Is Every Low Back Pain a Herniated Disc?

Our waist is the structure that carries the weight of our body, transfers it from the hips to the legs, and also ensures that our body is mobile. There are 5 vertebrae in our waist and cartilage cushions (discs), joint structures and supporting soft tissues between these vertebrae. The lumbar vertebrae serve as protection for the spinal cord and nerve roots. Pain felt in the waist area is called low back pain. Low back pain itself is not a disease, but, like other pains, it is a symptom of a disease. Low back pain is a very common problem. Low back pain can occur in anyone at any time of life. More than 80 percent of the society complains of low back pain at some point in their lives. Although the frequency of applying to a health institution due to low back pain varies from society to society, it is among the top three in every society. Diseases that cause back pain affect employees and are an increasing problem in terms of wages, workforce loss and treatment costs around the world. Since low back pain is a very common complaint, it is often ignored by both patients and doctors. Thus, diseases that manifest themselves with low back pain cannot be diagnosed for a long time. This delays the timely treatment of diseases and may lead to irreversible consequences. For this, it is important to examine low back pain well and have information about its causes.

It is necessary to separate low back pain into new-onset (acute) and long-term (chronic). Acute low back pain accounts for 70-90% of all low back pain. Acute low back pain is pain that can last up to 12 weeks. 50% of these pains heal within a week with treatment, rest and various local applications. These pains are generally mechanical low back pain, which is frequently seen in society. Less common causes of acute low back pain are diseases such as gynecological diseases, stomach ulcers, prostatitis, kidney stones, gallbladder stones, pancreatitis and aortic aneurysm. Since there are other findings related to the diseases that cause these conditions, low back pain appears as an additional complaint rather than the main complaint. Chronic low back pain is pain that lasts longer than 3 months. It accounts for 5% of all low back pain. Chronic Low back pain is generally pain related to rheumatic diseases, serious diseases of the abdominal organs and serious mechanical problems of the lumbar region. Classifying low back pain according to its characteristics will be more useful in understanding the subject. There are basically three types of lower back pain. These are mechanical, rheumatic and referred low back pain.

 

Mechanical Low Back Pain:

Mechanical low back pain is caused by trauma to the structures that form the waist, such as muscles, bones, ligaments and discs. or pain that occurs as a result of straining. We can roughly divide the causes of mechanical low back pain into two groups: musculoskeletal system diseases and spine diseases. The majority of low back pain falls into the group of musculoskeletal system diseases. It mostly occurs with minor damage to the muscles, connective tissue or joints. Other musculoskeletal system problems that cause low back pain include poor and incorrect body posture, shortness of one leg, and psychosocial factors such as stress.

Spine diseases also constitute the other group. These diseases are proportionally less common than musculoskeletal system diseases. The disorders that most commonly cause low back pain in this group are: herniated discs (lumbar disc herniations), wear of disc tissue (degenerative disc disease), waist slippage (lumbar spondylolisthesis), narrowing of the lumbar spinal canal (lumbar stenosis). Apart from these, collapses due to tumor, infection, trauma, osteoporosis, which are much less common but serious disorders of the spine, can be listed.

If the event that causes mechanical low back pain recurs or there is a more serious trauma or If strain occurs, it may cause longer-lasting mechanical back pain. Some of the characteristics of these pains distinguish them from other causes of low back pain.

    Mechanical low back pains are generally pains for which the onset time or the initiating event is clearly known. Patients can specify the date of onset of pain as month or day.

Although it can be seen at all ages, these pains are often seen between the ages of 30-50.

     The localization of the low back pain is distinct and the patient can show the area where the pain occurs with his hand. .

    Low back pain decreases with rest but increases with standing and activity. The patient states that the pain decreases when he lies down, sometimes when he sits, and that the pain increases when he stands and does a job.

    The majority of mechanical low back pain causes pain to hit the leg, heel, or even the big toe, and is accompanied by burning or numbness.

     Patients may experience night pain, such as back pain. The characteristic of this night pain is that it can decrease and disappear with positioning. When patients lie on their back at night, they wake up with lower back or leg pain due to stretching of the sciatic nerve, and when they change position by bending their knees, the lower back pain or leg pain will decrease after a while. In fact, after a certain period of time, patients begin to sleep by constantly bending their knees.

