Our waist is a structure that carries the weight of our body, transfers the load from the hips to the legs, and also ensures that our body is mobile during our daily activities. There are 5 vertebrae in our waist, cartilage pads (discs) connecting these vertebrae, joint structures and soft tissues that support them. In addition to contributing to movement and carrying load, the lumbar vertebrae, like other parts of the spine, serve as protection for the spinal cord and nerve roots. Nerves that provide muscle control of the legs, carry the sensation of the legs, and control urinary, stool and sexual functions pass through the lumbar vertebrae.
Causes of Low Back Pain
Any event that develops in the vertebrae, discs and soft tissues can cause low back pain.
Low back pain is one of the most important reasons that restrict the daily activity of the individual today. It is known that approximately 80% of the population around the world experiences at least one episode of low back pain at some point in their lives. Low back pain ranks second among chronic diseases seen in developed societies, after heart diseases, and ranks fifth among diseases that require surgical treatment. Low back pain is most common between the ages of 20-40. We can divide lower back pain into two groups: acute and chronic. In acute back pain, the pain usually decreases within a few days and disappears completely after a few weeks. If the pain lasts more than 3 months, it is called chronic low back pain. The complaints of 90% of patients with low back pain resolve spontaneously within the first 4 weeks, but only 5% become chronic. In most cases of low back pain, the cause of the pain is determined by history and clinical examination, but nothing can be found in auxiliary examinations and radiological examinations.
We generally call this type of pain "Mechanical low back pain".
We can categorize the causes of lower back pain into 2 large groups.
1-Musculoskeletal system diseases
2-Spine diseases
1-Musculoskeletal System Diseases
< br /> The majority of low back pain falls into this group. It mostly occurs with minor damage to the muscles, connective tissue or joints. The term "myofascial pain syndrome" refers to muscle and soft It is used for the clinical picture caused by excessive stretching and injury of tissues. Other musculoskeletal system problems that cause low back pain include poor and incorrect body posture, shortness of one leg, psychosocial factors such as smoking and stress, as they cause low oxygenation of the vertebrae and cartilages in the waist.
2-Spine Diseases
Diseases in this group 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, and osteoporosis, which are much less common but serious disorders of the spine, can be listed.
a) Lumbar disc herniation: The disc material consists of a relatively harder sheath on the outside between two vertebral bodies and gel-like soft tissue parts on the inside. It acts like a cushion and undertakes the task of distributing the loads of the body. However, if too much load is placed on the lumbar vertebrae (excessive weight gain and heavy lifting), other structures that support the waist, especially the waist and abdominal muscles, are weakened (lack of exercise), or deterioration of these discs due to structural and genetic reasons may cause low back pain and herniated disc. If the outer sheath of the disc weakens or ruptures, the inner part slides out and starts to put pressure on the nerves in the spinal canal and/or legs, this is called a "herniated disc". While the weakening or tearing of the outer layer mostly causes lower back pain, a herniated disc, which can be defined as the displacement of the inner layer outwards, causes pain, especially in the leg, as it puts pressure on the nerve root. In a herniated disc, leg pain is more prominent than lower back pain. Depending on the level of pressure on the nerves, pain, weakness and numbness may occur in the thigh and leg.
b)Lumbar spondylolisthesis: It is the slipping of one vertebral body forward or backward on the other vertebral body. Nerve root damage due to this disorder If there is pressure on the skin, in addition to lower back pain, pain, weakness and numbness may occur in the thigh and leg.
c)Narrowing in the lumbar spinal canal (Lumbar stenosis): The canal in which the spinal cord and nerves coming from the spinal cord travel within the vertebral bones is called the spinal canal. As a result of many factors such as trauma, body abuse, and genetic factors, narrowing of this canal may occur due to thickening and coarsening of the soft tissue and bone structures that make up the spinal canal. As a result, compression occurs in the nerve roots. These patients complain of pain and numbness in the calf, especially when they stand for too long and while walking. Pain complaints ease or disappear when they sit and lean forward. This clinical picture, which occurs with standing or walking, is called "neurogenic claudication".
d)Wearing of disc tissue (Degenerative disc disease): The water content of the part forming the inner layer of the disc is high in childhood and young age groups. With aging, the water content decreases, the disc height begins to decrease, and small tears develop in the outer layer. The load-bearing and movement ability of the disc decreases. Low back pain occurs with the stimulation of the nerve fibers on the outer part of the disc. In these patients, lower back pain is more common than leg pain.
Evaluation and Diagnosis of Patients with Low Back Pain
The cause of most low back pain is excessive stretching or minor injuries of the muscles and soft tissues, as mentioned above. Since the pain complaints in these patients will subside spontaneously within a few days, they usually do not need to be examined. However, the following reasons require immediate medical attention.
1. Recurrent low back pain attacks
2. Chronic low back pain
3. Gradually increasing pain intensity
4. Pain in the thigh and leg accompanying low back pain, numbness, Having symptoms such as weakness, inability to voluntarily urinate and defecate, sexual dysfunction.
5. Low back pain that does not go away with rest.
6. Excessive weight loss, fever, chills and chills along with low back pain.
< br /> While investigating the causes of the patient's back pain, his/her history is taken and necessary examination is performed. After the examination is done, examinations should be performed in line with the preliminary diagnosis.
a) If the cause of acute low back pain is thought to be a herniated disc, excessive tension in the muscles and soft tissues, bed rest (not exceeding 5 days) and medication are recommended for these patients. .
b) In cases with chronic low back pain, in cases where rest and medical treatment were given due to acute low back pain but the pain did not go away, and in cases where a spinal tumor or spinal infection was suspected, we should start our examination with direct radiography and follow up by determining the lesion level and diagnosing the disease with Magnetic Resonance Imaging (MRI). must be put. In addition to these tests, if infection or tumor is suspected in the patient, blood tests and bone scintigraphy should be performed.
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