Back Pain

Lumbago is a sudden strong lumbar pain, which is mostly caused by a jerky movement, rotation, bending, rising, or heavy lifting while squatting. Like in a reflex the individual touches the source of pain. The person cannot get up or even sometimes falls down. He requires assist to pull himself up.

Reduction in pain can be achieved in the step position. The patient lays on his back with a cushioned box or chair under his calves so that his legs are raised at right angle.

The condition can persist for several days or weeks and will fade away gradually. The cause of this pain attack is a protrusion of a disc, which exerts pressure on a nerve leaving the spinal canal. In the disc protrusion the outermost layers of the annulus (the membrane surrounding the disc) are still intact, but annulus's innermost layers are weakened and possibly torn, thus weakening the annulus as a whole.

A disc protrusion does not mean that the disc itself has "slipped". This is not possible as it is fixed by fibers to the vertebral body. The longitudinal muscles of the back are now contracted, as a reaction to the pain.

If there is relief of symptoms by changing posture, warmth and bed rest one can assume that the protruded disc went back to its old shape and the nerve is not permanently damaged. As in many such cases, degenerative changes already exist and it can be predicted that the attack will repeated. In these cases a orthopedic specialist should be consulted.

More complicated is a lumbago, where there is a disc prolapsed (herniated / ruptured) into the spinal canal. The individual cannot derive from the degree of pain, if it was a protrusion lumbago or a more complicated prolapsed lumbago. If sensation disturbances are present, or if paralysis is present, or if there is a loss of bladder control, an orthopedic specialist should be consulted or called immediately. If symptoms are very severe, a hospital with a orthopedic or neurosurgical department is the best solution. The possibility of immediate disc surgery is very real.

Warning: Self administration of strong pain medication can conceal complications and prevent their early diagnosis.

Sciatica is defined as the inflammation of a certain part of the sciatic nerve. The sciatic nerve is a connection of several nerves, which exit the lower lumbar spine and the upper nerves of the sacral bone. Here the prolapsed disc contacts one of the nerve roots, which form the sciatic nerve. The result are strong pain radiating down to the toes.

In a prolapsed / herniated the strong outer fiber ring, which encompasses the jelly like nucleus, is not strong enough anymore to hold the pressure and breaks open. The jelly like material of the core squeezes outside partially or totally and presses on one or more nerves. Depending on the position and amount of prolapsed material the pain is more or less severe.

Sensation disturbances, paralyses, sexual dysfunction, problems urinating and with bowel control can be caused by prolapsed discs. These symptoms occur especially when the prolaps occurs in the lower lumbar spine. Loss of sphincter control when defecating and urinating are absolute emergency cases, which require immediate surgery. The patient should be hospitalized immediately. If this step is not taken immediately there is the risk of permanent paralysis.

The discs of the lumbar spine are affected by disc prolapses most often, because they have to bear the most weight. Second to lumbar disc prolapses are cervical disc prolapses. A disc prolapses of the thoracic spine is very rare.

An injured disc can never recover. It becomes thinner and looses part of its cushioning function. The associated vertebrae become less mobile and eventually fuse. The fusion of a single segment is not critical for the mobility of the whole spine, but can start a sequence of events accelerating spinal degeneration.

Degeneration of discs result in small fissures of the outer annulus ring quite frequently. If only a small amount of jelly is extruded and the jelly does not exert pressure on ligaments and nerves, the event will not result in pain. However, larger extrusions of disc material occurring between the age of 25 and 50 require surgery. Surgical methods are described later.

Beyond middle age degeneration affects the whole spinal segment. The single vertebrae begin to reduce their height gradually as a result of inadequate rehydration during resting periods resulting in wearing small joints of the vertebral arches.

This process will not cause permanent pain, but after heavy exercise painful muscle tension will develop more rapidly. The degeneration can be delayed by careful stamina training like power walking, hiking, biking, swimming, gymnastics, water treatment after Kneipp or massage at this stage. If this still leaves one with frequent and chronic muscle hardening a intensive cure should be considered where holistic natural treatment will often result in improvement.

Less frequent is genuine spondylolisthesis. In this condition the vertebrae and spinal arches, between the intervertbral joints, are misaligned. The intervertebral discs are prematurely deteriorated by the forces, which are misdirected. This results in sliding of vertebrae especially in children or teenagers. Spondylolisthesis can be a suspect in cases with frequent low back pain, especially when the pain increases after sport or exercises and is radiating into the legs and the small of the back.

Frequently spondylolisthesis in younger patients should be controlled by an orthopedic doctor. In cases with rapid progression surgery is necessary. Basically the muscles of the front and back should be strengthened. There are special training courses available and the learned exercises have to be performed over years.