LWS syndrome

Synonyms in the broader sense

  • lumbar spine syndrome
  • lumbago
  • chronic back pain
  • chronic lumbar spine complaints
  • Lumbar pain syndrome

English: low back pain

introduction

This article is written mainly from physiotherapeutic / physiotherapeutic point of view.

The term lumbar spine syndrome does not describe an independent, attributable to certain anatomical or morphological conditions disease, but is a collective description (syndrome) for various symptoms (symptoms). The hallmark of lumbar spine syndrome is local lumbar back pain.

The majority of adults have already had experience with the topic of "back pain". Almost every person will get back pain at least once in their lives. Hardly any other orthopedic complaint has seen such a rapid increase in recent years as the number of patients with back pain in need of therapy. Pain in the region of the lumbar spine (LWS) can be roughly divided into two major areas:

  • acute and
  • Divide chronic back pain.

Figure lumbar spine syndrome

Figure lumbar spine syndrome (female back)
  1. Wide back muscle -
    M. latissimus dorsi
  2. Twelfth thoracic vertebra -
    Vertebra thoracica XII
  3. First lumbar vertebra -
    Vertebra lumbalis I
  4. Wide back muscle -
    M. latissimus dorsi
  5. Iliac crest -
    Crista iliaca
  6. Fifth lumbar vertebra -
    Vertebra lumbalis V
  7. Middle gluteal muscle -
    M. gluteus medius
  8. Big buttock muscle -
    M. gluteus maximus
  9. Sciatic nerve -
    Sciatic nerve
  10. Iliac scoop -
    Ala ossis ilii
  11. Lumbar-sacral nerve plexus -
    Lumbosacral plexus
  12. Coccyx -
    Os coccygis
  13. Thigh shaft -
    Corpus femoris
    A - pancreas
    B - uterus
    C - bladder
    D - sciatic nerve

Causes of a lumbar spine syndrome

The causes of a lumbar spine syndrome are numerous. The most common cause of lumbar spine pain is degenerative changes of the lumbar spine.
These include, in particular, spinal disc bulges of the lumbar spine ( protrusion ) and herniated discs of the lumbar spine ( prolapse ), which can lead to nerve pain in the back, as well as arthritic changes of vertebral bodies and vertebral joints, such as, for example, an osteochondrosis.
Spinal stenosis of the lumbar vertebra (spinal stenosis) and spondylolisthesis (spondylolisthesis) may also be caused by spinal cord wear and cause lumbar spine syndrome. Muscle tension and malalignment of the back due to weakness of the back muscles are also common causes of lumbar spine syndrome.

osteoporosis

Another major cause of discomfort associated with lumbar spine syndrome is spinal injuries, such as vertebral fractures. Vertebral fractures can be caused by trauma to the spine (for example, in a car accident), but more common are so-called osteoporotic vertebral fractures, that is, vertebral fractures resulting from osteoporosis. In osteoporosis, which can also be referred to as bone loss, there is a degradation of bone material and thus a decrease in bone density and strength of the bone, which can lead to fractures, including on the spine.

Rarer is another disease, osteomalacia, which leads to a mineralization disorder of the bones, reason for vertebral fractures.

Another important cause of lumbar spine syndrome is the group of inflammatory diseases of the back, which may be of rheumatic and infectious origin. Inflammatory diseases of the back of rheumatic genesis include Bekhterev's disease, reactive arthritis (for example, Reiter syndrome), enteropathic spondylarthritis (arthritis associated with inflammatory bowel disease such as Crohn's disease or ulcerative colitis), psoriatic spondylarthritis ( psoriasis-associated arthritis) and the undifferentiated arthritis commonly found in children and adolescents.

In very rare cases tumors of the vertebrae in the lumbar spine or congenital malformations of the lumbar spine, such as scoliosis (vertebral body curvature), are the cause of lumbar spine syndrome.

symptoms

Lumbar spine syndrome (LWS) syndrome is a collection of various lumbar spine disorders.
These symptoms either affect the region of the lumbar spine itself or are from this region and can radiate to the coccyx.
Symptoms in this area are more common than in other areas of the spine, since the lumbar spine is exposed to special stress.

