LOW BACK PAIN (LUMBAGO)

According to the Merriam-Webster Dictionary, lumbago is “acute or chronic pain (as that caused by muscle strain) in the lower back.” Mosby’s medical dictionary adds that it may be due to “rheumatoid arthritis, osteoarthritis, or a herniated intervertebral disk.” Other sources would add inflammation of the spinal nerve root or the sciatic nerve, as well as inflammation-induced changes in spinal joints, ligaments, and muscles.

In any event, this is a dreadful condition. A sudden acute pain does not let you straighten up or turn around. It can last for hours, days, and even weeks. It can seize you at any moment ("I just picked up the child, and ...", "I was just sitting in the car, and then, all of a sudden ..." "I just bent to brush my teeth, and could not straighten up again ... "

This experience is familiar to anyone who handles heavy objects, like movers or van drivers, as well as those unfortunate guys who are into cleaning snow on their lawns or moving heavy furniture without help. What is behind this agonizing pain? Let’s try to sort it out. One of the reasons is the loss of integrity of an intervertebral disk and its protrusion towards the spinal cord and nerve roots, or, in other words, disk herniation.

Breaking the blockade

Lumbago means that the expelled gelatinous content of the herniated disk irritates nerve endings and causes acute pain in the lower back, as well as in the buttocks, hips, knees, and ankles.

The expelled gelatinous content of the herniated disk irritates nerve endings and causes acute pain in the lower back, as well as in the buttocks, hips, knees, and ankles. Such loss of disk integrity is dangerous. It can badly impair the functions of the nerves that control lower limb movements, the gut, and the bladder. That’s why many doctors send lumbago patients to get an MRI (magnetic resonance imaging). As opposed to X-ray imaging, MRI provides a layer-by-layer picture of the spine and visualizes soft tissue (muscles, disks, and ligaments) as well as the bones. Does every lumbago sufferer need it? Not necessarily. MRI is needed only if a disk fracture is suspected after lifting a heavy object or if a major trauma has impacted the sensitivity and movement of the limbs.

Inflexibility is a typical quality of radiculitis sufferers.

A popular joke

What should the others do? What could cause a strong pain in the absence of a herniation? Most often, like in the case of a knee or ankle trauma, it may be a sprained muscle or ligament, a muscle spasm, edema, and/or inflammation. There are no disks in the legs, but the dull or piercing pain can afflict them too, making it impossible to rest on your leg or move it. The vertebrae are also surrounded by muscles that are easily traumatized, suffer spasms, inflammation, and edema.

Rest and the cold

People often apply heat to the painful spot, but this only enhances edema and leads to stronger pain.

What is the best home remedy against lumbago? Some people believe that lower back pain results from cold temperatures, and the best way to cope is to apply something warm to the painful spot. In my practice, I met numerous patients who were literally “twisted” after such treatment. The reason is simple: inflammation increases the permeability of blood vessels and leads to edema. This is a normal defense reaction to immobilize the injured area and prevent hemorrhage. Our smart body knows how to fix itself and feel better. On the other hand, strong edema increases pressure on the tissues, irritates nerve endings, and causes more pain. What happens if you warm the swollen area, thereby increasing the blood supply? You enhance edema, intensify the pain, and cause further spasms, so your lower back eventually becomes crooked and twisted.

Edema is meant to immobilize, so Rule No. 1 is to help your body move less.

The best approach is to assist your body in its efforts. Since swelling (edema) is meant to immobilize, Rule No. 1 is to wear a tight elastic bandage available at any good drugstore. Switch to “robotic” movements: turn the whole body at once, raise and sit down with some help from your hands, and adjust your workplace as much as you can for maximum convenience. Take the best care of your back. You’ll be surprised how fast your body will give you a grateful response.

Rule No. 2: An ice pack or a cold pack brings instant relief.

Now, for Rule No. 2. Since heat is harmful, why not use cold? Precisely. An ice pack or a cold pack, properly applied, brings instant relief. Even better, 10-15-minute ice massages every two or three hours greatly reduce edema, improve the tone of the blood vessels, and soothe inflammation. Incidentally, the ubiquitous Ibuprofen (or similar drugs) is a good remedy against inflammation, edema, and pain, if taken in the right dosage. Note that it is not just a painkiller that “cheats” your body, but a real help against the processes causing lower back pain.

Relaxing the spasms

Staying in bed for a long time can cause muscle atrophy, a condition where muscle fibers become thinner and shorter.

Finally, the main source of pain is muscle spasm, the one that gives you the sensation of pinching, jamming, and immobility. Like edema, spasms are a defensive response of the body meant to immobilize the suffering area. However, this works only within reason: a strong spasm becomes a source of further inflammation and pain. This is where we must help the body by using a bit of force. The reason is simple: once the body gets used to staying in bed, it will remain in this condition for a long time. And a complete absence of movement gives the green light to unfettered muscle spasms that may become critically deep and almost impossible to relax.

Here’s a problem. Complete immobility is bad; movement is dangerous. Who can help eliminate the spasm without aggravating the inflammation? Who knows how to reach those hidden triggers that would undo the knots of your spasmed muscle fibers?

A good manual therapist can relax muscle spasms without aggravating inflammation.

The answer is right at your fingertips. A manual therapist has an equally good knowledge of clinical medicine, with its diagnostic methods and pharmaceutical remedies, as well as of all kinds of manipulation, such as neuromuscular massage, chiropractic, and osteopathy. Unfortunately, in America, where I work, this medical profession hardly exists. Chiropractors are not licensed to use medication and make injections. Massage therapists are not doctors, though they usually have an adequate knowledge of the health sciences. Osteopaths are recognized as doctors, but they rarely use manual techniques for fear of being taken for massage therapists or chiropractors.

This was one of the main reasons I set up a rehabilitation center in Chicago, where we successfully treat lumbago and other painful conditions using the tools of classical as well as traditional medicine.

A combination of drugs and manual treatment can indeed cure even the most complicated cases of lumbago.

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