What kind of back pain requires prompt medical attention? Is sitting properly relative to the spine important?

Author: Zou Haibo, Chief Physician of China-Japan Friendship Hospital

Reviewer: Li Jun, deputy chief physician, Peking University First Hospital

With the accelerated pace of life and the extension of working hours and computer time, more and more people are suffering from waist and leg pain, especially low back pain.

1. What kind of low back pain requires seeing a doctor promptly?

First, the waist pain persists or cannot be relieved by painkillers; second, the waist pain affects work and life; third, the lower limb neurological symptoms appear, such as lower limb numbness and radiating pain. In these three cases, it is recommended to see a doctor as soon as possible to avoid delaying the disease.

Because low back pain is not simply caused by muscles or lumbar disc herniation to a certain extent, there are many other factors, such as pelvic tumors, kidney tumors, etc., which need to be eliminated one by one and a clear diagnosis is made.

2. How to detect whether it is sciatica?

The entire spine is filled with nerves, including the central nerves and peripheral nerves. The central nerves run in the spinal canal. The nerves below L1 are called the cauda equina, which is a type of peripheral nerve. The sciatic nerve that everyone talks about is mainly from L4 and L5 downwards, which is emitted by the spinal nerves and runs all the way down to the lower limbs.

The most typical symptom of lumbar disc herniation is sciatica. The simplest detection method is called the straight leg raising test, which is a very common detection method. Lie on your back with your knees straight and slowly raise your lower limbs. Normally, you can raise it to about 70°. The affected side often cannot reach 70°, which will cause pain.

Figure 1 Original copyright image, no permission to reprint

Of course, it is recommended to let a specialist perform the straight leg raising test. First, if it is not performed in a standard way, it may result in false negatives or false positives to some extent; second, if it is not performed in a standard way, it may easily cause self-injury.

An experienced spine surgeon can basically determine whether there is a herniated disc and the approximate location of the herniated disc based on the medical history and physical examination. Of course, the patient will usually undergo some imaging examinations, such as CT, MRI or X-rays. These are called auxiliary examinations, and the most basic ones are still medical history and physical examination.

3. What are the treatments for lumbar spine diseases?

For lumbar diseases, such as lumbar disc herniation and lumbar spondylolisthesis, the goal of treatment is to eliminate the symptoms.

There are two main types of treatment:

The first is conservative treatment. Conservative treatment is effective for most low back pain, leg pain, neck and shoulder pain. Conservative treatment includes changing your lifestyle appropriately. If it is caused by sitting for a long time, you can stand up and move around every 40 to 50 minutes. If it is caused by bad posture, you can change your posture. The second is physical therapy, such as some rehabilitation exercises. The hospital's physical therapy department also has some rehabilitation facilities. The third is to use some medicines appropriately. For example, if the pain is severe and affects your life, you can use some non-steroidal analgesics and plasters. These can relieve symptoms.

If conservative treatment cannot relieve the symptoms and after examination it is confirmed that it is indeed caused by lumbar disc herniation, targeted surgery can be used to solve the problem.

There are many minimally invasive methods for the surgical treatment of lumbar disc herniation, such as the earliest technology under a microscope. After the microscope, there was a discoscope. In the late 1990s, the foraminal endoscopy was gradually invented. The herniated disc can be removed by looking at the screen, and the nerve root can be well released. Therefore, the foraminal endoscopy is the most minimally invasive technology at present, with very little trauma.

Figure 2 Original copyright image, no permission to reprint

4. Why is it important to have a good sitting posture to prevent lumbar disease?

Prevention should start from daily little things, such as maintaining a good exercise condition and having a correct posture when exercising; maintaining good living habits and not sitting for long periods of time; and avoiding injuries.

In addition, sitting and standing properly are very important for the spine. The lumbar spine has a curvature, which we call physiological flexion; the cervical spine also has a curvature, which is also physiological flexion, so that the entire spine force line can be in a straight state. Bad posture and muscle spasms will reduce the physiological flexion of the lumbar and cervical spine. Over time, the intervertebral discs are prone to degeneration, which will cause a series of problems.

Therefore, a standard sitting posture is good for the spine. To some extent, the pressure on the intervertebral discs is much less than that on the bad sitting postures. For example, when you sit forward with your back bent, the pressure on the intervertebral discs is the greatest. Therefore, there is a certain theoretical basis for sitting properly.