WHO statistics show that 90% of people, that is, almost every one of us, experience pain in the lower back muscles at different periods of life, to varying degrees of intensity.

Only half of those who have ever had lower back pain go to the doctor to be examined and treated for the disease, perhaps this is due to the fact that the pain symptom is most often not acute, intolerable. However, the causes that provoke pain can be quite serious; if they are not identified in a timely manner, the disease can become chronic and affect not only the lumbar region, but also other parts of the body, internal organs and systems with complications.

Causes of pain in the lower back muscles

Pain is often one of the main symptoms, the leading clinical sign of the disease, which sets the direction for all diagnostic measures. However, the causes of pain in the lower back muscles are not easily recognized and determined. It is believed that the root cause of pain symptoms is mostly degenerative pathology of the spinal column – osteochondrosis; in fact, spinal diseases account for no more than 25% of the total number of factors causing pain in the lumbosacral area. Basically, this is displacement of intervertebral discs and pinching of nerve endings. The rest of the reasons consist of many different diseases, which include nephropathologies, diseases of the pelvic organs in women, muscle hypertonicity after intense training, diseases of the digestive tract, neurological conditions and many others. Actually, all organs and systems that innervate the lumbar region can cause pain in the lower back muscles.

Statistics on factors that induce lower back pain:

  • Inflammation, hypertonicity, spasm of muscles and soft tissues – 70%.
  • Degenerative diseases associated with the spine – no more than 12%.
  • Intervertebral disc herniation – 4%.
  • Spondylolisthesis (lumbosacral instability) – 4%.
  • Injuries – 1%.
  • Congenital anatomical anomalies of the spine – 1%.
  • Osteoporosis, compression fractures – 4%.
  • Spinal stenosis – 2%.
  • Tumor processes – 1%.
  • Referred pain symptom – 1%.

Pathological causes of pain in the lower back muscles:

  • Osteochondrosis, spinal deformity, both in the chest and in the lumbosacral area.
  • Myofascial syndrome.
  • Fibromyalgia.
  • Pathological changes in the abdominal organs.
  • Neuropathy.
  • Diseases of the pelvic organs.

Factors that can trigger muscle pain in the lumbar region:

  • Muscle overstrain as a result of physical activity or training.
  • Static tension of the muscles located in the lumbar area when working while sitting, standing, or bending over.
  • Exposure to constant vibration is a professional cost for drivers of agricultural and construction vehicles (tractors, combines, pavers, loaders, etc.).
  • Injury to the spine, hip joints, bruise of the lower back, tailbone.
  • Subcooling.
  • Psychogenic factors (stress, depression).

A more specific description of the etiological factors will help determine what actually hurts in the lower back – the muscles themselves or is it referred pain? The causes of muscular spinal pain in medical practice are divided into primary and secondary

  • Primary pain syndrome is morphofunctional changes in the skeletal muscles located in the lumbar region; this syndrome is also called muscle-tonic. As a rule, the cause of the syndrome is dystrophic damage to the spine:
    • Osteochondrosis, most often of the lumbosacral zone. Dystrophic, degenerative changes in the intervertebral discs lead to the development of spondylosis; this process is inevitably accompanied by lumbar pain.
    • The facet form of osteochondrosis is spondyloarthrosis, when degeneration penetrates into the intervertebral structures – facet or synovial.
  • Secondary low back pain syndrome has more diverse causes, some of them are also caused by functional disorders of the spine, but often they are not associated with it at all:
    • Fixed or non-fixed deviation of the spine, curvature in the frontal plane or scoliosis.
    • Osteoporosis, osteomalacia.
    • Non-infectious diseases of the musculoskeletal system – RA (rheumatoid arthritis), Reiter’s syndrome, ankylosing spondylitis, polymyalgia rheumatica.
    • Spinal injury – crack, fracture of a vertebra.
    • Tumor process in the spine.
    • Infectious diseases – epidural abscess, brucellosis, tuberculosis.
    • Diseases of the gastrointestinal tract.
    • Myofascial syndrome.
    • Myositis is an inflammatory process in the muscles of the lumbar zone of an infectious nature.
    • Sciatic bursitis.
    • Lower back pain during pregnancy.
    • Some variants of stroke, when an acute disorder of spinal blood flow is diagnosed.
    • Lumbago (shot).
    • Referred pain in the lower back, including in the muscles, can be caused by renal colic, gynecological diseases and some types of STDs – gonorrhea, ureaplasmosis, chlamydia, trichomoniasis.

