Most middle-aged people have at least once experienced unpleasant pain in the lumbar region. The occurrence of such conditions may occur from time to time or be constant. In any case, the patient experiences serious discomfort and inconvenience, limiting himself to the usual rhythm of life. Some people strive not to notice such changes at all, especially if they are practically imperceptible. Someone is trying to get rid of pain using folk remedies. And someone does more correctly and goes for a consultation with a doctor. There can be many reasons for lower back pain in women on the right side, and they will be studied further.
Women who are faced with a similar phenomenon first of all wonder why it hurts and what exactly causes this disgusting condition. Such unpleasant sensations arise due to various factors, ranging from an irrational lifestyle to pathological changes. Most often, this condition is associated with disorders in the musculoskeletal system, but often it acts as a signal of some serious illness. The pain can have completely different localization zones - lower, upper, cover a specific part of the lower back or touch it on one side. Depending on the location and nature of the pain, you can determine the cause of tired back syndrome most accurately.
Features of the classification of pain on the right side of the back
- Prolonged pain. It may indicate that a person has serious problems with health. After all, physiological factors are usually indicated only by short-term pain.
- It's a dull pain. When aching pain occurs, it indicates a pathological condition called osteomyelitis. To diagnose it, you need to undergo a thorough examination in a good medical center and listen to all the recommendations of a specialist.
- Acute pain. Traditionally, they form after injuries, so in the event of a fall, it is necessary to go to a medical center in order to promptly diagnose and identify the exact causes of discomfort.
- Drawing sensation. Traditionally, it acts as a consequence of hepatitis. So, regardless of other characteristics of the pain, it is necessary to urgently contact a treating specialist.
These are the types of sensations you may encounter if your back hurts in the lumbar region on the right side. Once you determine the specific type of pain you are experiencing, you can come to a decision regarding the right way its elimination.
Common Causative Factors for Low Back Pain on the Right Side in Women
In modern medical field There are several fundamental causes of pain on the right side in the fairer sex.
- diseases of the musculoskeletal system;
- neurological pathological conditions;
- inflammatory phenomena;
- traumatic situations in the area of the muscular structures of the lower back;
- injuries and bruises;
- inflammation in organs located in the abdominal cavity;
- natural or pathological changes in hormonal levels.
These are common factors according to which you can observe the phenomenon of lower back pain on the right and back.
Diseases associated with lumbar pain on the right in women
Most often, as practice shows, pain in the back is associated with disorders of the musculoskeletal system. Moreover, these difficulties can be congenital or acquired. The first thing you should pay attention to and carry out the appropriate diagnosis is spinal curvature and injuries. In addition, there are several more characteristic pathologies that cause pain in the back of varying nature and duration. These are numerous internal diseases.
Poor posture
With this disease, there is an uneven distribution of body weight, which leads to problems and difficulties with the spine and lower back. Posture gets into a “faulty” state due to the uncomfortable position in which modern women find themselves for a long time. For some representatives of the fair sex, the main cause of spinal deformation is wearing uncomfortable shoes (with uncomfortable platforms, high heels, unstable wedges), regularly lifting heavy loads while being in an uncomfortable position. Due to the curvature of the spinal column, changes occur not only in the back, but also in other internal organs. This causes characteristic pain. Most often, having problems with posture, women complain of nagging pain on the right side below the lower back.
Inflammatory processes in the body
If the lower back (right side) hurts, and this sensation is unpleasant, aching, then we can confidently talk about inflammatory phenomena in the body. When conducting diagnostics in this case, doctors most often make the following diagnoses:
- osteomyelitis;
- spondyloarthrosis;
- spondylitis;
- osteochondrosis;
- lumbosacral radiculitis;
- tumor phenomena.
In this case, there is severe acute pain in the right side of the lower back, which radiates to the thigh, gluteal muscle, and lower leg. If you leave everything as is and ignore the need for treatment, additional phenomena and symptoms may occur:
- transfer of pain to the abdominal cavity;
- general weakness of the body;
- increased pain;
- numbness of the legs;
- development of other intervertebral pathological processes.
In this case, a dull aching pain in the lower back on the right may appear if the disease becomes chronic and is not treated in a timely manner.