 

Rheumatic Low Back Pain      

The second most important cause of chronic low back pain is rheumatic low back pain. This group of pains is the group of low back pain whose characteristics and causes are least known in society. Unlike mechanical low back pain, this is a rheumatic disease of the spine and adjacent joints. Diseases that cause rheumatic low back pain are called spondyloarthritis. In this group of diseases, ankylosing spondylitis, psoriatic arthritis with psoriasis, enteropathic arthritis with rheumatic bowel diseases such as ulcerative colitis or Crohn's disease occur 2-4 weeks after a urinary tract infection or diarrhea caused by certain bacteria. There are unclassified spondyloarthritis with reactive arthritis and sudden onset of eye inflammation with redness and pain in one eye (acute anterior uveitis). Rheumatic low back pain caused by these diseases is distinguished from other types of low back pain by some features.

    Rheumatic low back pain has an insidious onset. The patient does not clearly remember when the pain started. It tries to define the onset of pain with a wide period of time, such as 6 months ago, 5 years ago.

    Low back pain usually occurs 20-30' ago. It occurs at an early age. It is rare for it to start over the age of 40-45. In women, it may sometimes start at a later age than normal due to the slow course of the disease, and in men, due to events such as prostate infection, it may start at a later age than normal.

    Low back pain has a chronic course that continues for at least three months. Having chronic pain is important. Because there is no rheumatic pain that lasts for a few days. However, at the beginning of the disease, the pain lasts for a few days, then passes and then recurs. Even in this case, the pain must continue for at least three months.

    Morning stiffness and pain are one of the most important features of rheumatic low back pain. The patient usually does not immediately sit up from bed when he wakes up in the morning. He/she can get out of bed after doing some movement and exercise in bed. Patients describe this as being unable to bend over and put on my socks when they wake up in the morning. Morning stiffness usually lasts 1 hour or longer. Similar to morning stiffness, the patient describes a stiffness when sitting for a long time during the day or when starting to move.

    Morning stiffness or pain decreases or disappears with movement and exercise during the day. Patients state that they forget the pain during daily activities and remember it when they are inactive.

     Pain in the second half of the night is one of the most important features of rheumatic low back pain. The patient wakes up from a night's sleep with back pain, gets up for a while, walks around, and then goes back to sleep after the pain subsides. He feels pain or cannot turn over in bed at night.

Apart from these low back pain characteristics, if you have psoriasis, inflammatory bowel disease, a urinary tract infection or diarrhea attack within 2-4 weeks, or if someone in your family has spondyloarthritis, the possibility of having spondyloarthritis increases. . Family history is especially important in spondyloarthritis called ankylosing spondylitis. If a person has a first-degree relative with ankylosing spondylitis, such as a mother, father, or sibling, the probability of developing the disease is 8%. For those with second-degree relatives such as uncles and aunts, this rate drops below 1%. HLA B27 antigen is prominent in familial or genetic predisposition. is coming out. Patients with spondyloarthritis and especially ankylosing spondylitis have a significantly higher rate of HLA B27 antigen compared to the general population. For example, while HLA B27 is found at a rate of 7-10% in the normal population, the rate exceeds 90% in ankylosing spondylitis patients. Therefore, finding HLA B27 is important in the diagnosis of spondyloarthritis. In addition, the probability of contracting the disease is 12% in people with HLA B27 antigen and a first-degree relative with ankylosing spondylitis, while this rate is around 1% in people without HLA B27 antigen.

Referred Low Back Pain

Referred low back pain. is another cause of lower back pain. These pains are a condition that usually occurs behind the abdominal lining called peritoneum and occurs in internal organs, lymph nodes and vascular enlargements. Diseases such as testicular tumors and lymphoma, which occur especially in young people, can often be confused with spondyloarthritis, as they also occur at this age. For this reason, it is necessary to distinguish referred low back pain from rheumatic low back pain. Referred low back pain is distinguished from other types of low back pain by some features.

The most important feature of referred low back pain is that it is not affected by rest and exercise. While mechanical low back pain decreases with rest and rheumatic low back pain increases with rest and decreases with exercise, the intensity of referred low back pain remains the same.

    The presence of additional findings related to the disease causing low back pain is the most important feature of referred low back pain. Structural complaints of diseases such as cancer, such as fatigue, loss of appetite, weight loss and fever, accompany low back pain.

    Patients experience low back pain with an insidious onset. They cannot specify the exact time of onset.

    Referred pain due to some cancers and other diseases is seen in patients over the age of 50.

    Night pains are prominent. However, it does not decrease by changing the sleeping position, as in mechanical pain, or by getting out of bed and moving, as in rheumatic low back pain.

     The location of the low back pain is not obvious. The patient cannot show the exact location of the pain as in mechanical low back pain.

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