Low back pain

Low back pain is familiar to everyone. According to statistics, it is the cause of 25% of all requests for medical care. Appearance can be caused by many different factors, from banal fatigue to quite serious illnesses. Therefore, you should not ignore the problem, especially if the anxiety occurs regularly and over time. In such cases, you should contact a therapist as soon as possible or consult a neurologist directly and undergo a thorough examination.This will allow the disease to be diagnosed in the early stages of development and take timely measures to stop its development. However, if you have an injury or a failed fall on the eve of the onset of pain, you should immediately consult a traumatologist or spinal surgeon.

Features of low back pain and accompanying symptoms

Back pain can be of different nature and severity. Strong, shooting, painful, tight, etc. Physical exertion may be exacerbated while sitting or standing for long periods of time, and may pass while at rest. All these are important diagnostic factors that allow the doctor to make a correct diagnosis and find the real cause of the patient's condition.

The main importance in making a diagnosis is whether the pain spreads to the hips, thighs, knees, legs, and if so, where and how. In addition, a difficult point is that the patient is able to bend freely, the body rotates or the range of motion is reduced, and there are restrictions on the mobility of the spine.

Back pain is called lumbodynia. If it spreads to the legs, it is called lumboischialgia.

Acute pain is pain that lasts less than 3 months, otherwise they are chronic pain. In the latter case, the disease often continues with periods of exacerbation and remission.

Low back pain rarely occurs in isolation. In most cases, there is another disease complex that patients themselves rarely associate with each other. Often back pain:

combined with

• feeling of crawling on the back and / or legs, numbness;
• muscle weakness;
• pain in the hips, knees;
• pelvic disorders (menstrual disorders, potential problems, loss of urinary control, defecation);
• foot paralysis.

Similar symptoms indicate pathology of the spine.However, because they cannot only provoke the appearance of back pain, there is another group of symptoms that accompany back pain and indicate pathology of the internal organs or cancer. Therefore, you should pay special attention to your situation when it appears:

• fast and unnecessary weight loss;
• incisions and pain in the groin, perineum;
• increased urination, pain;
• increase in body temperature, chills;
• changes in skin color at the epicenter of pain;
• menstrual disorders, abnormal discharge.

If back pain is associated with one or more of the above symptoms, you should see a doctor immediately. When symptoms appear in the first group, you need the advice of a neurologist, and in the second - the help of a urologist, gynecologist, endocrinologist or other narrow specialists. The therapist will help you understand exactly which doctor to contact.

Causes

All causes of back pain in the lumbar region can be divided into 2 groups: back pain and pathologies of internal organs, especially gynecological diseases, kidney pathologies, organs of the gastrointestinal tract, endocrine diseases. However, in most cases, these are the result of changes in the muscles of the spine and surrounding areas. The most common causes of back pain are:

• osteochondrosis;
• spondylosis;
• inflammatory diseases of the spine;
• myofascial syndrome;
• ankylosing spondylitis;
• scoliosis;
• injuries.

However, back pain can also be the result of too much work or certain physiological changes. Such situations do not require special treatment, but only a reduction in physical activity and a more economical daily regimen.

Osteochondrosis and intervertebral hernia

Osteochondrosis is the most common disease of the spine. Development is often associated with inevitable age-related changes, as symptoms occur to a greater or lesser extent in almost every adult.

Osteochondrosis is a substitute for the ability to walk straight. It is characterized by the gradual destruction, thinning, loss of elasticity and strength of the intervertebral discs. As a result, they stop coping with stress and may become bloated. Thus, an intervertebral hernia occurs.

Osteochondrosis often affects the intervertebral discs of the spine. When it enters the spinal canal or the foraminal foramina, the nerves are almost damaged, causing severe back pain and radiation to the legs and thighs.

Spondylosis

Spondylosis is a complication of advanced osteochondrosis in which bone protrusions called osteophytes form along the edges of the spine due to the almost complete destruction of the intervertebral discs and ongoing degenerative processes and increased load on the spine.Therefore, there is a high risk of crushing and damaging nearby nerves. This causes severe pain that can radiate to the feet.

