Lower back pain is a common issue that affects two-thirds of adults throughout their lifetime. Eight out of ten people have experienced lower back pain at some point in their lives.
In most cases, it is caused by simple muscle or ligament strain and is not a serious problem. Typically, with simple treatments, most lower back pain subsides within a few weeks.
However, it can occasionally be a sign of more serious problems. People experiencing persistent or severe lower back pain, which limits their daily activities and is accompanied by other symptoms, should consult a doctor.
If you have numbness in the lower back or genital area, loss of strength in the legs, difficulty walking, difficulty urinating, loss of urinary control, or loss of bowel control, and if the pain is increasing in severity and getting worse, it is essential to seek medical attention immediately.
When evaluating patients with pain complaints, the first thing we consider is the nature of the pain. Our initial step is to determine whether the pain is mechanical or inflammatory.
If the pain worsens with movement, decreases with rest, changes with specific positions, and increases with activities like coughing, sneezing, or bending forward, we classify it as mechanical pain.
On the other hand, if the pain persists during rest, wakes the patient up at night, is accompanied by prolonged morning stiffness, or decreases with movement, these are indicators of inflammatory pain.
In fact, in many cases of lower back pain, no specific cause can be identified, and we label these as mechanical lower back pain. Most often, lower back pain starts intensely and subsides within a few days or weeks.
We refer to this type of pain as acute lower back pain. If the pain continues for weeks or even months, it is categorized as chronic lower back pain.
“People with chronic lower back pain often have good and bad days. The cost to society is also high due to healthcare expenses and missed workdays resulting from lower back pain.
In imaging studies of individuals without lower back pain, more than 50% of those aged 30-39 have shown disc degeneration, bulging, or height loss.
Degenerative changes can occur even in young individuals and may not necessarily be the cause of existing lower back pain.
What Are The Causes Of Lower Back Pain?
The cause is unclear in many individuals.
- Poor posture
- Development of stiffness in the spine due to lack of exercise, shortening, and weakness of the abdominal, lower back, and leg muscles
- Muscle strains
- Lumbar disc herniation, sciatica, spinal stenosis, spondylosis in the lower back
- Inflammatory rheumatic diseases (ankylosing spondylitis, spondyloarthropathy)
- Bone fractures (due to osteoporosis)
What Are The Conditions And Findings That Require Immediate Medical Attention In Lower Back Pain?
- Lower back pain in individuals under the age of fifteen and over the age of fifty-five.
- Nighttime pain that doesn’t subside with rest.
- Pain radiating to both legs.
- Concurrent back and abdominal pain.
- Prolonged severe pain that worsens despite treatment.
- Intense and progressive symptoms.
- Localized neurological damage symptoms (numbness, weakness, loss of balance, etc.).
- Inability to control urine and feces or difficulty in urination.
- Abnormal gait.
- History of cancer.
- Unexplained weight loss.
- Loss of appetite.
- Intravenous (IV) drug use or drug addiction.
- Systemic steroid (cortisone) use.
- Presence of accompanying diseases (AIDS, urinary tract infection, etc.).
- Suppression of the immune system.
- Structural deformity (scoliosis, kyphosis, etc.).
- Elevated sedimentation rate in blood tests.
- General fatigue/weakness.
- Fever above 38 degrees Celsius.
- History of trauma.
- Recent history of back surgery.
- History of past infection.
- Morning stiffness.
What Can You Do to Prevent Lower Back Pain?
The first question many patients with lower back pain ask is usually, ‘Do I have a herniated disc?’ Many people fear having a herniated disc and want to make sure they don’t. That’s why they immediately request an MRI when they experience lower back pain.
As I explain to my patients, our priority with lower back pain is not necessarily to determine whether they have a herniated disc but rather to understand the nature of their pain and develop a diagnosis and treatment plan based on that. If there are any of the urgent symptoms I listed above, it’s crucial to see a doctor promptly.
As someone who has experienced the pain of a herniated disc firsthand, I must emphasize this: take care of your body and incorporate exercise into your life before you experience pain or illness. Suffering from pain is not a pleasant feeling.
Not everyone with a herniated disc experiences pain. Claiming that ‘I don’t have a herniated disc’ and thoughtlessly engaging in movements that strain your body can actually pave the way for herniation in the future.
In individuals without any pain complaints and completely normal physical examinations, it is not uncommon to incidentally detect a herniated disc in imaging studies. Pain is an emotion that inevitably makes us panic, and none of us want to experience pain. However, pain is also an emotion that alerts us to potential danger.
In cases of new-onset pain, it’s essential for the individual to be aware of why the pain might be occurring. What is the pain trying to tell us? We need to recognize this.
I often hear sentences from many of my patients like, ‘I can’t bend forward, and when I try, the pain shoots through my leg. Why can’t I bend?’ My response is, of course, ‘If the pain is telling you not to bend, then you shouldn’t bend for a while.’ Pain is warning you, saying, ‘Look, be careful, when you bend, you’re putting stress on your back nerve/muscle/tendon, etc., and you’ll worsen the situation.’ Your responsibility is to pay attention to this and learn how to move within pain-free limits. Unfortunately, what I’ve observed is the opposite; there’s a tendency to repeat painful movements, thinking, ‘Why can’t I bend? I should be able to,’ which only prolongs the healing process and makes the problem more painful.
If you have new-onset pain, first identify the factors causing the pain and learn to move within your pain-free limits.
If you don’t have immediate symptoms that require a doctor’s visit, you can try over-the-counter pain relievers, gentle mobility exercises that won’t exacerbate the pain, and hot/cold applications at home for a while. However, if your pain doesn’t improve, it’s essential to see your doctor for an examination.
Even if your pain subsides with these treatments, remember to take care of your back and incorporate exercise into your life. I recommend consulting your doctor for the right exercise selection.
Sometimes, during treatment, pain can increase again even if it had previously decreased. To determine the reason for this, you need to monitor yourself.
Various activities like coughing, straining, constipation, excessive walking, excessive stair climbing, sports involving jumping, frequent half-body twisting activities while sitting, rushing through exercises without allocating enough time, performing exercises incorrectly, bending forward while working, washing your foot in the sink, staying in wet clothes without changing when sweaty, and exposure to wind can all cause muscles to contract again. Identifying which activity is straining you and correcting it will help prevent the recurrence of your pain.
Can You Provide Information About Back School?
In the treatment of back pain, the first step is patient education and information. The fear of ‘What should I do if my pain returns?’ in someone experiencing back pain can lead to limitations in daily activities.
It’s important for individuals with back pain to stay active and avoid prolonged bed rest. The education aimed at ensuring the proper use of the back is referred to as ‘Back School.‘ The goal of this education is to learn how to use the back more effectively and prevent the recurrence of back pain.
It includes teaching proper posture, identifying activities that place more stress on the back, and providing exercise instruction.
Helping the patient understand their body, roughly learning about anatomy, knowing whether the problem originates from the disc, facet joints, or involves nerve compression, all contribute to promoting back care.