    Summarizing the wide variety of causes that provoke muscle pain in the lumbar region, we can systematize them as follows:

    • 70-75% are the causes of pain in the lower back muscles associated with the degenerative-dystrophic process in the spine.
    • 10-15% – myofascial syndrome.
    • 10-15% diseases of the abdominal cavity and pelvic organs.
    • 5-10% neuropathy.

    How does pain in the lower back muscles manifest?

    Like other pain symptoms, symptoms of pain in the lower back muscles are divided according to the degree of intensity and the nature of the sensations:

    • Acute pain symptom. Duration from 1 day to one and a half months.
    • Subacute pain symptom. Duration from one and a half months to 3 months.
    • Chronic pain symptom. The duration of pain is more than 3 months or more.
    • Recurrent pain.

    Symptoms of pain in the lower back muscles are directly related to the disease, condition, factor that provokes the pain:

  • Lumbodynia is a disease that has many causes, most of which relate to overexertion, physical overload and hypothermia. The pain is localized in the back, in the lower back, spreading towards the thigh, along the surface of the leg. The pain appears during physical activity and intensifies with sudden movements and turns. Lumbago can recur and be provoked by hypothermia. The pain symptom is localized in the paravertebral muscles, at the very beginning it is shooting, acute in nature, then turns into aching pain, radiating to the buttock, limiting motor activity.
  • Lumboischialgia is a variant of lumbago, which is associated directly with the spine, of vertebrogenic origin. The syndrome is most often provoked by compression compression or herniation of the intervertebral disc (L5-S1 or L4-L5). It should be noted that compression pain is rare; more often the symptom indicates irritation of nearby muscles and ligaments. The pain is symmetrical, diffuse, poorly localized, felt deep in the lower back, rarely radiating below the hip. If lumboischialgia is provoked by a hernia, then the pain is felt more acutely, depends on movements, static posture, bending, and can intensify with the slightest strain (coughing, sneezing).
  • Myofascial syndrome. This complex polysymptomatic disease can provoke muscle pain on its own, but can complicate the symptoms of vertebrogenic pathologies. The nature of the pain depends on the extent of the process; most often it is aching and intensifies with movement. The pain is localized in the piriformis muscle, as well as in the gluteus medius and paravertebral muscles of the lower back. In the muscle tissue, small painful compactions are palpated, which are diagnostic criteria. Myofascial pain syndrome is observed in 80% of patients with complaints of pain in the lower back muscles.

    • There are symptoms of pain in the lower back muscles that require immediate diagnosis and medical attention, regardless of the suspected cause:

    • Severe pain in the lumbar region for 1,5-2 days, which does not subside in a horizontal position and intensifies at night.
    • Pain in the lower back muscles, radiating below the knee.
    • A painful symptom that causes numbness in one or both legs.
    • Low back pain accompanied by pelvic disorders (intestines, bladder).
    • Pain caused by a severe bruise of the lower back or injury.
    • Chronic pain in the lower back muscles, accompanied by steady weight loss.

    Diagnosis of pain in the lower back muscles

    The specificity of the diagnosis of pain in the lower back muscles lies in the subjectivity of the patient’s complaints. They are considered significant in the first place, although not a single symptom of lumbar pain can be pathognomic; moreover, quite often the examination does not reveal any serious anatomical or degenerative changes in the musculoskeletal system. Therefore, the initial stage of diagnosis is the exclusion of threatening conditions and diseases of the spine. This is followed by neurological and instrumental examinations that clarify the diagnostic direction.

    Diagnosis of pain in the lower back muscles, algorithm:

  • Exclusion of serious pathologies (red flag system):
    • Oncological process.
    • Unexplained loss of body weight.
    • Decreased immunity (possible long-term use of glucocorticosteroids).
    • Infectious diseases of the urinary system.
    • Thrombocypenia, prolonged use of anticoagulants and the possibility of retroperitoneal hematoma.
    • Osteoporosis over 50 years of age.
    • Serious injury, including falling from height.
    • Cauda equina syndrome, other neurological pathology, including those that require surgical treatment.
    • Dependence of pain symptoms on diseases of internal organs.
    • Obvious deformation of the spinal column.
  • Determining the location, nature and other parameters of pain by interviewing the patient:
    • In what position or posture of the body does the pain intensify?
    • At what time of day does the pain become most intense?
    • What position can reduce the pain symptom.
    • What body movements are associated with pain?
    • How the pain arose – spontaneously or intensified gradually.
    • The presence or absence of traumatic injury to the lower back, hypothermia, overexertion.
  • External visual inspection of the lumbar region and palpation:
    • The presence or absence of scoliosis.
    • Determination of spasmodic areas of the body – trigger points.
    • Identification of areas of muscle wasting.
  • Determination and clarification of range of motion, clarification of neurological status:
    • Tension symptom (Lassegue-Wassermann test, Neri test, planting, tilting symptom).
    • Examination to determine sensitivity, reflexes and sufficient muscle tone.
    • The presence or absence of swelling.
    • Condition of the skin of the lower back (temperature, color, humidity, etc.).
  • Instrumental types of examination:
    • X-ray of the spine.
    • CT and MRI.
    • Ultrasound of the pelvic organs in women.
    • Sigmoidoscopy according to indications.
    • Gynecological examination according to indications.
    • Gastroscopy according to indications.
    • Laboratory tests of blood and urine to differentiate possible inflammatory infectious pathologies that provoke pain in the lower back.

