acute period has passed. The aim of exercise is to strengthen the muscles around the waist, shorten the muscles that are shortened due to spasm, and stretch the ligaments. In this way, a balanced and natural corset formation around the waist is ensured.
For lower back pain, in addition to exercises for the lumbar region, exercises that work on large muscle groups, called aerobic exercises, and increase the heart rate and respiratory rate should also be performed. These exercises also contribute to weight control. It also improves the patient's mood and reduces pain by increasing endorphins, called happiness hormones. These exercises are exercises such as running, walking, swimming and dancing. The patient should do whichever he/she likes more. Because aerobic exercises must be done for at least 8 weeks for the expected effects to occur.
Exercises that increase body flexibility such as pilates and yoga can also be done. It is recommended to avoid movements that cause pain while performing these exercises and to increase the exercise intensity slowly. It is recommended to explain the situation to the relevant sports instructor for exercises performed in gyms outside the control of a physician, to increase the exercise intensity slowly, to avoid lifting weights inappropriately, and to avoid movements that cause pain.
Waist protection techniques can be used both while performing daily life activities. It should also be taught to be applied while performing professional activities. For this reason, when it is necessary to learn the patient's profession and what body movements he makes while doing this profession, ergonomic arrangements should be made and patients should be warned in this regard.
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