Anatomy
The back is made up of box-shaped vertebrae that are held in place partly by the shape of the bones, partly by ligaments and partly by the large and small back and abdominal muscles.
The spine seen from the side
A. Vertebra prominens
B. Vertebra coccygea I
C. Promontorium
D. L I
E. Th I
F. Axis
Cause
If the back is subjected to a load that exceeds its strength, overuse pain will be triggered from muscles, tendons, ligaments and possibly from the cartilage discs (disci), facet joints (small joints between the vertebrae) and bones. Neck and back injuries account for approximately 10% of all sports injuries. 1/3 of people over the age of 18 experience at least one episode of short- or long-term low back pain each year.
Symptoms
Pain (sometimes acute) and stiffness in the lower back (‘lumbago’) sometimes radiating to the buttocks and legs (‘sciatica’). Regardless of treatment, 90% are symptom-free within 3 months.
Examination
Mild back pain does not necessarily require a medical examination, but all cases of severe or recurring back pain should be examined by a doctor, especially to see if there is an indication for further examination, such as an X-ray, CT or MRI scan.
Treatment
Treatment includes relief from pain-inducing activity and graduated rehabilitation of the back within the pain threshold. It is therefore advisable to be instructed (possibly by a physiotherapist) on how to load your back in the most appropriate way and which maximally stressful movements to avoid (‘ergonomic guidance’). It may be necessary to take a few days off work to reduce the pain, but then you should start increasing training with abdominal and back stabilising and strengthening exercises.
Regular 30-minute walks (3-5 times a week) reduces back pain and almost doubles the time interval for low back pain recurrence that requires treatmentPocovi, NC. et al. 2024 ) .
If painkillers are needed, paracetamol is recommended, possibly in combination with (NSAID). If there is very localised pain that is aggravated by finger pressure (e.g. at some of the back stabilising ligaments, iliolumbar ligaments), you can try to supplement rehabilitation with adrenal cortical hormone injections around the sore ligaments. For chronic back pain, you should be extremely reluctant to use stronger painkillers (which quickly lose their effect and risk habituation).
Complications
If the pain does not subside after treatment, you should be (re)examined by a doctor.
In particular, you should consider:
- Slipped disc
- Secondary muscle infiltrations
- Pain from sacrum joint
- Piriformis syndrome
But there are many other causes of lower back pain, some of which will require further investigation. In the vast majority of cases, however, the treatment will be the same.
Especially
Smoking tobacco increases the risk of back pain by reducing the blood supply to the cartilage discs (disci), so everyday injuries don’t heal as well.Smoking cessation is therefore an important part of treatment.