Hypothermia and injuries
Trauma is also a common cause of low back pain. After undertaking heavy physical exertion or hypothermia, a phenomenon called lumbago (lumbago) may occur. It is characterized by sharp pain with right side which occurs suddenly. In addition, an unpleasant feeling can result from a fall or blow. Sometimes such pains make themselves felt as a result of a woman’s attempt to lift something very heavy. If the injury is minor, you may not need medical attention. But often such situations imply the need for urgent therapy.
Osteochondrosis, sciatica
If the unpleasant sensation is associated with the phenomenon of osteochondrosis thoracic spine or lumbar region, then it can be dull and aching in nature, but sometimes it can be acute (in case of pinched nerve). Such pain entails constrained movements and can intensify as a result of the following phenomena:
This condition goes away after a short rest or after taking anti-inflammatory drugs. General condition the patient noticeably deteriorates, and pain occurs in the lower back on the right during prolonged walking, while coughing, sneezing. It is important to provide an integrated approach in order to recover from the disease completely. In practice, medications, physiotherapy, massage, physical culture therapeutic orientation, folk remedies. By the way, identifying the signs of osteochondrosis is quite simple.
Spinal hernia
If the pain is acute and occurs on the right side of the back above the lumbar region, it makes sense to talk about an intervertebral hernia. Sometimes its localization occurs even lower, based on the location of the lesion. In this case, the patient suffers from several other symptoms:
- impaired body mobility;
- atrophy of the muscle structures of the legs;
- change in gait;
- general weakness of the body.
As it turned out, this condition may indicate a hernia. This pathology is treated with medication, but if nothing from pharmaceuticals helps, the doctor may prescribe surgery.
Diseases of the liver, kidneys, pancreas
The most common causes of this phenomenon are sometimes considered to be these pathologies. They lead to lower back pain in the upper back right. In the process of examining patients, doctors most often make the following diagnoses:
- pyelonephritis;
- kidney stones;
- hydronephrosis;
- colic.
With these diseases, the pain can be so unbearable that the woman cannot find a place for herself and constantly rushes about in the hope of easing the pain. The situation is saved by taking antispasmodic drugs. If the case is advanced, surgery to remove the kidney is necessary. If the situation is aggravated by a feeling of heaviness in the right hypochondrium, we can talk about diseases of the liver and biliary organs. In this case, a woman may suffer from obvious disturbances in digestive function, yellowing of the skin, and heaviness in the liver. In these situations, it is advisable to use choleretic drugs, antispasmodics, and be sure to follow a dietary diet.
In addition, pain in the lower back on the right side is often accompanied by an inflammatory process in the pancreas. In this case, pain can be observed not only on the right, but also on the left, and be girdling. If the attack is acute, the disease can be completely cured only in a hospital setting.
Gynecological diseases
Lower back pain occurs on the right side also in the case of gynecological diseases. Most often, doctors diagnose the following pathologies:
- tumor processes in the uterus;
- inflammatory reactions in the ovaries;
- inflammatory phenomena in the inner wall of the uterus;
- inflammation in the area of the appendages and ovaries.
The insidiousness of such ailments lies in the fact that sometimes they manifest themselves almost imperceptibly, and the patient simply thinks that her lower back is slightly pulled.
Age difficulties
Acute pain in the lower back on the right in an elderly person may indicate age-related changes in the spine, as well as osteoporosis. Most often, this symptom makes itself felt in the case of metabolic reactions disturbances, diabetes mellitus, gout.
Tumor processes
Intense pain in the right side of the lower back in women can occur as a result of malignant neoplasms. The pain is intense, bursting in nature, and is accompanied by a disturbance in general well-being. The woman's mobility is impaired and paralysis is observed.
Hormonal disorders
They can be natural (during pregnancy, menopause, puberty) or pathological (diseases of the adrenal cortex, thyroid gland). Since hormones are a special link in the entire chain of chemical processes in the body, they can lead to pain in the back and other organs. Only a specialist will help solve the problem.
Diagnostics
If such a condition occurs, you should consult a therapist. Only after conducting the necessary studies will he send you to a specialist, who may be an oncologist, gynecologist, neurosurgeon, neurologist, orthopedist, nephrologist. The list of tests is prescribed on an individual basis, depending on the nature of the pain and the presence of secondary symptoms. Usually, if there is pain in the lumbar region on the right side, blood tests, CT and MRI, ultrasound of internal organs, etc. are necessary.
