15 March 2019 Author : Álvaro Lima In many cases it is not possible to determine a direct cause for chronic lower back pain, such as trauma or extreme exertion. However, the spine is warning us something needs to be corrected. What are the risk factors for chronic lower back pain? Typically, chronic lower back pain is the cumulative result of several risk factors: Individuals - age, professional background, obesity, smoking; Genetics - may give rise to greater fragility of the tissues; Physical - professional activities, posture, body mechanics, physical exercise; Psychosocial - stress, depression, somatisation, job satisfaction. How is chronic lower back pain diagnosed? Case studies should start with diagnostic examinations in an attempt to understand the cause and the structure responsible for the persistence of the pain. Once infection, tumour or traumatic diseases have been ruled out, complementary examinations will usually diagnose degenerative processes of the intervertebral discs and the joints between the vertebrae. In view of these changes, we must try to understand which structure is causing the pain. Injection tests and percutaneous infiltration should be performed on the discs, discography or joint areas. The discography is essentially diagnostic, making it possible to see if a particular intervertebral disc is painful and to what extent it is degenerated. Intra-articular injections, facet nerve block injections or radiofrequency facial energy lesions can: Diagnose the predominantly painful site; Alleviate complaints of pain for a longer or shorter period. Is there any treatment for chronic lower back pain? The treatment of chronic lower back pain is more complicated and can require long-term care , including: Preventive measures; Muscular rehabilitation; Medical treatment; Surgical treatment. Some cases of chronic back pain can become very incapacitating and persist in spite of medical treatment and rehabilitation. Is physiotherapy indicated in cases of chronic lower back pain? In the case of persistent acute lower back pain or in situations where the chronic back pain is worsening, physiotherapy may be indicated. In these situations, the following treatments may be indicated: Lumbar traction; Massage; Ice or heat; Ultrasound; Electrical muscle stimulation; Muscle stretching exercises. Surgical solutions Finally, if less invasive methods of treatment cannot improve the patient’s quality of life, a surgical solution may be offered. There are two surgical solutions for these situations: Insertion of a disc prosthesis; Spinal fusion. Can chronic lower back pain be prevented? In most cases, chronic back pain can be avoided by adopting: Preventive measures; Healthy living habits. The desire to maintain a healthy spine and the initiative for changing lifestyle habits are an individual responsibility . Although this desire will not prevent occasional complaints, it will certainly lead to episodes of lumbar pain becoming milder and less frequent, allowing for significant improvement in quality of life. Preventive measures To prevent chronic lower back pain , it is essential that these important preventive measures are taken: Care with posture Sitting and standing correctly, keeping the spine physiologically aligned; Avoid sitting still for prolonged periods; Avoid incorrect spinal posture for extended periods. Care with body mechanics These measures should be taken into account particularly when handling heavy loads : Always bend your legs when lifting heavy objects and avoid bending your spine; Avoid rotation of the torso. Healthy living habits Eat healthily; Keep body weight under control; Avoid smoking - tobacco exacerbates degenerative processes and interferes with muscle blood supply; Take regular physical exercise (e.g. walking, cycling, cardio fitness, swimming, hydrogymnastics or Pilates, depending on which is most suitable for you). Aerobic exercise enables you to maintain good physical condition; Specific exercises for strengthening the paravertebral muscles and relaxing joints make it possible to improve resistance to day-to-day effort and reduce the likelihood of vertebral lesions. Avoid stressful situations that increase muscle tension; compensate for these with periods of relaxation and massages. More about the neurosurgery team at Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