Inflammatory diseases of the spine

Inflammatory diseases of the spine often occur in young people, mainly men. They also cause excruciating pain at night, which is their specific difference. As it develops, without timely treatment, the pain becomes more intense and more disturbing.

It is not uncommon for patients to seek medical attention several years after the first symptoms appear. As a result of such a long course of the inflammatory process in the spine, irreversible changes can occur, which can eventually lead to immobility and disability.

Sometimes, in addition to back pain, there is discomfort in the joints of the legs and arms. In such cases, the cause of concern may be arthritis, osteomyelitis.

Myofascial syndrome

Myofascial syndrome is a common pathology in which pain occurs after a long period of restlessness or physical exertion. Myofascial syndrome is a little more common in women. However, back pain occurs after careless movement or physical exertion. A distinctive feature is the presence of trigger points in the lumbar region and spasmodic muscles of the thighs, pressing on it causes a sudden attack of pain. Myofascial syndrome significantly reduces the quality of human life, but does not pose a serious threat.

Bechterew's disease

Ankylosing spondylitis or ankylosing spondylitis is a chronic joint disease that primarily affects the sacroiliac joint, spinal joints, and surrounding soft tissues. People with this disease are concerned about back and sacral pain and stiffness of movements, but the symptoms usually disappear in the afternoon and at night without a trace.

In addition, physical activity has a positive effect on the patient's well-being and helps to eliminate the pain syndrome. A specific symptom of ankylosing spondylitis is flexion, curvature of the spine, and progressive restriction of mobility.

Scoliosis

Scoliosis is a lateral curvature of the spine. This can be of varying degrees, which directly affects the intensity of back pain and other symptoms. Because spinal deformities cause the displacement of all anatomical structures, the nerves are often constricted, causing severe pain. In addition, other neurological symptoms, including numbness and paresis, may be present.

Compression fractures

In older people with osteoporosis and trauma, low back pain may be the result of an undetected spinal cord fracture. As a result, the vertebrae are straightened and take an abnormal position, which leads to incorrect distribution of the load on the spine, degenerative processes in the intervertebral discs and the appearance of pain.

Physiological causes of low back pain

Exercising hard, intense sports training creates an increasing load on the muscles, which in turn accumulates in lactic acid and causes pain. Back pain is not uncommon to wear uncomfortable shoes for a long time, especially with the heel.

Low back pain is also common during pregnancy. In such cases, it causes a change in the center of gravity and increased stress on the spine.

Diagnostics

It is recommended that you consult a neurologist to determine the causes of low back pain. Initially, you can consult a therapist, but most likely the doctor will refer the patient to a neurologist.

At the reception, the specialist will conduct a thorough examination of the patient, find out what worries him, what lifestyle he leads, and so on. will find. In addition, a physician is required to assess the severity of the reflexes, perform neurological examinations, and assess the patient's mobility. Based on the results, the doctor can make an initial diagnosis and understand the type of disorders that cause the onset of back and back pain.

The patient is thoroughly examined to confirm the existing hypotheses, to accurately determine the causes of pain, which include:

• general and biochemical blood tests - they detect changes in the blood that indicate the presence of inflammatory processes, infection or tumor in the body;
• general urinalysis - used to distinguish kidney disease as a cause of pain in the lower back;
• X-ray - shows a change in the bone structure of the spine, shows signs of fracture, provides information about bone density and allows to identify the main diseases of the spine, as well as osteoporosis (detection of lumbar pathology leads to further examination using CT or MRI);

• CT is a modern radiation diagnostic method that allows you to visualize all bone structures very clearly and detect the smallest deviations from the norm;
• MRI - provides comprehensive information on the condition of soft tissues and cartilage, including intervertebral discs, using MRI you can identify intervertebral hernias of any size, changes in blood vessels, tumors.

Treatment of low back pain

Treatment of low back pain is strictly individual. At the same time, it is always complex and includes symptomatic therapy, lifestyle changes, and treatment aimed at eliminating the identified causes of back pain. Therefore, if the first 2 components of therapy are generally universal and prescribed to all patients, etiotropic therapy is developed strictly individually, taking into account the existing disease.