Treatment of lower back pain
Pain in the abdomen and lower back in women absolutely cannot be ignored, because they can become a kind of warning sign about the beginning of the development of certain diseases, which can subsequently worsen your life. Traditionally, pain goes away as soon as the doctor manages to determine its cause and take treatment measures. Therefore, any condition that entails limited mobility, severe pain, or stiffness requires a visit to a neurologist, who will determine further measures.
If the pain is caused by a condition that indicates problems in the spine, such as an injury or bruise, immediately contact the nearest trauma center or visit the appropriate doctor at the clinic. In other cases, a visit to a therapist is required, who will determine whether the pain is an independent condition or acts as a sign of some disease.
Thus, we looked at how such pathologies are diagnosed and treated, and what to do in this case.
Lower back pain on the right can occur for several reasons; its nature can be either acute or chronic. You should never neglect this pathological symptom, because pain in the right side of the lower back can indicate not only diseases of the spine, but also pathology of the internal organs, some of which require emergency surgical care. By collecting all the symptoms into one and identifying the nature of the pain, you will be able to recognize that something is wrong and seek help in time. medical care.
Causes associated with spinal pathology
This group of causes of pain in the lumbar region is the most common. It is diseases of the spinal column that in most cases are the culprits of lower back pain on the right.
Degenerative-dystrophic processes of the spine
Degenerative-dystrophic changes in the tissues of the spinal column (osteochondrosis, spondylosis, spondyloarthrosis) can provoke both acute and chronic pain in the lower back. If your back hurts, then this group of etiological factors must be excluded first.
The lower back will hurt if the lumbar or lumbosacral part of the spinal column is affected. The pain can be of a very diverse nature. Most often, a person is bothered by aching pain in the lumbar region, which appears after physical overexertion, prolonged stay in an uncomfortable position, after hypothermia. It can even last for several weeks (lumbodynia). You can only get rid of such an unpleasant symptom using complex treatment, which will include drug therapy, therapeutic exercises, physiotherapy and lifestyle modification.
If osteochondrosis has already gone far, in addition, its complications have developed (protrusion of the intervertebral disc or its hernia), then the pain syndrome often develops in the form of lumbago. This is an acute and sudden pain that often occurs on one side, for example, in the right side, and radiates (“shoots”) to the corresponding leg. Patients get the impression that this is an electric shock. Lumbago is accompanied by a sharp restriction of mobility in the spine - a person freezes in the position in which the pain found him. Most often this happens when bending over and making sudden movements. The development of this symptom is based on compression of the spinal roots by pathologically altered tissues of the spine.
Osteochondrosis of the lumbar region and its complications (herniated intervertebral disc) lead to compression of the spinal nerve roots and the development of pain
Other diseases of the spine
In addition to degenerative-dystrophic changes in the spinal column, lower back pain on the right can be caused by the following diseases and pathological conditions:
- traumatic injuries (fractures of vertebral bodies and processes, sprains of ligaments and muscles of the spine, etc.);
- radiculitis is a non-infectious inflammation of the spinal nerve roots, in most cases it develops against the background of osteochondrosis, but can occur without it;
- pathological curvature of the spinal column - if a child has lower back pain, then first of all you need to look for scoliosis, pathological lordosis or kyphosis;
- malignant and benign tissue tumors in the lumbar region on the right side.
Causes associated with diseases of internal organs
Pain in the right side of the lower back can also occur with diseases of the internal organs. First of all, this concerns the kidneys, female internal genital organs and the organs of the “lower floor” of the abdominal cavity.
Causes associated with kidney pathology
Often the cause of pain in the lower right is urolithiasis. Moreover, the pain can be unbearably acute (an attack of renal colic) or a person may be bothered by nagging pain in the lower back on the right, which indicates that the stone blocks the path of urine outflow and can cause complications such as hydronephrotic transformation of the kidney with loss of its function.
Gynecological diseases
In women, pain in the lower back on the right can be caused by gynecological diseases:
- adnexitis and salpingitis - inflammation of the uterine appendages;
- endometritis, myometritis and parametritis - inflammation of the lining of the uterus;
- benign formations of the reproductive system - cysts, cystomas and other neoplasms;
- malignant tumors genitals.