The affected patients often describe that the pain has occurred suddenly and depends on the strength in which position they are currently.
Certain behavior of the patient may make the pain stronger or weaker, for example when walking or sitting.
Additionally, the intensity of the symptoms may be:

  • to cough
  • Sneeze
    or
  • Press

be strengthened.
The pain itself is often described as dull pain, more rarely as stabbing pain.
The most common cause of this sudden, piercing pain is a lumbago, often caused by a previous lumbar spine malfunction, which then suddenly hurts severely during a particular movement. Most often it comes to a lumbago in jerky movements, heavy lifting or bending over.

If the symptoms begin rather creeping, this indicates an increased wear (degeneration) of the lumbar spine.
Here, vertebral joints, ligaments and muscle can be equally affected.
Other causes, such as inflammation, tumors or malformations, are more rarely found as the cause of the lumbar spine syndrome (lumbar spine syndrome).
In addition, although the pain may be localized in the lumbar region, it may originate from the internal organs (eg, uterus, pancreas, or bladder).
This is also rather rare, but requires a more detailed investigation in order to detect malignant neoplasms (carcinomas) early.

The symptoms of lumbar spine syndrome are mostly located in the lumbar spine itself, but may also be located above or below the lumbar spine. The symptoms rarely radiate into the extremities (legs). If the pain nevertheless radiates into the extremities, the sciatic nerve (sciatic nerve) is also frequently affected.
This subgroup of the lumbar spine syndrome is referred to as doctors with lumbosacral or lumbar root syndrome.

Radiate the symptoms in the legs as described above and in addition symptoms such as:

  • deafness
  • tingle
    or
  • paralysis

observed, a doctor should urgently be consulted.
If, in addition or in isolation, there are bladder and bowel movements, this is particularly alarming and should therefore be clarified in an emergency.
These symptoms are often associated with an acute herniated disc, so that an operative intervention is necessary to relieve the nerves in the spinal cord again.

In addition to the back pain, it can also lead to increased sweating at night. Not infrequently, the patients sweat so much that a change of bed linen is inevitable.

If there are also fever episodes in addition to the back pain, then an inflammatory disease of the lumbar spine (eg a spondylodiscitis) must be clarified directly. This is a medical emergency.

Pain

Pain in the lumbar spine syndrome manifests as back pain in the lumbar region (lumbar spine), which can radiate into the coccyx, in the legs and even into the feet. Pain in the context of a lumbar spine syndrome is of drawing, stinging or dull-pressing character of varying intensity and characterized by a sudden, sudden appearance. It can lead to a chronic pain, that is, the pain can persist over a longer period.

In addition to the pain, the lumbar spine syndrome can lead to other complaints such as sensory disturbances, such as numbness, ants or tingling, as well as to a reduction in leg strength.

Pain in the context of a lumbar spine syndrome should necessarily be treated, otherwise it can lead to a prevention of movement and in the long term to a malposition of the back. Most commonly used to alleviate the pain of the lumbar spine syndrome are non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or naproxen. In cases of intolerance or contraindications to NSAIDs, paracetamol may also be used as an alternative, which also has an anti-pain mechanism via a mechanism other than NSAIDs. If the pain in the lumbar spine syndrome does not respond to the aforementioned medications, stronger analgesics such as morphine or tramadol must be used.

Pain localization of the lumbar spine syndrome

When patients complain of back pain, commonly referred to are lumbar spine disorders.
Alternatively, in a lumbar spine syndrome, the term spinal or back problems is used.
As a rule, the pain is perceived as dull or tugging. In parts, this pain can radiate into the legs. This form of back pain is also called lumboischialgie.

Acute lumbar spine syndrome

Acute complaints in lumbar spine syndrome:

A large proportion of these complaints results from a herniated disc of the lumbar spine (prolapse). In fact, most disc herniations are found in the lumbar region (LWS).

While disc herniations of the cervical spine (cervical spine) are still quite common, they are very rare in the area of ​​the thoracic spine (thoracic spine).

