Lower back and lower back pain are not necessarily caused by lumbar protrusion! The doctor will give you details of other causes

01

Have you ever had lower back pain, do you think it must be caused by a lumbar protrusion?

Pain in the lower back and lower back is a problem that plagues many adults. There are many patients in outpatient clinics because of this problem. What are the reasons that cause patients to have lower back pain? What are the characteristics of low back pain caused by different reasons? How to deal with it? Dr. Xie will tell you in detail today.

Our back is a relatively broad concept. In medicine, we usually refer to the anatomical area between the lowest rib and the upper part of the hip as the lower back. There are many important anatomical structures in this area, such as the lumbar spine, such as the lumbar spine. Muscles, fascia, and nerves protected by the lumbar spine can cause lower back pain when these structures fail.

02

Pain caused by problems with lumbar muscles and fascia

I don’t know if you usually have such symptoms, that is, when you bend over to wash dishes, you may not be able to brush for three or five minutes, you will feel obvious pain in your waist, and you will not dare to straighten your waist! After sitting for a long time, you will feel obvious soreness around the waist, and even when you press a certain part, it will induce obvious pain. There are also some friends who feel particularly uncomfortable around the lumbar spine when they get up in the morning, but the pain is relieved and even disappeared when they get up in the morning. In fact, although these problems will cause us a certain amount of trouble, but the pain is not particularly serious. This situation is often caused by problems with the muscles and fascia around the lumbar spine.

If we don’t pay attention to our standing and sitting posture in our daily life, or work at a desk for a long time, bow your back, bow your back for a long time, or drive for a long time, these habits will increase the stress on the muscles around the lumbar spine, which is very bad. It is easy to cause the muscles and fascia to be in a tense state for a long time. Over time, it will lead to the tearing of local small muscles and fascia, which will gradually produce aseptic inflammation and even scarring, causing pain in patients. Some severe patients may even feel some small pimples in the local area when pressing the painful part. Pressing this part will induce obvious pain. Some patients may even radiate to the buttocks and have obvious abnormal feeling. Scar, some people call it tendon knot, Western medicine calls it trigger point or trigger point.

●How to diagnose: Generally, doctors can feel the obvious tender points after physical examination, and they can make a diagnosis by inducing the same symptoms in patients. If the patient has a specific request to find evidence, musculoskeletal ultrasonography can be performed, and ultrasonography can detect locally abnormally disorganized nodules and damaged muscles. Under normal circumstances, it is difficult to find muscle and fascia problems with X-ray, CT and MRI, unless it is particularly serious, and there is no need to receive this radiation and spend more money.

●Coping: If the pain is not too big, and the trouble is not particularly obvious to me, you can help yourself to control the symptoms by taking proper rest, paying attention to your standing and sitting posture, and not cross-legged or cross-legged for a long time. If the pain is obvious and has caused some trouble in daily life, you can take acupuncture treatment and manual therapy to help yourself control the symptoms, or you can apply non-steroidal anti-inflammatory analgesic ointment to the painful area to help relieve the symptoms.

If drug treatment and acupuncture treatment cannot help patients relieve symptoms, there is a particularly effective treatment method for muscle and fascia strain, that is shock wave therapy. This technology is a kind of energy therapy, which uses shock waves to smash the problematic tissue at the microscopic level, and uses our own body's self-healing ability to re-grow the problem-free tissue, and the problem will naturally be solved. Usually once a week, 3 to 4 times as a course of treatment.

In addition, you can also perform some waist rehabilitation exercises in daily life to help you release tense muscles and fascia. If you stick to it, you can get very good therapeutic effects without spending money. The following actions have lumbar disc herniation. patients can also try it.

03

A herniated disc is also a common cause of lower back pain.

The intervertebral disc is composed of the nucleus pulposus between the two vertebral bodies, the annulus fibrosus that protects the nucleus pulposus, and the cartilage endplates of the vertebral bodies on both sides. A good state of the intervertebral disc plays a very important role in buffering the pressure on the vertebral body. However, with the prolongation of use time, weight, trauma and other factors, the annulus fibrosus that slowly protects the nucleus pulposus may be slightly torn, and the nucleus pulposus will gradually degenerate, no longer as it was before. Full of elasticity, over time, disc herniation will appear.