As a rule, such pain is intense and cramping in nature, does not depend on body position, and is accompanied by other pathological signs (fever, vaginal discharge). A gynecologist will be able to accurately establish the diagnosis.
Pathology of the abdominal organs
There are cases when the symptoms of diseases of the abdominal organs occur atypically, for example, with an atypical arrangement of organs inside the abdomen. Therefore, pain in the lower back on the right may indicate the following acute diseases:
- appendicitis;
- intestinal obstruction;
- perforation of an ulcer of the intestinal wall;
- paraproctitis.
This is a very serious pathology that requires emergency surgical care. Therefore, you should never neglect such a symptom as lower back pain. After all, every minute matters.
Low back pain in pregnant women
Why might lower back pain occur in pregnant women? Due to a significant increase in the load on the spinal column, pregnant women may experience aching, monotonous pain in the lower back. As a rule, it appears from about the sixth or seventh month of pregnancy and accompanies the woman until childbirth. Then it goes away on its own.
During pregnancy, the load on all parts of the spine increases, especially the lumbar, which causes pain in the lower back
If a pregnant woman has sharp pain in the lower back and sacrum, this may be a symptom of a threatened miscarriage, premature birth, or a harbinger of full-term labor.
In any case, it is better to protect yourself and seek medical help for pain in the right lower back. Only a specialist will determine whether this pain is life-threatening or not.
Pain in the right side of the back, arising for an unknown reason, is a symptom of many diseases and pathological conditions, some with severe consequences (even fatal). Any pain signal is a way feedback an organism with a brain that insistently demands attention to a specific area of the body.
The right side of the back hides important nodal points and vulnerable organs. Even a shadow of doubt about the origin of pain in the right side of the back requires immediate consultation with a doctor. Timely detection of a problem saves the patient’s health, becoming the first step towards recovery.
Along with pain caused by directly located organs, in medicine there is the concept of radiating pain.
Referring pain is characterized by unexpected spread and localization in unexpected places, even far from the direct source.
The subjective perception of pain on the right side of the back can be characterized in detail by the following characteristics:
- Stabbing– usually occurs when moving. Acute pancreatitis can be an example of the alarming consequences of why the right side behind the back hurts with injections while standing still;
- Sharp, burning, cutting– are equally likely to be caused by injuries to the spine, lateral or spinal muscles, and by pathologies in the functioning of internal organs;
- Pulling– run in a continuous background and are signs of severe pathological processes;
- Shooting– characteristic of vertebral injuries, radiculitis, rheumatism, and other neurological disorders. Usually this is pain in the lower back and lower back.
Mild pain and muscle stiffness are a natural consequence incorrect posture and conditions: lack of optimal furniture, choice of a sleeping position that is inappropriate for the body. If the intensity of pain gradually increases, inflammation most likely occurs.
A sharp pain in the right side of the back, gradually transforming into aching, serves as one of the criteria for determining muscle tension, vertebrae, and blocks.
Where does it hurt?
You can recognize or at least specify back pain on the right, guided by the basic principles that are characteristic (but not mandatory; it is necessary to take into account hundreds of nuances) for certain diseases.
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Between the shoulder blades
In the area of the scapula, pain is characteristic of both pulmonary and neurological diseases. The difference is revealed by the presence of additional factors: temperature, vomiting, swelling, cough, difficulty breathing.
Under the ribs
From the back, under the last rib - in the area on the back right - there are four vital organs: the liver, gallbladder, pancreas, spleen (not directly, but can shoot through). The disease of each of them is extremely dangerous and requires immediate hospital treatment.
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A sharp stabbing puts emphasis on problems with the gallbladder (cholecystitis, associated with feverish heat of 39 and above), if the pain on the right side is aching and continuously radiates to the back - the problem is in the liver.
On the right side
The back area in the right center is an acute penetrating pain, which most likely means a problem with the kidneys (especially if the right side hurts from the back, shooting down to the bladder and urinary ducts). Less commonly, an acute form of appendicitis (due to the genetic characteristics of the structure, an anomaly in the placement of the appendix, in which it is located closer to the back, is regularly encountered).
In the lower back
If the lower back hurts unbearably, shooting in the right side or below, this is a sign of both pathologies in the spine (coccyx hernia) and the urinary system. The difference is that in the first case the pain depends on the posture of the body and rises from below, in the second it is constant and radiates to the perineum.