Many patients with sudden (acute) back pain are primarily concerned that a lumbar disc herniation could be the cause of their discomfort. The disease is widely "known" and is classified as serious and dangerous - not entirely wrong.
Little is known about other diseases that can lead to an acute lumbar spine syndrome or a so-called "lumbago". At most, the concept of "blockage of the lumbar spine" in the wider sense for the presence of a lumbar spine syndrome is still known. The patients understand this usually an acute back pain, which leads to a limited physical flexibility and resilience.

Characteristic signs of lumbar disc herniation are:

  • A sharp back pain (lumboischialgie) pulling in the leg, which often radiates up to the foot. In most cases, however, a lumboischialgie is based on a more harmless cause.
  • Pain enhancement by sneezing, coughing or pressing.
  • The pain in the leg outweigh the back pain.
  • There are abnormal sensations (paraesthesia, eg tingling, running of ants) or minor sensations (hypoaesthesia, eg "as if the foot were packed in cotton wool") in the area of ​​the legs.
  • There are paralysis or loss of strength of certain muscle groups (difficult toe or heel).
  • Loss of control for urination or defecation (incontinence).

In any case, a doctor (orthopedist) should be consulted for uncertainties regarding the cause of the disease.

  • Herniated disc of the lumbar spine
    • Symptoms of lumbar disc herniation
  • Tingling as a sign of a herniated disc
  • L5 syndrome

Chronic lumbar spine syndrome

Chronic complaints in lumbar spine syndrome

This topic includes diseases such as:

  • Osteochondrosis = common disease of intervertebral disc and vertebral body in the context of wear-related (degenerative) changes.
  • Spondylarthrosis = arthritis of the vertebral joints (facet syndrome)
  • Small herniated disc (herniated disc of the lumbar spine)
  • Lumbar disc protrusion of the lumbar spine
  • Spinal canal stenosis = wear-related vortices
  • Spondylolisthesis / spondylolysis = vertebral gliding
  • Scoliosis = spinal column curvature
  • Muscular insufficiencies = weakness of the back muscles
  • Chronic Muscle Harness = Painful muscle hardening / cramping
  • Osteoporosis = bone loss
  • Vertebral Fracture = Most osteoporotic vertebral fracture
  • Etc.

Most of these diseases can be summarized under the name degenerative spinal disease.

The above-mentioned clinical pictures can occur in combination with each other or as a single disease. Especially with severe, wear-related spinal changes, the differentiation of the cause of pain is very difficult. For detailed information on individual diseases please follow the link.

The application of physiotherapeutic and physical therapies is very successful in the treatment of lumbar spine syndrome and is routinely used, at least in hospitals.

diagnosis

Since the lumbar spine syndrome does not itself describe any illness of its own, the possibilities for diagnosis are also very different.
LWS syndrome is the local pain in the lumbar spine, which can have a variety of causes.
Due to the specific history of the pain, the possibility of the causes can be limited many times over. Here, the doctor asks exactly the place, the duration and type of pain but also whether the pain changes in different situations.

If the pain is dependent on the movement and causes a restriction of movement, the most obvious cause is a muscle tension in the lower back. The question of the profession and everyday life can be further evidence. Even a physical examination reveals bad postures, which often indicate a long-standing problem. These include hollow crosses or lateral curvatures of the spine.

If the problem is muscular, this can also be determined by pressing the back muscles. These are hardened in the case and pressure sensitive.

If the patient mentions a specific event, such as an accident, as the cause of his pain, muscular problems are less likely to occur.
If involvement of the spinal nerves is close to a neurological examination or if the accident occurred during deep stooping or heavy lifting, apparatus diagnostics should be used.
These include X-ray, CT and MRI of the lumbar spine images. There is a suspected diagnosis of disc prolapse or lumbar disc herniation.

In severe cases, with the involvement of nerves, acute paralysis may occur. The diagnosis must be secured quickly, with the MRI being the first choice. An X-ray image mainly shows bony structures well, whereas MRI can detail especially soft tissue.

