Spinal discomfort is the main reason people see a doctor. Almost 80% of the adult population faces this problem. Back pain causes significant disability and can be a persistent problem from childhood to adulthood.
Dorsopathy affects almost all areas of life. Sleep is disturbed and bending, reaching or turning becomes difficult. Difficulties arise when driving, walking, lifting and doing physical exercises. If you have pain in the spine, you should immediately consult a doctor. The specialist will study the medical history, collect anamnesis and conduct an examination. If any violation is detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of dorsopathy is muscle tension and spasm. Strain can be a result of heavy physical work, awkward positions and even bad posture.
Studying the anatomy of the spine can help you better understand the problem. The main parts of the spine:
- Cervical is a mobile segment that undergoes degenerative changes. With age, pain often occurs in the so-called "transition zone" between the flexible cervical vertebrae and the more rigid thoracic spine.
- Thoracic - connects to the chest and connects to the ribs. In particular, older adults may develop compression fractures in this area as a result of bone loss.
- Waist - lower back. Younger patients are more prone to discogenic back pain, while older patients are more likely to have disorders of joint structures.
- Sacral - the lowest part of the spine. It consists of a flat, triangular sacrum bone that connects the hip and tailbone. Degeneration of this area usually occurs in elderly patients or after a fall.
Between the upper back and the tailbone are 17 vertebral bodies, many joints, the sacrum and tailbone, as well as fibrous and muscular supporting structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. The spine is more than the sum of its parts, but you need to know about those parts.
The spine generally consists of 33 vertebrae, each divided by an intervertebral disc. Vertebrae are a series of small bones to which muscles attach. Each vertebra consists of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which houses the canal and also protects the spinal cord.
Back muscles are divided into three groups:
- intermediate - is responsible for the movement of the ribs;
- internal - to stabilize the spine, control the movement and position of the spine;
- surface - provides movement of the neck and upper limbs.
The muscles that support the spine are built in layers. They act as the main stabilizers of bone and ligament structures. The tension of these muscles is possible in patients of different age groups.
There are other parts of the spine that need to be considered when diagnosing dorsopathy. These include ligaments and tendons, intervertebral discs, and joints that provide stability and mobility.
Inflammatory diseases, malignancies, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, herniated disc, spinal stenosis, sacroiliac joint dysfunction, facet joint injuries, and infections are part of the differential. Distinguishing the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, height loss, and mucinous annular degeneration).
Degenerative changes in the disc are already observed in one third of healthy people between the ages of 21 and 40. The high prevalence of asymptomatic degeneration should be considered when evaluating spinal symptoms.
With age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is violated by excessive loading. This will eventually lead to cracks in the annulus fibrosus. A herniated disc is defined as displacement of disc material (cartilage, nucleus, fragmented annulus and apophyseal bone) outside the intervertebral disc space.
Rhachiocampis
The natural curves of the spine are important to ensure its strength, flexibility and ability to distribute load evenly. Natural curves have a normal range. Abnormal curves include lordosis, kyphosis, and scoliosis.
Abnormal lordosis
Lordosis, a curvature of the spine, is defined as a severe inward bending of the spine. Although this disease mostly affects the lumbar region, it can also develop in the cervical spine.
The normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can cause instability in gait and a change in figure - the hips become more prominent. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal misalignment, is defined as excessive outward bending of the spine and can result in forward bending. It most often affects the thoracic or thoracolumbar regions, but it can also occur in the cervical region.
The normal range of kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality results in the development of a kyphotic curve outside this normal range, the curve becomes abnormal and problematic. It is manifested by the rounding of the shoulders and the forward tilt of the head.
Scoliosis
It is defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by backward or forward curvature of the spine. Scoliosis involves an abnormal lateral curvature of the spine.
The most common form of scoliosis is juvenile scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% is caused by neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom often occurs with developmental defects and can be combined with neurological manifestations.
Dorsopathy is manifested by the following developmental anomalies:
- Fragmentation - there is moderate discomfort in the lumbosacral region with small bone defects. After some time, radicular syndrome appears.
- Lumbarization, sacralization - compression of the roots is accompanied by burning or burning pain. Sensory disturbances or paresis may be added.
- Wedge-shaped vertebrae - discomfort occurs during stress and when maintaining a static body position for a long time. It is accompanied by chest deformation and poor posture.
Osteoporosis
It typically affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by the loss of bone mineral density, which causes the bones to become brittle.
Osteoporosis can cause compression fractures of the spine, loss of height, stooped posture, and even scoliosis. To prevent osteoporosis, it is necessary to ensure a balanced diet, to give up smoking and alcohol abuse. An active lifestyle is also recommended.
Injuries
The severity of dorsopathy corresponds to the severity of the injury. As a rule, it is combined with symptoms of nerve tissue damage.
