Lower back pain

Low back pain is probably familiar to most modern people. Hiring can be affected for a variety of reasons. Among them are back pain, sciatica, osteonecrosis and other pathological changes in the dorsal spine. This should not be overlooked, because back pain is not only incredibly powerful, making the patient's life unbearable, but can also be a symptom of the most dangerous diseases.

Lower back pain can be varied: acute or dull, aching or burning, local (appearing in one place) or radiating to the entire back. Feelings of discomfort also appear in different ways: sometimes suddenly, suddenly, and sometimes gradually, intensifying each day.

The response to pain and tolerance to it depends on many factors: age, psychiatric characteristics, comorbid symptoms, and other factors. But in any case, you can't let the disease run its course. Timely treatment will help avoid dangerous consequences.

To diagnose the cause of back pain, it is necessary to examine the spine and do some more procedures: X-ray, computed tomography or magnetic resonance. The pain, lumbosacral, occurs throughout life, in about 80% of modern inhabitants of European countries.

Acute or chronic low back pain in the low back is the result of a variety of neurologic, degenerative-dystrophic diseases in women and men. In some cases, low back pain is the result of internal diseases, obesity, stress, mental disorders.

Pain syndrome - primary and secondary

Understanding the reasons why the lower back hurts, we must not forget that the causes of such pains are in the tens of thousands, and a non-professional will never be able to determine the true source of the pain. problems. In general, the medical classification separates primary and secondary pain syndromes that can affect the low back.

Primary low back pain syndrome occurs due to morphological musculoskeletal changes. It is he who is the cause of the vast majority of cases of low back pain. The most important cause is due to degenerative-dystrophic changes occurring in different parts of the spine:

• Osteonecrosis, which is the damage of bone and cartilage tissues, is dystrophic in nature. With it, the discs and adjacent vertebrae are affected, spondylolisthesis begins to develop.
• Osteoarthritis is a form of degenerative joint disease in which the disease affects the disc joints, responsible for spinal mobility, or the synovial joints.

Secondary pain syndromes have more diverse causes of pain:

• scoliosis, which is a curved spine, as well as a number of other growth disorders;
• various combustible substances which are not infectious in nature. Examples include rheumatoid arthritis, Reiter's syndrome, etc. v . . . ;
• the tumor is located on the vertebrae, in the spinal cord or in the retroperitoneal space, whether primary or metastatic;
• fracture of one or more dorsal vertebrae. This is probably one of the most serious causes of back pain;
• various infectious diseases that lead to damage to the vertebrae and discs (tuberculosis, brucellosis, epidural abscess, etc. );
• stroke conditions in which there is a serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
• gastrointestinal diseases. For example, acute appendicitis with atypical course, bowel obstruction;
• often back pain is of a reflective nature. A similar problem can occur with some diseases of the organs located in the pelvic region. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all these diseases cause back pain).

Acute and chronic low back pain

Low back pain is also divided into acute and chronic pain caused by various pathologies of the nerves or the spine itself. The so-called displacement low back pain is also often observed: in this case, there is a displacement of pain sensations from the internal organs and deeper structures of the body; in other words, the patient appears to have pain in the lower back, but in fact a completely different part of the body is affected.

Usually, back pain is in the lumbar region, when the pain radiates into this area from the pelvic organs, kidneys, pancreas, colon or retroperitoneal tumors. Many patients don't know what to do if their lower back hurts. But there is one clear recommendation, exactly what not to do: self-medicate. The causes of pain are so varied that only a qualified specialist can make an accurate diagnosis.

Possible causes of acute low back pain include:

• The pain accompanies acute muscle tension. In this case, the pain signals are localized in the back, they are provided by long muscles that contract. The pain does not tend to move to the groin or leg area. Human mobility is limited.
• One of the most common and serious causes of severe back pain is a spinal fracture (fracture of the vertebrae, including pinched vertebrae). As a rule, this happens with an unsuccessful fall, back bend and other injuries; but in cases where the patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, has cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, the fracture isvertebrae can literally happen. , and even without sensory immobilization at the time of fracture.
• An equally unpleasant situation where the lower back is in severe pain is the displacement of the discs that has occurred in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second frequency; LIII-LIV and higher are rarer cases.

Symptoms include severe lower back pain, forced posture, and limited range of motion. Participation in the pathological process of the nerve roots is indicated by:

1. lenticular pain, usually unilateral;
2. sensitivity disorders (numbness, increased or decreased sensitivity);
3. decrease or disappearance of the Achilles reflex (in the case of S or S2 root damage);
4. reduced intensity or absence of knee jerking (indicating L3-L4 area injury).