If the herniated intervertebral disc irritates the soft tissue around the vertebral body, nerves, or chemical inflammation caused by the herniated intervertebral disc itself, it may lead to low back pain. You can look at the animation below. It is very good to understand the whole process of lumbar disc herniation. With the different degree of protrusion, the patient will also have different symptoms. When the nerve is compressed, the patient will have obvious symptoms of nerve stimulation. , such as lower extremity pain, that is, sciatica, which we are all familiar with.

How to diagnose: If the patient has symptoms of low back pain or radiating pain in the lower extremities, and the doctor suspects that the patient has lumbar disc herniation through the physical examination, CT or MRI should be performed to determine whether there is intervertebral disc herniation and what happened to the intervertebral disc herniation. To this extent, where exactly did it oppress? If you choose between CT and MRI, I personally recommend MRI, because MRI is more comprehensive and more accurate for small damage.

●Treatment: About 80% of patients with lumbar intervertebral disc herniation can be cured clinically through conservative treatment, that is to say, the herniated intervertebral disc is difficult to reset, but the symptoms can be disappeared through treatment. General treatments, such as acupuncture and manual therapy, can help patients with mild symptoms to relieve symptoms. If the pain is more obvious, then some physical therapy may be required, such as microwave therapy, transcutaneous electrical nerve stimulation and other treatments. It is also a good choice to take some traditional Chinese medicines for promoting blood circulation and removing blood stasis, and traditional Chinese medicines or proprietary Chinese medicines for the treatment of lumbar disc herniation. If there is radiating pain in the lower extremity, traction therapy can be performed as appropriate to help the patient relieve symptoms.

If the symptoms cannot be relieved after 1-2 months of systematic conservative treatment, invasive treatments such as intraspinal injection and nerve root block can be considered. Doctors can inject drugs into the spinal canal to help For patients to control inflammation and reduce pain, this kind of treatment is best carried out in the pain department of major hospitals. If this treatment is still not relieved, it may be necessary to consider minimally invasive transforaminal surgery, or open surgery.

●Rehabilitation exercise. Most patients with lumbar disc herniation can perform rehabilitation exercises if the symptoms are not particularly serious. Some exercises for the lumbar spine mentioned above can be done. After the symptoms are relieved, it is necessary to strengthen the muscles around the lumbar spine. Why? Because the muscles are very important to maintain the stability of the vertebral body, after the muscles around the lumbar spine are strengthened, the vertebral body becomes more stable, so the possibility of recurrence of lumbar disc herniation in the future will decrease. Symptoms may also not be as severe as they used to be.

The following methods of strengthening the muscles around the lumbar spine are not suitable for all patients with low back pain. It is recommended that patients with low back pain can try a certain movement during the remission period, and they can continue to do it without discomfort. Or the waist is very uncomfortable, so don't do it. As long as you can persevere and keep doing flexibility exercises around the lumbar spine and muscle strengthening exercises, you will definitely gain something.

04

Problems with the lumbar facet joints are also a common cause of lower back pain.

In clinical practice, we often encounter such patients, that is, when a friend bends over to hold water at home, he suddenly sees a sound in his waist, and then the lumbar spine does not dare to move or rotate, and a little The pain is obvious when you move, have you ever encountered this situation?

Sometimes it doesn’t have to be bending over to hold the water, but it may also be the moment from sitting to standing up, changing the body position, or moving a flower pot or turning over too fast, and the lumbar spine feels stuck. Induce severe low back pain, and even severe numbness of the lower extremities.

Does it sound like a symptom of a herniated disc? Actually not! This situation is a very common problem called lumbar facet joint interlocking. Repeated long-term occurrence, lumbar facet joint interlocking can lead to lumbar facet joint osteoarthritis.

The following picture shows the facet joints of the lumbar spine. It has a certain flexibility, but it is also important for maintaining the stability of the joints. If the facet joints are repeatedly misplaced, the patient will have interlocking, and the interlocking is small. The cartilage of the joints may wear away, and then osteoarthritis of the facet joints may occur, resulting in the formation of osteophytes, a reduction in the angle of motion of the joints and pain.

