Low back pain: causes, prevention and treatments

January 04, 2023

Definition: what is low back pain?

Low back pain is a general term for localized pain in the lower back (in the lumbar region). We speak more commonly of "lumbago" even of "turn of the kidneys".

It is a very common condition in adults and its incidence increases with age: according to a 2002/2003 ten-year health survey, more than half of French people aged 30 to 54 declared having suffered from low back pain at least once. day in the past year. Low back pain is responsible for many medical prescriptions and many work stoppages.

We distinguish common low back pain, of mechanical origin, and specific low back pain which is secondary to a disease. Low back pain can also be acute, chronic (when it lasts for more than 3 months) or recurrent.

Common or specific low back pain: what are the differences?

Depending on the origin of low back pain, we must distinguish:

  • the common low back pain which can be spontaneous or result from an excessive effort, a sudden rotation or a prolonged bad posture. It results from damage to one or more structures of the back such as muscles or ligaments. The pain, violent, brutal, can make the movements very difficult to carry out, even impossible. We are then faced with a blockage.

  • the specific low back pain is the symptom of a disease (inflammatory or infectious pathology, cancer) or a bone fracture.

What causes lower back pain?

The causes of chronic low back pain

Chronic low back pain can come from various structures such as:

  • collapsing or widening of a spinal disc related to age or herniated disc (common after 50 years). In the latter case, the disc protrudes from the vertebra.

  • wear of the edges of the vertebrae;

  • a lumbar vertebral fracture original osteoporotic Where traumatic ;

  • a lumbar osteoarthritis (due to cartilage degeneration caused by age):

Note that chronic low back pain can also be linked to:

  • certain chronic inflammatory, tumoral, infectious diseases ... (inflammatory rheumatism, spondyloarthritis, spinal tumors or metastaseshematological or digestive disease or cancer, heart or kidney damage, etc.);

  • a malformation (arachnoid cyst);

  • damage to another organ whose pain radiates to the lower back;

  • stress, anxiety, underlying depression (psychogenic pain and muscle tension);

  • fibromyalgia, a disease characterized by a decrease in the activity of certain neuromediators resulting in hypersensitivity to pain.

The causes of acute low back pain

Acute low back pain is in most cases related to muscle or ligament damage due to poor posture or a sudden "wrong move" as :

  • a badly done recovery (stand up with your legs straight, instead of having your legs bent);

  • Iand carrying loads in a bad position;

  • a a coughing fit or sudden sneezes;

  • of the repeated efforts (within certain professions)…

Acute pain is likely to become chronic if the cause of the pain is not removed (such as a bad position in front of his workstation for instance).

Who is at risk for low back pain?

People at risk for low back pain are:

  • them sedentary people ;

  • them people whose professional activity requires the carrying of heavy loads (garbage collectors, movers, etc.) or prolonged work on the computer.

  • high-level athletes particularly predisposed to the development of traumatic spondylolysis;

  • seniors ;

  • people with chronic conditions likely to cause bone, joint or back pain;

  • obese people;

  • pregnant women ;

  • people who are stressed or depressed.

What are the symptoms of low back pain?

In low back pain, pain is felt in the lower back. The lumbar region is complex and symptoms can vary depending on the person and the cause of low back pain. Symptoms differ depending on whether low back pain is acute or chronic:

Acute low back painChronic low back painMode of onset of painSudden onset following a false movement or prolonged bad posture.Often gradual onset with no specific trigger. Evolution of painDecrease over the days.Stabilization or even worsening over more than 3 months.Pain schedulesMechanical pain aggravated by movement. It can be maximum in the morning (when the muscles are cold) or at the end of the day due to fatigue.

Latent and permanent pain, even at rest. In case of chronic inflammation, the pain can rage at night altering the quality of sleep or even preventing sleep.

IrradiationsNo painful irradiation unless pinching of the sciatic or crural nerve accompanies low back pain (the pain may then radiate to the lower limbs).

Lumbar pain can itself result from radiation from damage to another organ (kidney, urinary tract, genitalia, aorta, meninges, spinal cord, etc.)

Associated symptomsNo other symptoms.

There may be other associated symptoms such as a deterioration in general condition or neurological disorders: these are criteria of severity.

With osteoarthritis, other joints in the body can be painful. The patient may also present with morning stiffness and painful movements.

In case of chronic pathology (spondyloarthritis, tumour, etc.): other pains are generally associated.

Anxio-depressive symptoms point the way to chronic low back pain of psychogenic origin linked to an anxiety disorder, stress or an underlying depression.

The prevention of low back pain requires the adoption of good postures on a daily basis and the regular practice of physical activity.

In case of overweight and obesity, it is advisable to lose weight and do muscle building.

For people who strain their back on a daily basis, it is necessary to adapt their work and take care of their back. To do this, you must lift an object keeping your back straight and lifting with the strength of your legs without putting your back forward. This remains true for occasional heavy lifting.

Here are some other recommendations for avoiding lower back pain:

  • remain aware of your posture at all times.

  • keep your back straight, looking forward, shoulders back.

  • avoid sudden rotational movements of the spine.

  • prefer backpacks to handbags and use both shoulders to carry the backpack.

  • pushing heavy objects rather than pulling them.

  • avoid wearing high-heeled shoes, more than 5 cm.

  • use straight-backed chairs that provide good support for the lower back and adjust the height of the chair.

  • place your feet on a small stool so that your knees are a little higher than your hips.

  • warm up before any sporting activity.

For doctor Philippe Guedet, general practitioner, often, clinical examination sufficient to establish the diagnosis of low back pain:

“If the picture is pure, that is to say it is muscle pain without fever or neurological abnormality, the clinical examination is sufficient. X-rays are only done in the event of an inflammatory syndrome, fever or very localized pain that is not typical of low back pain. »

In addition, if no obvious cause appears after a physical examination, the doctor may prescribe an x-ray, computed tomography (CT), or magnetic resonance imaging (MRI). Other examinations can then be carried out, depending on the presumed origin of the pain.

What are the treatments for low back pain?

Treatment for low back pain depends on its cause. If it is secondary to a disease, specific management of the latter is essential.

Prolonged immobilization or bed rest is not recommendedas Dr. Philippe Guedet, general practitioner, points out:

“Before, we immobilized patients, but we realized that prolonged immobilization was not beneficial. In reality, you have to keep what is called “relative rest”, that is to say that you eliminate major efforts while maintaining an activity, such as walking for example. »

A simple lumbago generally passes in about ten days. In case of pain, taking paracetamol, applying heat and wearing a lumbar belt may be necessary. The absence of carrying loads is recommended. However, once the patient is in less pain, it is essential to resume activity quickly in order to avoid recurrences.

In case of chronic lumbago

When lumbago becomes chronic, three types of treatment should be considered:

  • oral medications : analgesics (opiates or not), non-steroidal anti-inflammatory drugs, muscle relaxants.

  • local treatment: non-steroidal anti-inflammatory gels or even intra-articular infiltration of corticosteroids. Wearing a lumbar belt can also provide temporary relief.

  • manual processing: physiotherapy sessions (including massages, ultrasound, laser or electrical stimulation sessions), spa treatments, back school sessions (to learn how to lift loads without putting your back in danger, how to how to sneeze without risking your back, how to move around safely).

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