The general trend is disc protrusion affecting the underlying root (eg, LIV-LV misalignment causing L5 radiculopathy). With the defeat of cauda equina (horsetail), the functions of the bladder and rectum are disturbed. In addition, a similar condition can occur with strong protrusion of the spinal discs.

Strong back pain in the lumbar region with supine syndrome: in this case, the disc remains unaffected, and the pain appears due to compression of the root itself at the outlet of the spinal canal. Facial syndrome is often observed of type one side in the region of the L5 root; arises on the basis of an increase in the facets of the intervertebral disc joint (upper and lower), and as a result narrows the foramen.

In addition, severe lower back pain accompanies an epidural abscess, a serious illness that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine; The pain becomes especially strong when there is mechanical impact on the pathological area (pressing, percussion).

If there are signs of spinal cord compression, any highly effective medical measures are recommended, including surgery. Another reason for lower back pain could be diseases of the hip joints - mainly coxarthrosis. In this case, the pain is characteristic, spreading down the lower back, buttocks and also the legs to the knees.

Diseases characterized by chronic low back pain:

• Deforming spondylosis is a disease in which there are dystrophic changes in the lumbar vertebrae, calcification of the ligamentous apparatus and further growth of bone; Bone growth presses on the roots and narrows the spinal canal. In the case of low back pain accompanied by leg weakness, numbness and other neurological symptoms, the possibility of episodic compression syndrome, possibly due to spinal stenosis. An examination is required, the results of which establish the final diagnosis.
• Ankylosing spondylitis (or Bechterew's disease). In the early stages, it is characterized by limited mobility, especially in the morning, due to decreased movement of the ribcage during breathing. There are pulling pains in the lower back; continued generation and progression of spinal curvature in the thoracic region. X-rays identify anomalies of the sacral joint: destruction, structural changes, "bamboo" spines. A thorough examination and finding out why the lower back hurts is necessary, as similar symptoms and limited mobility of the lower spine can also cause other diseases - Reiter's syndrome, psoriatic arthritis, chronic colitis.
• Cancers (tumours, metastases), metabolic disorders (including NBO). It is necessary to exclude the causes of back pain such as: carcinoma of the lung, breast, prostate and thyroid gland, kidney, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by radiography and myelography.
• Osteomyelitis also causes long-lasting pain in the lower back. If this disease is suspected, X-ray of bone tissue, skin test for tuberculous tubercle and ESR determination to determine the presence/absence of tuberculosis or pyogenic (pus-producing) bacteria in the body, usually staphylococcus - the causative agent of osteomyelitis.
• Tumors of the spinal cord (intramedullary tumors) of various types. Diseases such as lipomas, neurofibromas, and meningiomas can cause constant back pain, initially without any accompanying neurological symptoms.

The cause of back pain is intermittent. Many diseases of the internal organs cause recurring, sharp or pulling pain in the lower back. At the same time, the patient did not have a feeling of tightness in the back, no obvious localized pain, and the pain did not increase when moving as much as possible. As for the question of what to do if your lower back hurts intermittently but occasionally, the answer is simple: don't wait until it hurts "as usual" but consult your doctor.

There is an obvious pathological effect of one or another organ on a certain segment of the spine. So, from the pelvic organs, the pain spreads to the sacrum, in diseases of the organs located in the lower part of the abdominal cavity it spreads to the lower back (segment L3-L5), and in the upper part -to the segments of the upper part of the lumbar region or the lower part of the chest area.

Diseases - causes of lower back pain and the main area of \u200b\u200bdistribution of \u200b\u200bpain:

• If the pelvic organs are affected, endometriosis, ovarian or uterine carcinoma, the lower back will hurt. In men, such bouts of pain may be caused by chronic prostatitis or the development of prostate carcinoma.
• Various kidney diseases cause pain at the junction of the ribs and spine.
• Tumor of the stomach, duodenum, peptic ulcer, pancreatic tumor (especially if the disease spreads outside the peritoneum) - pain spreads to the region of the T10-L2 spinal segments;
• When you have ulcerative colitis, diverticulitis, or a colon tumor, your lower back hurts;
• If back pain is present in the thoracic/lumbar region, aortic dissection (dissection of the aneurysm) should be ruled out.

Diagnosing low back pain

For lower back pain and low back pain, you should undergo computer (shows the condition of the bone tissues of the spine) and magnetic resonance (which allows you to assess the condition of the soft tissues) computed tomography andUltrasound of internal organs. .

One diagnostic method is radiography, which is relatively inexpensive and can be useful in detecting a wide range of disorders, from fractures to kidney stones. Many of the changes detected only suggest the correct diagnosis and additional studies may be required to confirm that. In addition, several radiological changes may be concurrent findings that are not the cause of pain.

It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological status is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the state of the regional muscles. back and buttocks. At this stage of the study, a patient with osteonecrosis of the spine and back and lower back pain could be diagnosed and treated.

