Low Back Pain
Low back pain is an important health problem due to its high incidence.
The rate of those who have had severe back pain at least once in their lifetime is 75-85%. It is the most common reason for referral to primary care physicians in the adult population.
The waist area is the center of gravity of the body and is affected by almost all body movements. Therefore, it is a region subject to constant and repetitive strains.
Causes of Low Back Pain
Causes of low back pain can be divided into mechanical and degenerative causes, and inflammatory causes.
Mechanical and degenerative causes
They constitute approximately 95% of all back pain. Mechanical reasons; Lumbarization, sacralization, lumbar lordosis increase, disc hernias, trauma and back pain due to weak muscles.
Degenerative reasons are the aging of tissues and calcification due to other reasons.
Mechanical and degenerative low back pain; In general, pain that decreases with rest, increases with movement, often decreases with heat, increases with cold, increases or decreases depending on the position, and short-term stiffness in the morning is observed. There is no deterioration in blood tests.
Inflammatory causes of low back pain
Inflammatory involvement is expressed by the term. Inflammatory rheumatism (Ankylosing Spondylitis), causes of infection (Brucella, tuberculosis), cancer-related involvement are among the inflammatory causes.
Pain increases with rest in back pain due to inflammatory reasons. Pain increases at night and decreases when you get out of bed and move. Pain increases with heat applications. There are impairments in the tests (such as sedimentation, CRP) in blood tests that show inflammation.
How to Treat Low Back Pain
Medication and rest
In degenerative and mechanical low back pain, it may be necessary to use anti-inflammatory drugs and cortisone in the acute period. Simple pain relievers may be sufficient in the chronic period. A few days of full bed rest is sufficient for acute (newly started) low back pain. After resting, the patient should gradually move to normal daily movements over time.
Exercise and Physical Therapy
Strengthening the muscles and maintaining a certain degree of flexibility is extremely important in meeting the loads transferred to our lumbar vertebrae. Providing these requires some exercises. What should not be forgotten in this regard is that all kinds of exercises may not be suitable for every patient. The type of the exercises will change depending on whether the disease is acute or chronic, the form of the disease, the physical and social needs and age of the patient. In other words, exercises should be determined according to the patient. Exercises should be given to the patient by his physician.
Various physical therapy applications (superficial heaters, deep heaters, analgesic currents, traction methods) can be applied to patients with low back pain. The effects of these applications are used to relieve pain, relax muscles, regenerate tissue and accelerate the repair process. The form and duration of physical therapy applications should be prescribed according to the characteristics of the patient and the disease.
Is Surgery Necessary in Low Back Pain?
Surgical treatment in patients with low back pain is a necessary treatment method in cases where multiple nerve roots are affected at the same time and the nerves leading to the bladder are affected and in cases with known cauda equina syndrome in medicine, there is progressive loss of strength in the foot or leg. The situation should be evaluated very well in operations performed only to relieve pain.
Various complementary medicine treatment methods can also be used to get relief from low back pain. These; acupuncture, spinal manipulation, meso, prolotherapy and ozone.
Rules to Be Applied for The Protection of Low Back Pain
- patient should not stay in the same position for a long time. The sitting and standing time should not exceed 45 minutes.
- When sitting, a pillow supporting the waist should be used.
- Care should be taken to crouch down and do the work on the ground.
- The waist area should be protected from sweaty and cold
- Orthopedic mattress should be used for sleeping.
- The most appropriate position is to bend forward in the lateral position, pull the legs towards the abdomen and lie down.
Neck pain is a very common health problem and can be seen in people of all sex and age. Although neck pain is less common than waist pain, neck pain is seen in one third of the population. Most of them recover spontaneously in a short time and mildly. Rarely, it may be very painful or even severe enough to cause disability.
Neck pain can also spread to the back of the head, shoulder circumference, arm and front of the chest. Along with neck pain, numbness in the arm and hand, dizziness, instability and headache can be seen.
The incidence of neck pain increases with age. Tensions in daily life and work stress increase neck pain. It has been found that there is a relationship between neck pain and the patient’s work. Pain is more in those who work at work. Working in a fixed position for a long time (desk workers, assembly workers, musicians) also increases neck pain.
A specific cause cannot be found in most of the acute neck pains, but 95% of them are due to mechanical reasons.
Causes of neck pain;
1- Depends on bone structures
- Congenital: Torticollis, Klippel-Feil syndrome
- Traumatic: Fractures, slips, hernias
- Calcifications, channel stenosis
- Rheumatic: Ankylosing spondylitis, rheumatoid arthritis, polymyositis, polymyalgia rheumatica
2- Depending on soft tissues
- Posture disorders
- Fibromyalgia and myofascial pain syndrome
- Nerve and vascular problems
3- Reflected pains
4- Endocrinological and metabolic
- Parathyroid disease
- Paget’s disease
How are neck pains classified according to duration?