Traumatic causes of pain in the spine:
- A bruise is caused by a direct blow or a fall from behind. Dorsopathy is local, moderate. It gradually disappears within 1-2 weeks.
- Dislocation – occurs as a result of high energy impact. It is accompanied by severe pain along with sensitivity and impaired motor activity. The general situation is also deteriorating.
- Spondylolisthesis is a traumatic injury of the spine in the lumbar region. Dorsopathy spreads to the legs, there is a positive symptom of axial load.
- Compression fracture - occurs when the hip falls or jumps from a height. At first, the pain is sharp, then it becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, nagging and aching pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by stiffness and dull pain in the lower back. There is a characteristic circadian rhythm - symptoms occur at night and intensify in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, the mobility of the spine is limited and thoracic kyphosis is formed.
Also, pain in the spine occurs with tuberculosis. Deep local discomfort is characteristic of vertebral destruction. Dorsopathy increases with exercise and is accompanied by extreme skin sensitivity. With shooting and radiating pain, we are talking about compression of nerve roots. The condition is completed by the stiffness of the movement.
Intense dorsopathy is noted with osteomyelitis. The disease is diagnosed in children and adolescents. It is characterized by hematogenous nature. Discomfort increases with movement, so the patient stays in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis is manifested by pain that spreads to the area of innervation of the nerve roots. Symptoms stabilize and resemble sciatica. They are accompanied by motor disorders, sensory disturbances and loss of pelvic control.
Tumors
Benign neoplasms have a hidden course or are slowly progressing and accompanied by minor symptoms. Most often, visible hemangiomas appear in only 10-15% of cases. Discomfort is painful, local. It progresses at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and nerve conduction disturbances.
In the initial stage of progression, sarcomas of the spinal column are manifested by moderate intermittent pain that worsens at night. It is accompanied by limitation of motor activity and radicular syndrome. Discomfort is localized in the internal organs, legs or arms (taking into account the level of tumor location).
Other diseases
Discomfort in the spine is also observed:
- Spinal epidural hemorrhage - similar to the symptoms of radiculitis, accompanied by a violation of spinal cord conduction.
- Calvet's disease - radiates to the legs, occurs periodically, is mildly expressed. It decreases while sleeping and increases during physical activity.
- Forestier's disease - localized in the thoracic region, spreading to the lower back or neck. Symptoms are usually short-lived. It may be accompanied by pain in the elbow or shoulder joints. Rigidity of the spine cannot be ruled out.
Dorsopathy sometimes occurs with mental disorders. In this case, the clinical picture is unusual - it does not correspond to the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back dorsopathy affects 15-19% of people worldwide. Postmenopausal women are at greater risk, possibly due to osteoporosis and vertebral compression fractures.
Professional activities also cause back pain. Those who have to maintain a static body position for long periods of time, such as dentists or salespeople, face this problem more than others. Office workers experience upper back discomfort due to poor ergonomics at work.
Dorsopathy can occur at different points of the spine. The localization area shows the cause of the disturbance and makes the diagnosis much easier.
Pain on the right side
The cause is excess body weight, slipped disc or myositis. There is also discomfort with kyphosis on the right side of the back.
Somatic pathologies include salpingitis, ovarian inflammation, nephritis, and cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be emphasized.
Pain on the left side
The back on the left side hurts due to splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, compressed roots. Discomfort in the lower back indicates inflammation of the serous membranes of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is more often than others exposed to the development of pathological processes from the spine. This is due to a large load. When the nerve roots are damaged, the inflammatory process develops. Hernia protrusion and osteochondrosis are also possible.
A less frequent cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, a decrease in density, lumbar sciatica, arthritis, spinal tuberculosis. In most cases, back pain is chronic.
Pain in the right lower back region
Dorsopathy occurs in the following cases:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondylitis.
It may indicate the presence of a neoplasm. We are talking about radiculitis. It indicates liver dysfunction.
Pain in the left lumbar region
Discomfort is mainly localized after physical activity. The condition returns to normal after rest. If rest does not reduce anxiety, then we are talking about scoliosis, osteochondrosis, spinal infections and circulatory disorders.
A pinched nerve
In most cases, the sciatic nerve is compressed (sciatica). At the same time, its myelin sheath is not damaged. It often develops against the background of osteochondrosis. It is accompanied by acute, severe symptoms that spread to the lower back, sacrum, and lower limbs.
During compression radiculopathy, the spinal nerve roots are also compressed. The reason is a herniated disc or a decrease in the distance between the vertebrae. "Superficial" discomfort is felt, which is sharply intensified during exercise, sneezing, coughing.
