Most adults have experienced back pain during their lifetime. This is a very common problem, which can be based on many different causes that we will analyze in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Skeletal muscle:
- Bone tumor;
- disc herniation;
- Compression radiculopathy;
- Degenerative spine;
Inflammation, including infectious:
- Osteomyelitis
- Tuberculosis
nerve;
Injured;
Endocrine;
Blood vessel;
Tumor.
During the first visit to the doctor for back pain, a specialist needs to determine the cause and type of pain, paying special attention to "red flags" - manifestations of potentially dangerous diseases. "Red flags" refer to a specific set of complaint and history data that requires an in-depth examination of the patient.
"Red Flag":
- the patient's age at the time of onset of pain: younger than 20 years or older than 50 years;
- serious spinal cord injury in the past;
- the occurrence of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, lyme disease, and others);
- fever;
- weight loss, loss of appetite;
- Abnormal localization of pain;
- pain increases in the horizontal position (especially at night), in the vertical position - weakness;
- no improvement for 1 month or more;
- dysfunction of pelvic organs, including urinary and defecation disorders, perineal numbness, symmetric weakness of the lower extremities;
- Alcoholism;
- the use of anesthetic drugs, especially intravenous;
- treatment with corticosteroids and/or cytostatics;
- with pain in the neck, the nature of the pain.
The appearance of one or more signs by itself does not mean that you have a dangerous disease that needs the attention and diagnosis of a doctor.
Back pain is divided into the following patterns over time:
- sharp- pain lasts less than 4 weeks;
- semi-acute- pain lasts from 4 to 12 weeks;
- chronic- pain lasts 12 weeks or more;
- recurrent pain- recurrence of pain if it has not occurred within the last 6 months or more;
- exacerbation of chronic painThe pain recurs less than 6 months after the previous episode.
Diseases
Let's talk more about the most common musculoskeletal causes of back pain.
Bone tumor
This is a disease of the spine, based on the wear and tear of the vertebral discs and then the vertebrae themselves.
Is osteonecrosis a pseudo-disease? - No. This diagnosis exists in the ICD-10 International Classification of Diseases. Currently, doctors are divided into two camps: some believe that such a diagnosis is incorrect, others, on the contrary, often diagnose osteonecrosis. This condition arose because foreign doctors understood osteonecrosis as a disease of the spine in children and adolescents that is related to growth. However, this term specifically refers to degenerative spine disease in people of all ages. In addition, the most commonly identified diagnoses are myopathy and back pain.
- Spine pathology is a pathology of the spine;
- Low back pain is a non-specific benign back pain that radiates from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.
The spine has several segments: cervical, thoracic, lumbar, sacral, and coccyx. Pain can occur in any of these areas, described by the following medical terms:
- Cervical pain is pain in the cervical spine. The discs of the cervical region have anatomical features (the discs are absent in the upper part, and in other parts they have a weakly expressed medullary nucleus with its regression, on average 30 years), making them more susceptible to stress. and trauma, leading to ligamentous distension and early development of degenerative changes;
- Chest pain - pain in the thoracic spine;
- Lumbodynia - pain in the lumbar spine (lower back);
- Lumboischialgia is pain in the lower back that radiates down the legs.
Factors that lead to the development of osteonecrosis:
- heavy manual labor, lifting and moving heavy objects;
- little physical activity;
- long sedentary work;
- staying in an uncomfortable position for a long time;
- working for a long time at the computer with the screen placement is not optimal, creating a burden on the neck;
- violation of posture;
- congenital structural features and malformations of the spine;
- weakness of the back muscles;
- high growth;
- excess body weight;
- diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. v. ;
- natural wear and tear with age;
- smoke.
disc herniationis the convexity of the disc nucleus. It may be asymptomatic or cause compression of surrounding structures and manifest as lens syndrome.
Symptom:
- violation of the range of motion;
- hard feeling;
- muscle tension;
- radiate pain to other areas: arms, shoulder blades, legs, groin, rectum, etc. v.