In most cases, patients are initially offered conservative treatment, the main component of which is drug therapy. In more difficult cases, additional physiotherapy procedures, manual therapy and a course of exercise therapy are recommended.

But in any case, all patients with low back pain:

• to refrain from lifting heavy objects and tiring sports;
• lose weight in case of obesity;
• If a person is forced to sit for a long time, take regular breaks to warm up;
• Increase the level of physical activity, but avoid excessive work and hard work (daily walks, morning exercises, exercise, a special exercise therapy complex, swimming);
• Use a support bandage that will relieve the load on the lumbar region and thus provide favorable conditions for early recovery of the spine.

Depending on the source of the pain, you can advise patients to stay in bed for a day or two, or to increase physical activity, but only within reasonable limits. For example, pain caused by nerve compression requires you to rest your back for a few days. In other diseases, on the contrary, moderate physical activity is one of the mandatory components of therapy. Helps increase the effectiveness of drug treatment, reduce the risk of complications and prevent disability.

Unfortunately, conservative therapy cannot always be used to treat back pain. In some cases, it remains ineffective and does not work even after several months of adherence to medical advice. In other cases, the results of the examination indicate that it is a pathology that can no longer be removed by any non-surgical method. In such cases, patients are advised to consult a neurosurgeon and undergo appropriate surgery to restore the normal anatomy of the spine.

Drug treatment

The following are prescribed to improve the patient's condition and relieve pain as soon as possible:

• NSAIDs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
• corticosteroids - given in short courses to manage severe inflammation;
• muscle relaxant - necessary to relieve muscle spasm, which is often a reflex reaction of the body to pain and aggravates it;
• B vitamins - improve nerve conduction by normalizing the nutrition of nerve fibers and increasing the speed of transmission of nerve impulses.

Obstruction can be caused by unbearable severe pain. The procedure involves injecting the anesthetic solution directly into the area of ​​pain or nerve fiber passage. Thus, it is possible to completely stop the pain syndrome for a while and improve the patient's well-being.

However, the blockade has a temporary effect, and its application is possible only in one medical institution, because in most cases the drug is required to inject near the spinal column through which the nerve mass passes. Therefore, illiterate execution of the procedure can lead to serious and sometimes fatal consequences.

In addition to the medications listed above, a number of others are prescribed to help eliminate the underlying disease that causes pain syndrome. Therefore, patients may be prescribed antibiotics, chondroprotectors, immunomodulators and other groups of drugs.

Physiotherapy

Physiotherapy treatments are often prescribed for patients with spinal disorders. Properly chosen method of physical action and frequency of procedures can achieve a clear anti-inflammatory, analgesic effect, as well as improve microcirculation, eliminate local edema, muscle spasms, etc. Physiotherapy significantly increases the effectiveness of other treatments, but is mainly used only after acute removal. process.

Patients are often prescribed the following:

• electrophoresis;
• UHF;
• ultrasound therapy;
• magnetic therapy;
• reflexology;
• diadynamic currents, etc.

As a rule, the course of procedures covers 8-10 sessions performed at a certain frequency.

Manual therapy

Manual therapy sessions for osteochondrosis, scoliosis and a number of other diseases can have a really surprising effect on the condition of the spine. However, only a qualified chiropractor can perform a manual therapy session and not harm the patient.

The use of special manual methods not only improves microcirculation, relaxes over-toned and very relaxed muscles, but also increases the distance between the vertebrae and normalizes their position. A qualified therapist can find the site of nerve compression and reduce the pressure on the anatomical structures on it.

Literally, after the first session, most patients see an improvement in their well-being and a significant reduction in the severity of the pain syndrome until it is completely eliminated. However, to consolidate the results obtained, it is recommended to undergo a full course of manual therapy and supportive courses in the future.

exercise therapy

Physiotherapy exercises help the body to cope with stress. For each disease, a special set of exercises has been developed, which allows you to solve the most important tasks in the current situation with regular performance. Thus, with the help of a well-chosen set of physiotherapy exercises, it is possible to bring the muscles to normal tone and strengthen them. As a result, the spine will have less load, which will create favorable conditions for effective prevention and recovery of the disease.