On the image of the MRI, the doctor can then assess what the shape and the damage to the intervertebral disc is and in which direction the damage can spread. Based on this assessment of the very detailed picture compared to the other diagnostic options, the physician can plan a targeted therapy. Even in the rare case of a tumor that causes back pain, the diagnosis can be made by an MRI image.

In very rare cases, borreliosis or herpes infections can cause similar pain.
If nothing can be seen on the MRI image, such pathogens can be detected by a blood test.

LWS syndrome or facet syndrome

The so-called facet syndrome is a degenerative disease of the facet joints. These form together with the intervertebral discs the connection of adjacent vertebral bodies. Characteristic of the pain that occurs in a facet syndrome, an exacerbation of pain after exercise or when bending back of the upper body. Often the pain radiates down to the legs.

In contrast, lumbar spine syndrome often causes numbness or altered sensation in the legs.

ICD 10

ICD is the abbreviation for International Statistical Classification of Diseases and Related Health Problems. This is an international statistical classification for diseases and health problems. The current version is the ICD-10, whereby in Germany the ICD-10-GM (stands for "German Modulation"), ie a version specially adapted to Germany, is valid.

Each clinical picture has its own code, ie an encryption consisting of letters and numbers. Back pain generally starts with M54. The numbers that come after that indicate exactly how the back pain is classified. In the case of LWS syndrome, the encryption is M54.1.

GdB

The GdB (degree of disability) depends on the patient's limitation. A careful examination and subsequent assessment by an orthopedic surgeon or accident surgeon must be performed.

If there is no movement restriction or instability of the spine, this corresponds to a GdB of 0. With slight restrictions due to recurrent short spinal symptoms, this corresponds to 10, in the case of frequently recurring problems lasting several days 20. If 2 spinal segments are affected, this corresponds to a GdB of 30 to 40, with stiffening of large parts of the spine 50 to 70. The values ​​80 to 100 are reached with the heaviest load problems up to standing still.

Therapy of a lumbar spine syndrome

Because the lumbar spine syndrome is a collection of various disorders of the lumbar spine, a different approach must be taken depending on the origin of the pain. Therefore, it is particularly important that a detailed history (collection of medical history) is collected so that the cause of pain can be limited as best as possible.

The most frequent cause of the acute, suddenly occurring LWS syndrome is the herniated disc (prolapse of the lumbar spine).

When the lumbar disc herniation, the displaced disc pushes on nerves in the spine, so that it can cause pain and paralysis, which often radiate into the legs.

When the herniated disc has appeared fresh, the first goal of the therapy is to reduce the patient's pain. Already in this phase, the pain of the patient can be actively alleviated by certain physiotherapeutic storage maneuvers, for example, by the step storage. For more severe pain, an MRI scan of the lumbar spine of the back should be made to see where and how much the disc is pressing on the nerves.

Is this through conservative therapy like:

  • protection
  • acupuncture
    or
  • physical therapy

not to treat, so must be thought about a surgery of the herniated disc of the lumbar spine as a way out.

Basically, the operation is superior to the conservative treatment methods only if the patient already has paralysis in his legs. In addition to physiotherapy, warming bands or compresses may be used. During the complete therapy it should always be ensured that the patient is as painless as possible by appropriate medication with painkillers.

In rare, particularly severe cases, the patient is advised to have an operation in which the adjacent vertebral bodies are stiffened (spondylodesis).

In order to prevent the future development of the lumbar spine syndrome, the affected patient should be instructed exactly by his doctor or physiotherapist on the correct posture in everyday life as well as on physical or physiotherapeutic activities that protect the injured regions in the back and a renewed injury.

home remedies

The simplest treatment of the symptoms of a lumbar spine syndrome is a change of posture and an optimization of certain movements. It is important, especially when lifting objects to make sure that you go sufficiently low in the knee. Care should be taken when straightening up from the lying to roll sideways to relieve the back. Also, a step bearing while sleeping, in which the legs are stored high and the knees are bent at right angles, is advisable to relieve the discomfort.

Walks can help to relax and relax your muscles. Likewise, heat is usually helpful in back pain.

homeopathy

An attempt may be made to alleviate the pain of a lumbar spine syndrome using homeopathic remedies. On the one hand, there are creams with active ingredients that can be applied to the painful area or globules can be taken. It is recommended to apply Rhus toxicodendron as a gel or to take 5 globules 3 times a day. Also Aconitum and Bryonia Colocynthis are said to be helpful in pain of the lumbar spine.