Occasionally, as a result of a chiropractor's examination of a patient presenting with osteoarthritis pain, the following additional diagnostic procedures may be indicated:

• X-ray of the spine with functional tests;
• Computed tomography of the spine;
• MRI of the spine.

The center of the disc is occupied by the mucinous nucleus of the colloid nucleus. It is surrounded and supported by a fibrous ring (annulus fibrosus), consisting of fibrocartilage and connective tissue. You can read more about this in the article on the anatomy of the human spine and spinal cord.

The thickness of the discs decreases, the vertebral bodies come closer together, reducing the discs and endangering the nerves and vessels located there (osteonecrosis).

Protrusion of the discs (the protrusion of the disc) and their prolapse into the lumen of the spinal canal (herniated disc) often lead to nerve root compression, causing pain along the compressed nerve (pain)spread to the legs, arms, back of the head, neck, intercostal spaces depending on the degree of nerve compression) with a weakening of muscle strength in their internal regions and a violation of sensitivity.

Usually, a bulging or herniated disc is accompanied by muscle pain along the path of the nerve (along the arm or leg). In this case, one or immediately (rarely) two nerves are compressed.

In addition to nerve compression, the stability of the spinal segment may also be impaired. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, an X-ray of the cervical spine with functional tests may be needed.

Normally, the nerve bundles that form the sciatic nerve are compressed by their anatomical position, causing a herniated or protruding disc. The sciatic nerve consists of fibers L5, S1, S2, S3 - spinal nerves.

The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of a narrowing (spinal stenosis) and compression of the nerves and spinal cord that pass through it. That is why in the case of spinal stenosis, it is always necessary to carry out a full course of treatment using a whole range of different treatment methods, and in case of ineffectiveness, surgical treatment. art.

Which doctor should I contact?

When suffering from spinal pain, you should first contact a neurologist of a district hospital, if the patient's condition is stable, call an ambulance. Lower back pain can be one of the symptoms of gynecological, urological, surgical, and gastrointestinal diseases.

Lower back pain is associated with many infections and injuries to the extremities. Low back pain accompanied by heart and lung diseases is not excluded. This is established by in-depth testing. After the patient is diagnosed, he is usually prescribed drugs that relieve back pain, normalize blood circulation and help restore nerve tissues. These can be pills, gels, ointments, or injections to reduce inflammation and spasms.

Surgical intervention is often required when diagnosing a herniated disc, which is a complication of osteonecrosis. The hernia that was pressing on the nerve root is removed, it is restored, and the pain should go away with time.

It is best to relax the spine and vertebral muscles if you sleep on a firm mattress with a small pillow under your knees. At the same time, bed rest should not last too long, as this will weaken the vertebral muscles, which will only aggravate the problem. Even with severe pain, you should try to maintain at least weak physical activity.

How to relieve back pain

The appearance of a painful symptom is usually due to muscle spasms, which can be eliminated with the help of special means - muscle relaxants. Such drugs are actively used in the treatment of diseases of the spine.

So, with sudden, severe pain in the lower back, you should take a muscle relaxant, rub your back with a warming numbing gel. When using the fund, you should strictly follow the guidelines of the fund.

In the case of unpleasant symptoms due to inflammatory diseases of internal organs, you should not delay contacting a doctor, if at a specific time it is impossible to visit a specialist and the pain is too severe. you can use Pentalgin or No-shpu. It is not advisable to warm the painful area with a heating pad, as heat contributes to the spread of inflammation and, therefore, to an intensification of accompanying symptoms.

Ointment for back pain

Preparations in the form of ointments are often used in the treatment of diseases of the lower spine. These drugs include drugs that have anti-inflammatory, mild pain relievers, and fever-reducing effects.

The course of treatment is prescribed taking into account the severity of the pain symptom. Back pain ointment is used as a primary or secondary treatment. With pronounced symptoms of osteonecrosis, rubbing the lower back with Ketoprofen ointment, a substance with a strong analgesic effect, is indicated.

The main plus of local preparations is due to their effect not on the whole body, but on a specific area that needs treatment. Pain relievers and anti-inflammatory ointments have fewer contraindications and side effects than similar drugs in the form of tablets.

Exercises for back pain

Gymnastics is considered an additional method in the treatment of pathologies of the back spine. Exercises for the patient are quite simple and do not involve any special load on the body. For example, usually hanging from the crossbar of the crossbar has a beneficial effect on the condition of the spine, helps to relax muscles and eliminates lumbago - pain caused by compression of its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower part, include exercises:

• raise the legs (so that the knees touch the chin);
• "bicycle", supine performance;
• walk on your knees.

Every day, it is recommended to perform exercises for no more than 10-15 minutes, if the pain is pronounced - refuse to do them.