yogabook / pathologie / lumbago

Lumbago (lumbago, local lumbar syndrome)

Definition of

Acute, highly non-radicular, painful restriction of movement in the area of the spine with tension in the paravertebral musculature, presumably often due to strains or neuromuscular malreactions, which leads to persistent cramping of synergistic musculature (or weaker parts) of the musculature that is overtaxed by a movement or posture. Most common 30th-60th year M/F equally frequent. In addition to the acute form, there is also the chronic form with more or less continuous subacute to subclinical pain or complete remission; in recurrences, the pain is often (but not necessarily) less severe than in acute cases. Lumbago is not a disease in the true sense of the word, but a picture. The term is not used consistently in the literature; in some cases lumbago is used as „acute lumbalgia“, which contradicts the definition of lumbalgia as having a radicular aetiology. In addition to the lumbar spine form, there is also

1. Cervical spine form of lumbago with severe tension in the neck, neck stiffness and possibly nuchal headaches and possibly painful movement restrictions in one or both arms
2. Thoracic spine form (quite rare) with pronounced painful restriction of movement of the thoracic spine and painful restriction of breathing

In both cases, the psychological component is probably much more pronounced. The term lumbago is based on mythical ideas

ICD M54

Cause

1. Trigger: Overstraining of the muscles due to abrupt, often heavy movements, usually lifting, or prolonged bent forward posture, often in combination with cold and wet conditions

Predisposing

1. Weakness and lack of elasticity of the muscles in the lumbar spine area
2. muscular imbalances
3. Tired muscles
4. Stressful psychological factors
5. Frequent prolonged one-sided postures

Diagnosis

1. If necessary, imaging procedures to rule out non-muscular events
2. Rarely: Blood laboratory, cerebrospinal fluid puncture

Symptoms

1. Lightning-like onset of severe pain, often described as a „knife rammed into the back“; sometimes a rapid increase in tone leading to a painful spasm is also felt
2. Partial complete inability to move
3. The smallest movements in the degree range, especially slight forward bending movements with slight rotation of the spine, can trigger maximum pain
4. Reactive tension in other muscle groups
5. paravertebral myogelosis
6. Gentle posture

Therapy

For exercise therapy for lumbago, see also the recommendations in the FAQ.

1. KG
2. Chiropractic
3. Stretching exercises
4. There is no evidence for the effectiveness of muscle relaxants
5. Preventive and to prevent recurrence: Strengthening the back muscles
6. only in highly acute cases, step bed positioning if necessary
7. NO bed rest. Exercise, minimize resting posture!
8. Heat applications
9. NSAIDs if necessary, also as infiltration
10. local ointments
11. Even untreated, spontaneous healing within days or weeks, usually 90% of patients are symptom-free after 4-6 weeks, but recurrence is possible!
12. Muscle relapse prevention and movement/posture training

NHK

1. Local anesthesia with wheals

DD

1. Lumbalgia with disc hernia
2. Vertebral joint blockages
3. Muscle strains

Asana practice and movement therapy

The lumbago as a first occurrence or recurrence is likely to depend heavily on the muscular situation of the muscles in the lumbar spine, but also cranial and caudal. While the initial acute onset usually occurs with a maximum pain intensity of NRS 10 and is qualitatively compared to a knife thrust in the back, the occurrence as recurrence is not necessarily equally intense, but is often in the regions of NRS 4 to 8. It is possible that hypertonicity in the back muscles of the lumbar spine or the entire back has already been felt or would have been detectable. In most cases of acute lumbago or its occurrence as recurrence, muscular hypertonicity can be detected, for example, by rolling up the back, so that the flexibility of the lumbar spine is significantly restricted in the convex direction. These unhealthy tension conditions in the musculature tend to predispose to cramp-like overloading and neuromuscular malreactions, as is characteristic of lumbago. A lack of strength or strength endurance of the regional musculature is often a contributing factor. For example, multifidus dysfunction may play a significant role here. Recurrence prophylaxis therefore also consists of a sufficient degree of strengthening measures plus maintaining the mobility of the regional and cranial and caudal musculature so that the relevant muscle chains can work again without disruption. In chronic cases, the onset of a relapse can often be felt early on by increasing the muscle tone, so that early intervention can usually prevent a massive manifestation. Identical positions such as sitting or standing that are often held for long periods of time are unfavourable if there is a tendency to lumbago and should be regularly interrupted by a sufficient amount of movement. In acute cases with maximum pain intensity, it can regularly be seen that not only the regional musculature, but also the caudal muscles in particular, become significantly tense due to efforts to avoid pain. In addition, the affected person often exhibits asymmetrical pain avoidance behaviour. There is usually a certain degree of flexion of a small area of the lumbar spine, the exceeding of which in one direction or the other triggers the maximum pain, so that those affected endeavour to behave as completely as possible on one side or the other of the pain trigger. If the affected person remains predominantly on the extensor side of the pain trigger, a large part of the musculature in the area of the lumbar spine gains all the more tonus if they remain on the flexor side, the less favourable geometry in terms of the horizontal lever arm and a possible additional flexion of the hip joints, especially the psoas major, further exacerbate the problem care.