    Treatment of pain in the lower back muscles

    The main task that the treatment of pain in the lower back muscles solves is the relief of pain using accessible and adequate methods.

    Treatment of lower back pain – general recommendations:

    • Anesthesia.
    • Compliance with gentle bed rest, but no more than 3 days in the absence of serious pathologies of the spine.
    • Avoiding overexertion and physical activity.
    • Partial immobilization of the lower back is possible with the help of corsets and fixing belts.
    • The rehabilitation period is to strengthen the lower back muscles.
    • Prevention of relapse.

    The following groups of drugs are used as medicinal treatment methods:

    • Analgesics (drug blockade).
    • Nonsteroidal anti-inflammatory drugs.
    • Myelorelaxant.
    • Diuretics to reduce swelling.
    • Tranquilizers, antidepressants for fibromyalgia, depressive states, psychogenic factors that provoke pain.
    • Chondroprotectors.
    • Drugs that improve metabolic processes and blood microcirculation.
    • Vitamins of group B.

    Non-drug treatment of pain in the lower back muscles:

    • Vacuum therapy.
    • Compresses for myofascial syndrome.
    • Acupuncture reflexology.
    • Postisometric manual relaxation.
    • Magnetopuncture.
    • Massage.
    • Physiotherapy.

    Prevention of pain in the lower back muscles

    Preventive measures aimed at preventing relapses of lumbar pain include eliminating the root cause of the symptom, correcting the condition of the spinal column, correcting possible incorrect motor patterns, but most importantly, strengthening the muscles and creating a so-called muscle corset. In essence, prevention is the implementation of simple recommendations:

    • You need to learn to maintain physiologically correct body posture.
    • It is necessary to sit and stand correctly.
    • It is very important for people suffering from lower back pain to learn how to get up correctly from a lying position.
    • You need to learn to distribute the load on the spine when moving and lifting heavy objects.
    • It is necessary to follow a diet that includes foods rich in calcium, phosphorus, and B vitamins.
    • It is necessary to regularly strengthen the muscle corset, especially in the lumbar region.

    A little more detail about each point:

  • Walk and stand. When walking, you should monitor your posture and straighten your back to reduce the load on the lumbosacral area of ​​the spine. If a person’s job requires him to stand a lot, he should try to periodically move, change his position, and shift his body weight from one leg to the other. It is also useful to do slight bends to relieve fatigue in the muscles of the lower back and back in general.
  • If a person sits for a long time, it is also necessary to monitor his posture, keeping his back straight if possible. After 10-15 minutes, you should warm up – stretch, change the position of your legs. It is very important what a person sits on, a chair, an armchair, and so on, you need to choose a comfortable one, with a high back and a fairly soft seat.
  • Horizontal pose and getting up in the morning. The bed should be quite hard to maintain the physiological curve of the spine. A too soft bed develops a pathological deflection, “sagging” of the back. Getting up in the morning should begin with a warm-up in bed, then you can get up, turning sideways, first lowering one leg, then the other.
  • Moving heavy objects. There are certain weight standards: children under 16 years old no more than 10 kg, women – also, men can lift loads from 25 to 50 kg, but alternating with lighter work. If the work involves systematic movement of weight, you need to strengthen your lower back with a special belt or corset. In addition, when moving loads, you should not tilt your spine, but bend your knees (squat with a straight back). This is how weightlifters lift loads, keeping their back as straight as possible. You cannot carry a heavy load in one hand for a long time to avoid overloading the left or right side of the body. If you have to carry a load, you need to bring it as close to you as possible so as not to bend over and prevent rotation (twisting) of the body.

    • Experts say that pain in the lower back muscles can be prevented if you systematically strengthen your muscle corset and wisely assess your physical capabilities when playing sports or moving loads. A minimum knowledge of the structure of the spine, muscles and all the features of static and dynamic loads will also not hurt. In addition, an old, time-tested method – regular physical activity – allows you to avoid pain in the back and lower back, this is especially true in our time – the era of physical inactivity.

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