Sports therapy helps to improve blood circulation in the affected area, which accelerates the inflammatory process and leads to a more complete recovery. For many conditions, proper exercise can help reduce back pain and reduce the incidence.

The training program is developed individually for each patient. This takes into account not only the type of pathology detected and its severity, but also the presence of co-morbidities, the patient's level of physical fitness, age and other factors. Only a specialist can choose the most effective and safe set of exercises correctly.

The first lessons are under his control. In the process, the patient learns to perform each of the proposed tasks in a useful way. Gradually the load increases to the optimal level. However, it is not recommended to increase the number of repetitions yourself or make them more difficult. Any changes in the physiotherapy training program are submitted by a specialist only.

The patient should only strictly follow the recommendations and train in a comfortable environment every day. All exercises are performed at a slow pace. No sudden action is allowed. However, if you experience pain during the lesson, you should stop training immediately and see your doctor as soon as possible.

Low back pain surgery

Intervertebral hernias, which often cause spinal cord damage and the development of radical pain, require the help of a spinal surgeon. If the protrusion is already formed, it is impossible to force it to retreat in modern non-invasive ways. The only way to eliminate this and get rid of back pain at the same time is to remove the intervertebral hernia surgically.

There are several types of surgery used for intervertebral hernias. The specific tactics of surgery are determined by the type, location and size of the hernia:

• Nucleoplasty and hydroplasty are percutaneous surgical techniques that allow the removal of a portion of the nuclear pulp from a perforation of tissue several centimeters in diameter and reduce the size of the hernia.
• Microdiscectomy is a radical way to solve the problem of intervertebral hernia, which involves removing it or the entire disc through an incision of up to 3 cm in length, but unlike other methods to remove a hernia of any size, regardless of its location in the spinal canal. and allows release. such a compressed nerve in the most difficult part of the spine.
• Endoscopic surgery - involves the removal of a disc herniation through perforations up to 1 cm in diameter using special equipment with a video camera. It can be used for resection of hernias of any size, but the technique cannot be used to remove neoplasms in anatomically difficult areas.

You also need the help of a spinal surgeon for scoliosis. In this case, all forces are directed to restore the normal axis of the spine. Previously, this required making a large incision extending to almost the entire back. Today, however, spinal deformities can be minimally invasively corrected through miniature incisions.

Different types of metal structures are used to restore the normal axis of the spine, but their essence is almost the same. The structure is fixed on the vertebrae with special screws, and by adjusting the tension at different points, it is possible to return the displaced vertebrae and correct them in the correct position. Modern metal constructions allow to improve the initial result of the operation without re-interfering with the body over time. This is achieved by correcting the condition of the installed structure using special screws.

Surgery cannot be prevented in the presence of spinal fractures. In such cases, you can get rid of back and back pain only by restoring the normal shape, size and condition of the vertebrae. Kyphoplasty and vertebroplasty have recently been performed for this purpose. The essence of both operations is the injection of a special bone cement into the vertebrae, which is destroyed by damage with a fine piercing needle. Fills the entire gap and hardens after 10 minutes. However, in severe compression fractures, kyphoplasty is preferred because it can help restore the normal shape of the vertebrae, which will reduce the risk of complications and evenly distribute the load on the spine in the future. This operation involves inserting a special balloon into the destroyed vertebrae, which is gradually inflated to restore the vertebrae to their original appearance. The balloon is then lowered and removed, and the resulting cavity is filled with bone cement.

Thus, back pain can be the result of physiological changes, general muscle fatigue or serious pathologies of the spine or internal organs. Therefore, if it occurs regularly and especially against the background of the same factors, do not hesitate and ignore the problem. Contact qualified professionals to make treatment as quick and easy as possible. If it is not possible to recognize the disease in the early stages of development, the level of modern neurosurgery will make it possible to remove it surgically with minimal risk of complications.