Possible reasons
The concentration of organs and systems in the lumbar region makes accurate diagnosis difficult - too many vital nodes are concentrated here. Back pain appears on the right side as a manifestation of a wide range of problems:
- Respiratory system;
- Gastrointestinal tract;
- Urinary and reproductive system;
- Spine;
- Nervous system.
When the right back hurts, it is important to determine a clear description of the characteristic features, intensity and location of the pain - this will simplify the diagnosis and speed up adequate counteraction to the causes.
Respiratory system
- Dry pleurisy, pneumonia, emphysema - the consequences of various inflammations of the lung tissue are sometimes accompanied by acute pain in the right side of the back;
- Pneumothorax (difficulty breathing due to the accumulation of fluid or gases in the cavity inside the pulmonary pleura) - strong, paralyzing breathing that reverberates throughout the body;
- Cancers, sarcomas - often the main symptoms are hidden and the progression of metastases determines sharp pain in the right side from the back, intercostal type.
Digestive tract
- Colic in various areas intestines. Wave-like pulsating contractions, in a certain localization of the focus, spread from this area;
- Cholecystitis is an extensive inflammation of the gallbladder, caused by blockage of the bile duct with a stone. A piercing burning pain on the right side of the back just below the ribs;
- Appendicitis is an inflamed worm-like lower appendix of the intestine. Feature– the sensation covers the entire abdomen, then migrates and hurts a little on the right side of the back. Continuous aching with sharp outbreaks during movements.
Urinary system
- Renal colic - unbearable pain in waves in the right side of the lower back, shooting into the groin area;
- Hydronephrosis - resembles the previous version with more emphasis on wave-like sensations;
- Pyelonephritis and nephritis of general types - severe pain in the right back in an acute form is accompanied by similar symptoms of colic with fever and additional pain in the joints and muscles;
- Cyst - aching periodic pain in attacks, increasing in severity, swelling, problems with urination.
Spine
They are divided into diseases themselves (osteochondrosis,) and consequences of injuries ( intervertebral hernia). The latter, which causes nagging pain with flares in the right side of the back, can also include a fracture of the ribs or pelvic bone in the appropriate places. The criteria for an increased risk of spinal pain in the back and lower back are:
- Constant sitting position, leading to the accumulation of degenerative processes in the spine (driving, working in an office, at a computer);
- High physical activity on the body (work as a loader, builder, excessive strength training);
- Pregnancy and childbirth significantly change both lower posture and metabolism, making the young mother’s body more susceptible to back pathologies;
- Excess weight (doubly true for those who have lost a lot of weight).
Nervous system
- Pinching of the spinal nerves and dorsalgia (nerve pain) are characterized by a dull aching manifestation with acute outbreaks when the body takes a particularly unfortunate position;
- Neuralgia of the ribs in severe form radiates to the shoulder blade and lower back.
Pain in the lower back on the right or in the side is often one of the most recognizable and characteristic symptoms of dysfunction of the internal organs and the musculoskeletal system. The nature of the pain is both temporary, occurring in periods, and permanent.
Why does lower back pain occur on the right? Most often, pain syndrome is observed in the following cases:
- Curvature of the spine.
Constant poor posture or prolonged stay in an uncomfortable, physiologically incorrect position leads to the fact that the load, distributed incorrectly, causes compensatory deformation of part of the spinal column and, as a consequence, deformation of internal organs or accelerated aging of the spine.
- A slipped disc is another common cause of lower back pain on the right side, below or above the waist.
Weakness and numbness of the limbs, severe pain in the spine, pinching of the sciatic nerve - this is not a complete list of disorders that arise from intervertebral pathology. Most often, the disease overtakes those who like to lift weights, old people or young people with congenital pathologies of the musculoskeletal system.
- Traumatic injuries of the spinal column.
Painful sensations in this case appear soon after a blow or an unsuccessful fall that injures the back. As a rule, if the bruises are minor, the pain goes away on its own within a few days, without special treatment.
- Malignant neoplasms localized in the peritoneum and above can also manifest themselves as painful sensations in the side or lower back.
- Severe pain in the lower back on the right side indicates a problem with the kidneys. In this case, painful sensations, localized lower in the lumbar region, often radiate forward and higher, to the hypochondrium or to the side.