1- Acute: Lasts less than 1 month.
2- Subacute: Lasts 1-3 months.
3- Chronic: Lasts longer than 3 months.
What are the diagnostic methods in neck pain?
- The probability of detecting the cause of neck pain does not exceed 20% in 20-50 years of age and 12-15% in all ages. Therefore, ancillary examination methods are not required during the first evaluation in most of the cases.
- Laboratory examinations should be made for infections, rheumatic problems, cancers, and common diseases of the bone.
- EMG and nerve conduction studies
- It is mostly performed in cases with neck pain in the possibility of nerve root compression. It shows which nerve root is pressurized and its severity, and it distinguishes muscle and nervous system diseases.
- Display methods
- It should not be forgotten that in patients with neck pain, none of the more advanced diagnostic examinations such as radiography, CT, MRI, EMG or bone scintigraphy can replace history and physical examination, and treatment should be planned according to the patients’ complaints rather than the results of this examination.
In what situations should imaging examinations be performed?
- Advanced age
- Recent trauma
- Prolonged cortisone use
- The presence of cancer
- Presence of infection
- Having a fever
- 10% weight loss within 6 months
- Presence of persistent pain
- Neurological symptoms
What are the treatment principles in neck pain?
In the treatment, first of all, in order to relieve the patient, a way is followed such as relieving pain and reducing spasm, taking measures to prevent recurrence and correcting biomechanics to break the vicious cycle of pain-spasm-pain. The main methods used in treatment are:
Bed rest and neck collar
The patient must first be informed about the possible causes of his pain and educated about his disease. It has been determined that 2-3 days of rest is sufficient in acute pain and 7 days of rest in radicular pain, and resting for more than 1 week leads to loss of motion in joints, soft tissue shortening, and a decrease in muscle strength and cardiovascular condition. Therefore, activity arrangements should be made instead of bed rest in acute neck pain.
The use of the collar should be used for a short time in acute neck pain that is not caused by trauma and should not exceed 1.5 months. Exercises should definitely be done, as strength and volume loss may occur in the neck muscles during long-term use.
What are the goals of drug therapy?
- Reduce pain
- Increasing physical function and movement
- Restoring sleep patterns that are disturbed by pain and other complaints
- To improve social life that is impaired due to pain and discomfort
- To prevent job losses caused by pain and physical inadequacy
- Combating anxiety, tension and depression due to pain
- Pain medications, muscle relaxants, antidepressants, corticosteroids, and antiepileptics can be used in neck pain according to the patient’s condition and the patient.
Physical Therapy applications
Physical therapy sessions and exercise programs, which occupy the most important place in treatment, have been used for many years because they reduce complaints and can be applied safely.
In physical therapy, currents to reduce pain such as hot application, TENS or interference, ultrasound, laser, hiltherapy, traction, cupping therapy, massage, taping, dry needling, trigger point injections, mobilization and manipulation applications can be performed.
What are the main purposes of exercise in neck pain?
- Providing painless and full range of motion of neck and shoulder movements
- Providing full strength, endurance and balance of the muscles
- Prevention of loss of physical function
- Protection from repetition
- Providing physical adaptation
- Facilitating the return of chronic neck pain patients to a more productive life and increasing the quality of life
Exercises in the acute period are aimed at reducing pain and protecting the damaged structures from further damage. In the subacute period, it aims to restore the functions of damaged and supporting structures. In the chronic phase, it aims to eliminate psychological problems in recovery and decrease in physical function.
Joint range of motion, stretching, strengthening, posture, coordination and aerobic conditioning exercises are beneficial in neck pain.
A reduction in pain threshold and muscle spasm and an increase in quality of life are achieved with spa treatment.
Is surgical treatment necessary?
Surgical treatment (surgery) is required for the following problems related to the neck.
- Having a cervical hernia compressing the spinal cord with progressive loss of muscle strength, sensation and reflex
- Tumor or abscess in the spine
- Symptoms lasting longer than 3 months despite treatment, being unbearable and impairing quality of life
- Spinal fracture and severe spinal displacement
- In the presence of serious neurological problems due to compression in the spinal cord
Useful tips for people with neck pain
- Never lift, pull or push heavy objects. Divide the loads you will be carrying equally on both hands.
- Do not carry a load with your head. Do not lift loads above head level.
- Never lift, pull or push heavy objects. Divide the loads you will be carrying equally on both hands.
- Do not keep your neck constantly tilted forward or in the same position.
- Do not pinch the phone between the neck and shoulder while talking.
- While sitting, keep your back straight and lean.
- If necessary, reinforce your neck with a neck pillow that fits your neck curve.
- Do not fall asleep with your neck falling apart from the bed.
- Do not use excessively high pillows.
- Organize your working conditions and conditions well.
- Change positions every 30 minutes, especially at the computer and desk.