Kinesio taping

Applying Kinesio Tapes can relieve the symptoms of lumbar spine syndrome. On the one hand, this is due to the fact that more stability is given to the back by the tapes and that the posture is fundamentally improved by the pull of the tapes. On the other hand, the tapes cause the movement to create friction between the skin and the underlying tissue, resulting in heat. Especially with muscular dysbalances, warmth is very helpful and relaxes the muscles.

To tap the lumbar spine area four tapestries are needed. The patient should sit slightly bent forward. The first strip is stuck in the painful area under maximum tension along the spine. The second strip is glued horizontally over the pain point, so that the two tapes cross at the point of pain. The other two stripes are glued diagonally so that at the end a star is created. When setting up, the tapes should curl.

LWS syndrome in pregnancy

During pregnancy, women often complain of back pain in the lumbar spine area. This is called symptom-oriented as lumbar spine syndrome. The causes for this can be quite different. It is often intervertebral disc pain, as there is an increased risk of disc protrusions and prolapse in pregnant women.

But the growing baby and the widening of the uterus can also cause the symptoms of a lumbar spine syndrome. The baby needs more and more space in the lower abdomen and the pressure on the sciatic nerve may increase. It creates a lumboischialgie.

But also by the shift of the body's center of gravity by the increasing belly circumference it can come to the LWS syndrome. This is often due to muscular imbalances, as the pregnant woman takes a different posture. In addition, the back muscles during pregnancy is generally more stressed and it can cause tension in the muscles or even blockages of the vertebrae.

The following article may also be of interest to you: Back pain during pregnancy

Lumbar spine syndrome with abdominal pain

A lumbar spine syndrome can also be associated with abdominal pain, depending on the cause. If deformities of the spine exist, the deformation can exert increased pressure on the abdominal organs. Depending on how the deformity is pronounced, different postures may improve or even worsen abdominal pain.

On the other hand, with pain in the lumbar spine without cause also always an organic illness must be thought. If there are inflammations or other diseases of the abdominal organs, this pain can also radiate to the lower back. In women, a gynecological disease should definitely be excluded.

Lumbar spine syndrome with abdominal pain

Often the cause of back pain is not in the back of women, but radiates from the abdomen into the lower back. The pain may be cycle-dependent, and in most cases occurs at the time of ovulation or on the onset of menstrual bleeding. But cycle-independent abdominal pain can also occur. In any case, it should be clarified by a gynecologist whether an organic disease is present.

LWS with lumboischialgie

Lumboischialgia causes pain in the sciatic nerve and lumbar spine area. The most common cause of this is a herniated disc or disc protrusion. This compresses the sciatic nerve, causing pain and possibly numbness or discomfort that can drag along the thigh to the lower leg and foot. But also inflammation or tumors of the spine can lead to a lumboischialgie.

Lumboischialgie with numbness

Feelings of numbness in the legs or feet are common when a prolapse is the cause of the pain. Then the spilled core of the intervertebral disc can press on a spinal nerve and this pressure can cause a feeling of numbness. This can improve in the short term by raising the legs. But it can also become chronic if the compression of the nerve lasts a long time.

duration

The duration of a lumbar spine syndrome is highly variable and dependent on its cause, as well as the extent of lumbar spine injury. Depending on the cause, conservative and operative therapy measures may be considered in the case of the lumbar spine syndrome, the duration of which may differ greatly.

As soon as possible, you should start performing regular physiotherapy and performing back-building exercises after surgery, as this will speed up the healing process and shorten the duration of the illness.

Therefore, the administration of pain-relieving medications is also important, as they allow the painless movement of the back.

If the cause of the lumbar spine syndrome is not or not treated too briefly, symptoms may chronify, meaning that the symptoms can persist over a longer period of time.

Herniated disc as the cause of a lumbar spine syndrome

  1. disc
  2. vertebra
  3. disc prolapse

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