- Inflammatory disease bone tissue(osteomyelitis) causes excruciating nagging lumbar pain, signaling the emergence of an area of purulent-necrotic damage to part of the tissue.
Features of pain in the right side and lower back in women
In addition to the causes of painful discomfort inherent in representatives of both sexes, there are factors that determine the presence of purely female reasons to experience unpleasant sensations in the side or back. Pain localized in the right side of the lower back, most likely, indicates an inflammatory process in the reproductive system.
In a similar way, pathologies of the pelvic organs, cysts and benign ovarian tumors can make themselves known. The insidiousness of lower back pain is that, often, apart from it, a woman does not experience any other unpleasant sensations. And the pain, which at first is simply unbearable, weakens over time, remaining a familiar part of a person’s life. That is why the absence of pronounced symptoms leads to the patient postponing a visit to the doctor or self-medicating, only aggravating the problem.
Problem excess weight- another reason why lower back pain occurs on the right. Creating additional load on musculoskeletal system women, pain signals gradual deformation of the joints. Fortunately, this problem can be solved quite easily. Along with weight normalization, discomfort in the lower back also disappears.
If a woman is pregnant
The huge load on all organs and systems of the body that a woman experiences during pregnancy could not but affect painful sensations. Pain in the lower back on the right occurs due to the accelerated growth of the uterus, which compresses and deforms the internal organs. The liver, located on the right side of the body, and the kidneys, as well as the diaphragm located above, suffer the most.
Without maintenance therapy, including hepatoprotectors and nephroprotectors approved during pregnancy, tired back syndrome will accompany the woman until childbirth. A significant increase in pregnant women’s body weight over a short period of time increases the load on the back muscles, causing painful discomfort. In this case, excellent results are achieved by gentle physical exercise- leisurely walks or swimming. A special bandage that evenly distributes the load, and sleep on orthopedic mattress will ease the woman's discomfort.
How to be treated, which doctor to visit?
If back pain on the right side strikes you suddenly, schedule a visit to your doctor. A neurologist at any district hospital will conduct routine inspection and advise which specialists you should visit in the future. Before visiting a doctor, try not to self-medicate.
While the causes of pain are unknown, uncontrolled use of medications can only cause harm. During your illness, avoid any physical activity and, if possible, stay in bed. Strict adherence to medical recommendations, therapeutic exercises and physiotherapeutic procedures will allow you to forget about unpleasant painful sensations and maintain health and good spirits for many years.
Pain in the lumbar region on the right is an alarming symptom that should never be ignored. It can indicate many different acute and chronic diseases. Only after finding out the true cause can you treat lower back pain on the right. Let's look at the most common factors that provoke this phenomenon.
Causes of lower back pain on the right
Lower back pain on the right side can be caused by the following diseases:
- Diseases of the musculoskeletal system (congenital and acquired):
- osteomyelitis;
- spondylitis;
- sacroiliitis;
- spondylolisthesis;
- tumor processes;
- osteochondrosis, etc.
- right-sided neuritis;
- plexitis;
- neuromyalgia, etc.
- intestines;
- right kidney;
- liver;
- gallbladder;
- right ovary.
Nature of lower back pain on the right and possible diseases
Dull aching pain in the lower back on the right side can be caused by osteochondrosis, a disease associated with impaired mechanics of spinal movement or spasm of muscles and ligaments. Most often, such pain occurs in the morning.
Severe pain in the lower back on the right, both acute and dull, often characterizes lumbosacral radiculitis. Pain sensations radiate to the buttock, thigh, as well as the outer surface of the lower leg, aggravated by walking, changing body position, and coughing.
Sudden, sharp, acute pain in the lower back on the right - characteristic feature lumbago (lumbago). The reason for this may be heavy physical exertion, overexertion or hypothermia of the muscles, as well as infectious processes. In this case, the person takes a forced half-bent position and is limited in movements.
Nagging pain in the lower back on the right may be a consequence of an inflammatory process in the lumbar muscles (myositis). These pain sensations can also be characterized as long-lasting, aching, muffled, while the muscles are tight when palpated.
Acute pain preceded by prolonged nagging pain may indicate development. With this diagnosis, muscle spasms, limited mobility, poor posture, and a feeling of numbness and tingling in the legs also appear.
Painful pulling sensations in women are often associated with inflammatory diseases of the reproductive system. This can also be caused by benign and malignant neoplasms.