Intervertebral hernia
It is characterized by the extrusion of the nucleus into the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a small load leads to the progression of the pathological process. Dorsopathy is sharp and acute, spreading to the leg or arm.
Pain in shoulder blades
Depending on the nature of dorsopathy, a probable diagnosis can be determined:
- dull, growing - stomach ulcer;
- acute, worsening with movement - intercostal neuralgia;
- numbness of the hands, changes in pressure, dizziness - osteochondrosis;
- radiation under the clavicle - exacerbation of angina pectoris.
Pain along the spine and in the back
It develops due to compressed nerve endings against the background of curvature of the spine. If the symptoms are not clearly expressed, we can talk about a protrusion. Increased symptoms indicate osteochondrosis, myositis or fractures.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. It can indicate spondyloarthritis. The pain is constant and sharp.
Pain in the lower back
Often they occur with spondyloarthrosis and osteochondrosis. It is less common in diseases of female genital organs (oophoritis, cervicitis, endometritis, etc. ). It can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. Show bladder or prostate diseases in men.
Diagnostics
First, a physical examination is performed to identify signs that indicate the need for additional tests. Medical examination includes the following procedures:
- Examination of the back and posture to identify anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of reflexes, spinal sensitivity and gait characteristics. For patients with suspected radiculopathy, the neurologic examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder causing back pain may have physical symptoms, also known as Waddell's signs. These include patient hyperresponsiveness on physical examination, superficial tenderness, and unexplained neurologic deficits (eg, sensory loss, sudden weakness, or flexion on motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Treatment of spinal pain
In cases of dorsopathy, treatment should be carried out by a doctor. The specialist sends the patient for examination and prescribes effective therapy based on the obtained results.
Additional therapeutic measures should be used with caution and after consulting a doctor. Any type of medication comes with possible risks and side effects, so self-medication is unacceptable.
Help before diagnosis
Some of the main home remedies that can be effective in dealing with mild to severe pain caused by muscle tension include:
- Short rest period. Many episodes of low back pain can be relieved by eliminating physical activity. It is not recommended to rest for more than 2-3 days, because prolonged inactivity hinders healing.
- Change in activity. Staying active is recommended, but avoid activities and body positions that worsen dorsopathy. For example, if sitting for a long time in a car or at a desk increases anxiety, then you should do warm-up exercises every 20 minutes.
- Exposure to heat or cold. A heating pad or hot bath relaxes tense muscles and improves blood flow, reducing anxiety. If your back hurts due to inflammation, you can use ice or cold compresses to reduce swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medicines relieve inflammation and reduce discomfort in the lumbar region.
Conservative therapy
Oral drug therapy:
- Analgesics. Patients are prescribed drugs from the anilide group, such as paracetamol. Have a long-term analgesic effect. They act synergistically with NSAIDs and are used in combination to reduce pain without increasing toxicity.
- Non-steroidal anti-inflammatory drugs. They have analgesic properties. At higher doses, they have an anti-inflammatory effect.
- Muscle relaxants. They act centrally, affecting the activity of muscle stretch reflexes. The combination of an NSAID and a muscle relaxant provides significant relief from dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic pain relievers. Tricyclic antidepressants relieve chronic pain. Low doses may be sufficient to control symptoms. They do not work immediately and may need to be continued for several weeks before symptoms improve. Both peripheral and central mechanisms play a potential role when anxiety is mediated.
Local or regional anesthesia given by injection is part of the treatment regimen for some patients with back pain. The injection site can be a local injury site or a myofascial trigger point (a painful area of a muscle).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. It is used to alleviate the condition of intervertebral hernias, spinal stenosis and radiculopathy. Reduce dorsopathy and quickly restore sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. Indications for surgery vary depending on the patient's characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficits;
- radicular symptoms unresponsive to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. The operation is most effective when nerve compression manifestations predominate in the clinical picture of patients. The most common problem is inadequate nerve decompression. Related diseases including hip arthritis, osteoporosis and cardiovascular disease.
For patients with radicular pain due to a herniated disc, surgery primarily involves decompression. Protruding, extruded, or isolated disc material is removed. The nerve root is explored and released.
Prevention
Complications are determined mainly by etiology. They are divided into physical and social. The first includes chronic pain, deformity, neurological effects with either motor or sensory deficits, bowel or bladder damage. From a social perspective, complications are usually measured by disability and reduced performance.
Patients of all ages should:
- eliminate bad habits;
- lead an active lifestyle;
- strengthen the protective functions of the body;
- lift heavy objects properly;
- undergo preventive examinations with a doctor.
It is important not to slouch and keep your back straight. The place for sleeping and working should be properly arranged. It is recommended to do light gymnastics every day after waking up. You should also balance your diet by enriching your diet with enough vitamins and minerals. It is recommended to take a contrast shower in the morning.