LUMBAR PAIN LOW OR WAIST PAIN: WHAT CAN BE?

It is estimated that 8 out of 10 people suffer at least one event of back pain throughout their life. Well established quickly and acutely (muscle-ligament distension), or produced slowly and chronic (osteoarthritis or herniated disc). Lumbar pain is caused in 97% of cases by an alteration of the vertebral machinery itself. Musculoskeletal disorders (50% of cases), and less frequent degenerative or age-related disorders, such as osteoarthritis (40%), disc herniation (4%), or stenosis of the vertebral canal (3%). Only 1% of cases of low back pain is attributable to non-mechanical causes, such as neoplasias or infection, and the remaining 2% is caused by visceral disorders (renal, pelvis, gastrointestinal or aortic aneurysms, among others) produce referred pain. Therefore, the cause of back pain in nine out of ten patients is due to an alteration in some muscle, ligament or joint. And although it is interesting to know this theoretical incidence, the practice should not be conditioned by these statistics, with anamnesis and exploration being the key way to reach the diagnosis.

01:Muscle-ligamentous low back pain

The majority of acute episodes of low back pain are due to excessive strain on some muscle or ligament. This abrupt stretching with pain is called distension and occurs when the muscle stretches beyond its physiological possibilities, maintaining its integrity but without breaking.

The muscles that we most often see associated with low back pain are the lumbar square, the iliac psoas, and the pyramidal. In contrast, the ligament most likely to be injured the iliolumbar ligament.

02:The iliacus psoas

Its function is to be the great flexor of the hip, as well as external rotator and abductor. Psoas pain is reproduced at the trigger point at the inguinal level, with pressure on the torch- writer, on the right iliac fossa (in thin patients) and with the active hip flexion counter-resistance or passive extension maneuvers The stretch).

03:The lumbar square

Its function at the unilateral level is the lumbar inclination, and bilaterally it is responsible for the extension of the lumbar spine (producing hyperlordosis if it is actively contracted together with the psoas muscle) and the decrease of the 12th rib at exhalation.

Lumbar square pain typically reproduces by turning over in bed, and by pressing on its trigger point outside the spinous processes and paravertebral musculature (approximately 4 cm outside the midline and about 2 cm Above the highest point of the iliac crest).

04:The pyramid

Its function is internal rotation when the hip is neutral, but when it is in 90 ° flexions, it is in charge of the external rotation. The pain of the pyramidal muscle reproduces when we press its trigger point or "trigger point" located deep in the center of the gluteus. Also with passive internal rotation (stretching) or with external rotation of the hip, with or without counter-resistance.

05:The iliolumbar ligament