- "shot" of pain;
- numbness;
- crawling sensation;
- muscle weakness;
- pelvic disorders.
Localization of pain depends on the extent to which the hernia is localized.
Herniated discs usually resolve on their own within 4-8 weeks on average.
Compression muscle disease
Radular syndrome is a complex of manifestations occurring due to compression of the spinal roots at points of origin of the spinal cord.
Symptoms depend on how much spinal cord compression occurs. Symptoms may occur:
- pain in the extremities of a shooting nature with irradiation to the fingers, aggravated by movement or coughing;
- numbness or a feeling of flies crawling in a certain area (dermatology);
- muscle weakness;
- back muscle spasms;
- violation of the power of reflexes;
- positive symptoms of stress (appearance of pain with passive flexion of the extremities)
- limited mobility of the spine.
Degenerative spine
Spondylolisthesis is the displacement of the upper vertebrae relative to the lower vertebrae.
This condition can occur in both children and adults. Women are more often affected.
Spondylolisthesis may be asymptomatic with slight displacement and may be an incidental radiographic finding.
Symptoms may occur:
- uncomfortable feeling
- back and lower extremity pain after physical work,
- weakness in legs
- lens syndrome,
- pain relief and tactile sensitivity.
The process of vertebral displacement can lead to lumbar spinal stenosis: the anatomical structures of the spine degenerate and grow, gradually leading to compression of the nerves and blood vessels in the spinal canal. Symptom:
- constant pain (both at rest and with movement),
- In some cases, the pain can be relieved in the supine position,
- the pain is not aggravated by coughing and sneezing,
- the nature of the pain ranges from pulling to very strong,
- dysfunction of the pelvic organs.
With strong displacement, compression of the arteries can occur, leading to disturbances in the blood supply to the spinal cord. This is manifested by the weakening of the legs, the person can fall.
Diagnose
Collect complaintsHelp the doctor suspect possible causes of the disease, locate the pain.
Assessment of pain intensity- a very important diagnostic stage, allowing you to choose a treatment and evaluate its effectiveness over time. In practice, the image analog scale (VAS) is used, which is convenient for the patient and the physician. In this case, the patient rated the severity of the pain on a scale of 0 to 10, where 0 was no pain and 10 was the worst pain a person could imagine.
Interviewallows you to identify the factors that cause pain and destroy the anatomical structure of the spine, identify movements and postures that cause, strengthen and relieve pain.
Physical examination:evaluate the presence of back muscle spasms, determine the development of the musculature, exclude the presence of signs of an infectious lesion.
Assess neurological status:muscle strength and its symmetry, reflexes, sensitivity.
March test:performed in cases of suspected lumbar spinal stenosis.
Importance!Patients without "red flags" with the classic clinical picture are not recommended to conduct additional studies.
X-ray:performed with functional tests to suspect instability of the structures of the spine. However, this diagnostic method is not common and is done mainly with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):Doctors will prescribe based on clinical data, as these methods have different indications and benefits.
CT |
MRI |
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Importance!In most people, in the absence of complaints, degenerative changes in the spine are detected by instrumental examination.
Measure bone density:performed to evaluate bone density (confirm or rule out osteoporosis). This study was recommended for postmenopausal women at high fracture risk and consistently at age 65, regardless of risk, men older than 70 years, fracture patients with minimal history of trauma, glucocorticosteroids. Castle. The 10-year fracture risk was assessed using the FRAX score.
Bone scan, PET-CT:performed when there are signs of suspicion of cancer according to other examination methods.
back pain treatment
For acute pain:
- pain relievers prescribed in a course, mainly of the group of non-steroidal anti-inflammatory drugs (NSAIDs). Specific drugs and dosages are selected depending on the severity of the pain;
- maintain moderate physical activity, special exercises for pain relief;
Importance!Physical inactivity during low back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.
- muscle relaxants for muscle spasms;
- vitamins can be used, however, their effectiveness according to different studies is still unclear;
- manual therapy;
- lifestyle analysis and risk factors removal.