●How to diagnose: In general, it can be judged that the patient is a noose of the facet joint according to the symptoms of the patient, such as the limitation of the range of motion and severe pain when suddenly changing the body position. X-ray examination is often performed at this location, and it is difficult to find facet joint interlocking, and occasionally changes in interlocking are found on the x-ray.

●Response: When facet joint locking occurs, in fact, the best way is for a manual therapist to give lumbar interlocking reduction. Usually after facet joint reduction treatment, the patient's pain will disappear immediately, and the range of lumbar spine movement will be restored immediately. After that, because the process of reduction may cause a certain amount of edema, the patient will experience pain again after 8 to 12 hours for a period of time, and slowly return to normal.

The reason why patients have interlocking of the facet joints may sometimes be due to the sudden change of body position and the joints do not adapt to it, but most of the reasons are because the muscles around the lumbar spine are not strong enough, which is why patients with interlocking facet joints Most of them are due to women. Therefore, if the patients with frequent lumbar facet joint interlocking should strengthen the muscles of the lumbar intervertebral disc in daily life, minimize the possibility of joint interlocking in the future, and avoid lumbar osteoarthritis. How to strengthen the peripheral muscles of the lumbar spine has been introduced in detail before, so I won't repeat it.

05

Ankylosing spondylitis can cause pain and stiffness in the sacroiliac joints and lower back!

Ankylosing spondylitis occurs more often in young men. If you feel a sense of stiffness in your lower back when you get up in the morning, as if you are carrying a rock, you need to exercise for more than 20 to 30 minutes to relieve it. In this case, the possibility of ankylosing spondylitis is highly suspected, and it is necessary to go to the hospital for corresponding examinations, such as CT of the sacroiliac joint, X-ray examination of the lumbar spine and pelvis, and hlab27 test. Make a definitive diagnosis.

This disease will slowly "coagulate" the patient's sacroiliac joints and lumbar spine together, and finally form a special bamboo-like change. The patient's lumbar spine mobility will gradually get worse and worse. If the change stimulates the nerves , the patient may have radiating pain in the lower extremities.

●Coping: If the patient's pain is not particularly severe in the early stage, oral non-steroidal anti-inflammatory analgesics can be used to help control the pain and inflammation. In severe cases, drug treatment is required with the help of a professional rheumatologist. And this disease requires patients to insist on rehabilitation exercises every day to fight against the slowly solidified lumbar spine, so as to maintain the mobility of the lumbar spine as much as possible, in order to meet the needs of daily life and reduce pain.

06

Rare possibility of causing lower back pain!

There are also some rare reasons. For example, I met a patient like this two days ago. The pain in the lower back has been getting worse for about three months, but I always thought it was a herniated lumbar disc, but the MRI found that there was a tumor in the lumbar spine. .

In addition, some patients have malignant tumors in other parts, and bone metastases occur. When they reach the periphery of the lumbar spine, they will also cause patients to have low back pain.

In recent years, the incidence of lumbar tuberculosis has also increased significantly. If the patient has obvious weight loss, low fever in the afternoon, night sweats, and low back pain, we cannot rule out the possibility of lumbar tuberculosis.

07

Summarize

In fact, there are many reasons for our lower back pain, but the common clinical reasons are mainly the above. Dr. Xie has given you some detailed introductions in the article. In fact, most of the low back pain is related to our daily life. There is a relationship between habit and overuse.

It is recommended that friends who have lower back pain should pay attention to standing and sitting posture in their daily life in the future. If there is a problem, it is not terrible. Timely correction is our best choice. Carry out rehabilitation exercises for the lumbar spine, insist on stretching the lumbar spine, promote the blood circulation of the lumbar spine, maintain the flexibility of the lumbar spine, and at the same time maintain the strength of the muscles around the lumbar spine. attack.

If you have any other doubts, you can leave a message below and let's discuss together.

I am Xie Xinhui who insists on explaining the knowledge of complex diseases in simple language. It is not easy to code words. If you agree with my point of view, please help to follow or like it. If you or your family and friends also have waist and lower back pain Troubled, please forward this article to those who need it, thank you!