Low back pain: all the remedies

Rest, physical therapies and targeted exercises associated, if necessary, with anti-inflammatory drugs are the main remedies in case of low back pain.

What does low back pain mean?

The medical term “low back pain”, otherwise known as back pain, indicates a pain that affects the muscles and bones of the lower back, or the lumbar-sacral region.

Although it cannot be considered in all respects a disease, it is one of the most frequent disorders and can be associated with different clinical situations, more or less serious.

According to the duration of lower back pain, various forms of lumbagoare distinguished at:

• Acute low back pain: short-lived and generally resolved within a few days or at most within 4 weeks. It presents as a very intense and sudden pain. The most common type of this category is the so-called “witch’s blow“, in fact a muscle contracture caused by a sudden movement or excessive weight
• subacute low back pain: characterized by the persistence of pain for longer than the acute form even if it disappears within 12 weeks
• Chronic low back pain: although the pain is usually more bearable than the acute phase, it is the most disabling form as it lasts for more than 3 months compromising even normal daily activities in the most serious cases.

However, it is important not to confuse the terms low back pain and lumbosciatica. In the first case, in fact, the pain is localized at the level of the spine (ie the grouping of several vertebrae of a specific anatomical region) lumbar, dorsal or both, while in the second extends to the posterior surface of the thigh due to the involvement of the sciatic nerve that is inflamed.

What are the causes of low back pain

The causes of low back pain can be many, modifiable or not. Among the most common are:

• disorders affecting the muscles or joints at lumbar and sacral level andin turn caused, for example, by a muscle contracture, a stretch or a sprain;
• inflammation of the sciatic nerve also known as “sciatica” or better “sciatica“.

There are also numerous risk factors or predisposing physical conditions that can favor the onset of back pain:

• poor physical activity or maintaining an upright and static position for a long time (in this case the pain can also affect the buttocks and legs)
• Lifting heavy loads incorrectly
• excessive physical exertion (e.g. practicing power sports such as weightlifting)
• incorrect posture, especially if maintained for a prolonged period of time
• overweight and obesity
• muscle weakness
• smoke
• stress
• uncomfortable or unsuitable footwear
• mattress not adequate for a good night’s sleep
• minor accidents
• cold snaps or drafts
• pregnancy and menstrual cycle.

In some cases, back pain can be considered the alarm bell of various pathologies in progress:

• diseases affecting the joints or bones (osteoarthritis, rheumatoid arthritis, reactive or psoriatic arthritis, osteoarthritis, osteoporosis, etc.)
• deviations or impairments of the spine and posterior longitudinal ligament within the vertebral canal (scoliosis, herniated intervertebral disc or discopathy in general, spondylolisthesis, spondylolysis, fracture of one of the lumbar vertebrae, etc.)
• abdominal disorders (appendicitis, stones, gastroenteritis, cysts, etc.)
• neurological pathologies associated with the spine (the “cauda equina syndrome” for example is a very serious neurological pathology, in most cases the result of a voluminous lumbar disc herniation and which involves, if not treated promptly, the blocking of movement and permanent incontinence)
• some strictly female pathologies of the pelvic area (endometriosis, ovarian cysts, fibroids or uterine carcinomas, etc.)
• bone or bone marrow tumors.

How to recognize low back pain

As anticipated, low back pain or back pain can not be considered a real disease but more than anything else a symptom of other clinical conditions. Like all symptomatic manifestations, it varies depending on the triggering cause and can therefore:

• occur occasionally or chronically
• get worse with the days, stay stable or disappear in a short time
• be accompanied by other more or less specific symptoms
• accentuate at certain times of the day, after physical effort, a small movement in itself harmless or manifest itself even at rest.

If the pain persists or to make a more certain diagnosis of low back pain and therefore undertake the best treatment, in addition to listening to the symptoms reported by the patient (anamnesis) and physical evaluation, the doctor may decide to prescribe instrumental examinations including magnetic resonance imaging, a CT scan or an X-ray in case the presence of a trauma injury is suspected.

What to do in case of low back pain

Although treatment may vary depending on the cause, intensity and medical history of the patient, among the generally recommended and implemented remedies are:

• rest on days when the pain is more intense, even if not total so as not to weaken the muscles, and avoid lifting loads or making unnecessary efforts
• maintain moderate physical activity as soon as pain permits. In fact, it has been shown that keeping moving accelerates pain resolution
• the application of bands or warming creams to relax the muscles
• to relieve particularly annoying pain it is useful to take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, ketoprofen, diclofenac or naproxen orally or topically through ointments, creams, gels or medicated patches if the disorder is localized. To relax the muscles, some muscle relaxant active ingredients can also be used.
• Apply ointments, creams or herbal gels. Especially for milder cases, as an alternative or in combination with the pharmacological approach, it is possible to resort to natural products containing active substances with anti-inflammatory or soothing properties such as camphor, chilli or arnica
• undergo physiotherapy sessions thanks to which a specialist will practice a decontracting massage in the affected area also coordinating the execution of aerobic exercises and progressively more intense stretching to strengthen the muscles and ensure complete rehabilitation
• follow postural re-education courses. If the real problem is not being able to assume or maintain a correct posture, for example in the office or during the study, practicing postural gymnastics under the supervision of a specialist (physiatrist or physiotherapist) can be useful to learn how to facilitate the healing process and how to prevent further episodes
• alternative physical therapies. Acupuncture, tecar therapy, laser therapy, infrared, massage therapy or the application of elastic adhesive bands in particular positions (kinesio taping) are among the rehabilitation treatments that can give a benefit in case of low back pain even if their effectiveness depends a lot on the type and cause of pain.

If the pain does not pass, indeed it tends to worsen despite having followed all these measures, it may be necessary to resort to more aggressive pharmacological therapies (corticosteroid drugs, local anesthetics by injection or opioid analgesics), which should always be taken under the supervision of the doctor. Sometimes, especially in the case of a particularly pronounced herniated disc or serious clinical conditions (spondylolisthesis or spinal stenosis), it is also essential to resort to surgical treatment.

Useful measures in the prevention of low back pain

Considering how some of the causes or risk factors of low back pain depend on some of our incorrect habits, it is possible to play in advance by focusing on prevention.

Below are some of the most effective strategies to prevent the appearance of back pain:

1. Always keep moving by practicing physical activity appropriate to our age and physical condition. Swimming or regular walking are among the most recommended sports. Even pilates or yoga exercises, if done correctly, can bring benefits as they help maintain the elasticity of the muscles.
2. Raise the loads in the correct way, lowering and making strength also on the legs, not only on the arms and trunk.
3. Assume a correct sitting position especially if we have to maintain it for a long time. To facilitate this, it could be useful to use a support at the height of the lumbar tract to be mounted, for example, on the back of the chair or to be placed in the car seat. Alternatively, you can opt for a simple belly or a corset to wear under clothes, valid aids to go to support the trunk even when you are very standing.
4. Wear comfortable footwear that supports and supports the normal curvature of the spine, especially if you require to maintain an upright position for a long time.
5. Sperform postural gymnastics programs useful, as we have seen, even in the healing phase.
6. Keep your weight normal so as not to overload the joints, the muscles of the lumbar region and especially the spine with the consequent risk of developing hernias or disc disease, predisposing factors for back pain.
7. Choose an orthopedic mattress suitable to support the back that avoids making us bend our back excessively during night rest.
8. Do not underestimate the initial discomfort, especially if persistent, as they could worsen or lead to further complications.