For subacute or chronic pain:
- use pain relievers as required;
- special physical exercises;
- psychological assessment, as it can be an important factor in the development of chronic pain, and psychotherapy;
- medicines in the class of antidepressants or antiepileptic drugs to treat chronic pain;
- manual therapy;
- lifestyle analysis and risk factors removal.
In lens syndrome, blockade (epidural injection) or blockade is used.
Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, with significant narrowing of the spinal canal, and ineffective conservative treatment. Urgent surgical treatment is performed in the presence of: pelvic disorders with numbness in the anogenital region and progressive weakness of the feet (cauda equina syndrome).
Rehabilitation
Rehabilitation should be initiated as soon as possible and has the following goals:
- improve quality of life;
- eliminate the pain, and if it is not possible to eliminate it completely - relieve it;
- restore operations;
- rehabilitation;
- Self-service and safe driver training.
The basic rules of rehabilitation:
- the patient must feel responsible for his or her own health and adhere to recommendations, however, the physician must select treatment and rehabilitation methods that the patient can adhere to;
- systematic training and observance of safety rules when performing exercises;
- pain is not an obstacle to exercise;
- a relationship of trust must be established between the patient and the physician;
- the patient should not focus and focus on the cause of pain in the form of structural changes of the spine;
- the patient must feel comfortable and safe when performing the movements;
- the patient should feel the positive impact of rehabilitation on his condition;
- the patient needs to develop pain response skills;
- Patients should associate movement with positive thoughts.
Rehabilitation method:
- Take a walk;
- Fitness, physical training and sports programs at the workplace;
- Personal orthopedic appliances;
- Cognitive Behavioral Therapy;
- Patient education:
- Avoid excessive physical activity;
- Resistance to low physical activity;
- Exclude prolonged static loads (standing, in an uncomfortable position, etc. );
- Avoid hypothermia;
- Sleep organization.
Prevent
Optimal physical activity: strengthens the muscular frame, fights bone loss, improves mood and reduces the risk of cardiovascular events. The most optimal physical activity is walking for more than 90 minutes per week (at least 30 minutes at a time, 3 days a week).
With prolonged sedentary work, it is necessary to take a break to warm up every 15-20 minutes and adhere to the sitting rule.
Life hacks:how to sit
- avoid too thick upholstered furniture;
- feet on the floor, the height of the chair is equal to the length of the shins;
- it is necessary to sit at a depth of 2/3 of the length of the hips;
- sit up straight, keep the correct posture, the back should fit snugly with the back of the chair to avoid straining the back muscles;
- The head when reading or working on the computer needs to have a physiological position (looking straight ahead, not bending down continuously). To do this, you should use special stands and install the computer monitor at the optimal height.
For long standing jobs, it is necessary to change positions every 10-15 minutes, alternately changing legs, if possible, walk in place and exercise.
Avoid lying down for a long time.
Life hacks:how to sleep
- Sleep better on semi-hard surfaces. If possible, you can choose an orthopedic mattress so that the spine maintains its physiological curves;
- the pillow should be soft enough and of the right height to avoid straining the neck;
- When sleeping in the prone position, a small pillow should be placed under the abdomen.
Quit smoking: If you're having trouble, see your doctor, who will refer you to a smoking cessation program.
frequently asked Questions
I use ointments with glucocorticosteroids. Am I at increased risk of osteonecrosis or osteoporosis?
No. Topical glucocorticosteroids (ointments, creams, gels) do not penetrate in appreciable amounts into the systemic circulation, and therefore do not increase the risk of developing these diseases.
Is surgery necessary in each case of herniated disc?
No. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.
Should you stop exercising if you have back pain?
No. If the results of additional testing methods do not find anything that could significantly limit the amount of load on the spine, it is possible to continue playing sports, but after undergoing a course of treatment. course of treatment and add certain exercises from the course of physiotherapy and swimming exercises.
Will permanent back pain go away if I have a herniated disc?
They can after an effective course of conservative treatment, follow the recommendations of the attending neurologist, observe the rules of prevention, do regular therapeutic exercise and swim.