Low back pain is a common problem that can have multiple triggers.

Approximately 50% of low back pain cases are due to contractures or degenerative alterations of the lumbar spine, and generally resolve within a period of 7 to 10 days. This form of low back pain that lasts at least 6 weeks is known as acute low back pain.

When pain persists between 6 and 12 weeks, it is classified as subacute low back pain, and if it extends beyond 12 weeks, it is considered low back pain chronicle. In these cases, a detailed examination and additional testing is required to identify the underlying cause of the condition.

Low back pain or lower back pain can have triggers in various anatomical structures of the lumbar region of the spine: intervertebral discs, vertebrae, ligaments, muscles, facet joints, sacroiliac joints, etc.

To understand in more detail the origin of low back pain, we classify these into mechanical (90%) and non-mechanical (10%).

The Lumbago Mechanical originates from musculoskeletal dysfunctions in the lumbosacral spine, which generates structural/functional alterations:

• Traumatic or pathological vertebral fractures (osteoporosis or metastasis)
• Herniated discs
• Deep gluteal space syndrome (pyramidal syndrome)
• Segmental instability (spondyloarthrosis)
• Canal stenosis / Foraminal stenosis
• Spondylolysis / Spondylolisthesis
• Scoliosis

The non-mechanical low back pain It is significantly less common and can have various causes unrelated to structural dysfunctions. These causes may include:

• Inflammatory diseases: sacroiliitis, rheumatoid arthritis, psoriasis, ankylosing spondylitis or Crohn's disease.
• Infectious Spondylitis: ankylosing spondylitis, spondylodiscitis, tuberculosis and osteomyelitis.
• Tumors: primary bone tumors, metastases, retroperitoneal tumors and myeloma.
• Visceral: gastrointestinal, renal or gynecological referred pain.
• Bone diseases: Paget's disease and osteomalacia.
• Neuropathic pain: fibromyalgia and diabetic neuropathy.
• Circulatory disorders: aortic aneurysm and vasculitis.

He main symptom of low back pain is pain. When this pain in the lumbar region is of mechanical origin, it is characterized by increasing with physical activity and being relieved with rest, analgesic-anti-inflammatory treatment and progressive increase in activity. In general, it does not interfere with nighttime sleep, although in some cases, it can make it difficult to get complete sleep comfort.

In the case of 10% of non-mechanical lumbago, it is common to experience morning pain and a clear sleep disorder.

Rest is generally insufficient for the patient's improvement, and the diagnosis is crucial for adequate treatment of the injury.

• In the medical history, personal history and ongoing pathologies are investigated. Likewise, the causes of pain (mechanical or inflammatory) are identified, discriminating between low back pain and lumbosciatica, and contrasting different variables such as the evolution of pain.
• During the physical examination, the patient is evaluated. The type of gait, the postural attitude and the functional limitations in the examination positions are determining factors in the diagnosis. During the examination, active mobility is assessed in all planes (finger-floor distance, Schöber test, lateralizations and rotations), and possible root, hip and sacroiliac joint involvement is evaluated, and whether it should be performed. root elongation tests (Lasègue, Bragard, toe and heel walking) and explore strength alterations, atrophies or alterations in reflexes.

• radiological study: It is an essential test that should be the first one performed on the patient.
• Magnetic resonance: It is the best test to identify injuries found in soft tissues. It is fundamental in the sciatica diagnosis, suspicion of malignancy, infection or neurological deficit.
• CT scan: This is a very useful test in the structural bone assessment of the vertebra and the result can help us identify spinal stenosis or vertebral malformations.
• GGO complementary test: To diagnose tumors, inflammation or infections, the complementary GGO test is used.
• Electromyograms / electroneurograms- Neurophysiology studies (electromyograms / electroneurograms) are useful to evaluate Neuromyopathic alterations contributing to lumbosciatica pain.

He low back pain treatment It can be conservative or surgical. The choice between both approaches is based on the nature of the underlying condition causing the low back pain or sciatica, as well as the intensity and duration of the pain. The Surgery is mainly performed for cases of sciatica or lumbar hernia.

In most cases, the initial treatment of low back pain includes the use of analgesics, anti-inflammatories and muscle relaxants, supported by active physical rehabilitation therapy.

The importance of avoiding bed rest and passive maneuvers is emphasized, as well as correcting bad postural habits, maintaining an adequate body weight, and quitting smoking. Furthermore, maintaining effective muscle tone in the dorso-lumbar and abdominal region plays a crucial role in preventing and reducing relapses.

The therapeutic approach may vary depending on the intensity and duration of the process, as well as the response to conservative treatment. In some cases, when conservative treatment is insufficient or frequent relapses occur, the option of surgical intervention could be considered.

It is important to note that certain physical activities can be beneficial for people who suffer from low back pain. Regular exercise such as walking, swimming, and yoga can help relieve symptoms. It is advisable to go to our traumatologists specializing in low back pain in Madrid to treat the pathology in a particular and personalized way, as well as agree on a series of exercises at home for low back pain, or use of lumbar belts.

Before considering surgery, patients usually go to a physiotherapist treating lumbar compression. If this conservative treatment does not work, lumbar decompression surgery is used, which is quick and with minimal risks.

Lumbar decompression is used to treat neural impingement, which is a common cause of pain in the lower back. This procedure involves removing a portion of bone that puts pressure on the nerve root, thus creating space and relieving pressure. Among the lumbar decompression options, you can consider microdiscectomy and lumbar laminectomy as effective alternatives.

Lumbar fusion surgery is a highly effective approach in treating lower back pain. It is usually applied in patients suffering from spondylolisthesis or degenerative processes of the lumbar disc. This technique is known as lumbar arthrodesis and has proven to be a successful procedure for stabilizing and relieving pain in the lumbar region.

During a lumbar fusion operation, the surgeon accesses the spine through an incision in the lower back. Next, the damaged parts of the intervertebral disc are removed, and the adjacent bone surfaces are prepared for fusion. The next step involves inserting bone grafts between the affected vertebrae. These grafts encourage the formation of new bone mass and promote the union of the vertebrae.

In some cases devices such as plates or screws may be used to provide additional support and stability to the spine while the fusion occurs. The surgery is completed with closure of the incision. Throughout the recovery time, The bones gradually fuse, creating a more stable spine and relieving pain in the lower back. It is important to note that the lumbar fusion operation must be performed by a medical team specialized in the spine to guarantee optimal results and minimize complications.

Low back pain pain is often debilitating and has a significant impact on people's quality of life. Fortunately, many of the causes that cause it are preventable. Strategies to prevent this injury include:

• Maintain good posture: Proper posture is essential to prevent low back pain. When walking, standing or sitting, it is important to keep your back straight and shoulders down.
• Strengthen core muscles: The core muscles, which include the abdominals and lower back, play a crucial role in the stability of the spine. Performing strengthening exercises, such as sit-ups and back exercises, can help prevent low back pain.
• keep a healthy weight: Excess weight can increase the load on the lumbar spine and increase the risk of low back pain.
• Avoid excessive loading- When lifting heavy objects, it is important to use proper lifting techniques.
• Rest and stretching exercises- Adequate rest is essential to maintaining back health. Regular stretching to maintain flexibility of the muscles and joints in your back.
• ergonomic furniture: It is important to use, both at work and at home, ergonomic furniture that supports good posture.
• Avoid sedentary lifestyle: Sedentary lifestyle can increase the risk of low back pain.

It is crucial that, if symptoms occur, medical attention is sought as soon as possible to prevent the condition from worsening.