Back pain is probably familiar to almost every modern person. Employability can be affected for many reasons. These include back pain, sciatica, osteochondrosis and other pathological changes in the lumbar spine. You should not be careless in this, because back pain can not only reach incredible strength, making a person's life unbearable, but also prove to be a symptom of the most dangerous diseases.
Lower back pain can vary: sharp or dull, aching or burning, local (occurs at one point) or spreads all over the back. Unpleasant sensations also appear in different ways: sometimes abruptly, suddenly and sometimes gradually, which intensify every day.
The response to pain and the ability to tolerate depend on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can not leave the disease to chance. Early treatment will help avoid dangerous consequences.
To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: x-ray, computed tomography or magnetic resonance imaging. Pain attacks, lumbar, occur during life, in about 80% of modern inhabitants of European countries.
Acute or chronic low back pain in the lumbar region is a consequence of a variety of neurological, degenerative-dystrophic diseases in women and men. In some cases, back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why the lower back hurts, we must not forget that the causes of this pain are dozens and a non-professional will never be able to determine the true source of the problems. In general, the medical classification distinguishes between primary and secondary pain syndromes that can affect the lumbar region.
Primary back pain syndrome occurs as a result of musculoskeletal changes of a morphological nature. It is the cause of the vast majority of cases of back pain in the lumbar region. The most important of the causes are the degenerative-dystrophic changes that occur in different parts of the spine:
- Osteochondrosis, which is a damage to the tissues of the bones and cartilage, this disease has a dystrophic character. With this, the intervertebral disc and adjacent vertebrae are affected, the vertebrae begin to develop.
- Spondyloarthritis is a form of osteoarthritis in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine or articular joints.
Secondary pain syndrome has many more varied causes of pain:
- scoliosis, which is a curvature of the spine, as well as some other developmental diseases.
- various inflammations that are not infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc.
- a tumor found in the vertebrae, in the spinal cord itself or in the retroperitoneal space, regardless of whether it is primary or caused by metastases.
- 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 intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. )
- stroke conditions in which there is a severe violation of the blood supply to the spinal cord. In this case, there may also be a feeling of lower back pain.
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction.
- Often back pain is of a reflective nature. A similar problem can occur with certain diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, appendicitis - all of these diseases cause reported back pain).
Acute and chronic back pain
Lumbar pain is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced pain in the lower back is also often observed: in this case, there is a translation of the pain sensations from deeper localized internal organs and structures of the body. that is, it seems to the patient that the lower back hurts, but in reality a completely different part of the body is affected.
Most often, the back hurts in the lumbar region, when the pain is projected in this area by the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their back hurts. But there is a clear recommendation, what exactly you should not do: do self-medication. The causes of pain are so different that only a qualified specialist can make the correct diagnosis.
Possible causes of acute lower back pain include:
- The pain is accompanied by acute muscle tension. In this case, the pain signals are located in the back, provided by spasmodic long muscles. The pain does not tend to move to the groin or the foot area. Human mobility is limited.
- One of the most common and serious causes of severe back pain is a fracture of the spine (fractures of the vertebrae, including compression). As a rule, this happens with an unsuccessful fall, back flexion and other injuries. but if a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, there are cancerous tumors and their metastases in the area of the vertebrae or other lesions of the skeletal system, vertebral fractures can occur literally "from the blue". , and even without fixation by the patient's senses at the time of the fracture.
- An equally unpleasant condition in which the lower back hurts severely is the displacement of the intervertebral discs that has occurred in the spinal area. According to the frequency of lesions, the following areas are distinguished: LV-SII - most often. LIV-LV - second in frequency. LIII-LIV and above are more rare cases.
Symptoms include severe lower back pain, forced posture, limited mobility. Participation in the pathological process of nerve roots is indicated by:
- radical pain, usually unilateral.
- Sensitivity disorders (numbness, increase or decrease in sensitivity level).
- reduction or disappearance of the Achilles reflex (in case of damage to the roots of S or S2).
- reduction of tension or absence of concussion in the knee (indicates damage in the L3-L4 area).
The general tendency is for a protruding intervertebral disc to affect the underlying root (eg, poor LIV-LV alignment causes L5 root pathology). With the defeat of the cauda equina (horse tail), the functions of the bladder and rectum are disrupted. Also, a similar situation can occur with a sharp protrusion of the spinal disc.
The back aches severely in the lumbar region with vision syndrome: in this case, the disc remains unaffected and the pain occurs as a result of compression of the root itself at the exit of the spinal canal. The most common unilateral facial syndrome in the L5 root region. occurs on the basis of the increase in the faces of the intervertebral joint (upper and lower) and, as a result, narrowing of the intervertebral foramen.
Also, severe back pain accompanies an epidural abscess, a serious disease that requires urgent diagnosis and immediate treatment. Most often, the inflammatory process develops in the thoracic region of the spine. the pain becomes particularly strong with a mechanical effect on the area of pathology (pressure, stroke).
If there are signs of spinal cord compression, any highly effective medical measures are recommended, including surgery. Another reason why lower back pain can be diseases of the hip joint - especially coxarthrosis. In this case, the pain is typical, radiating to the lower back, buttocks and legs up to the knees.
Diseases characterized by chronic back pain:
- Deformity is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligament and further development of the bones. the outlets of the bones press on the roots and narrow the spinal canal. If lower back pain is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of intermittent claudication syndrome, which can be caused by narrowing of the spinal canal, should be considered. An examination is required, the results of which determine the final diagnosis.
- Ankylosing spondylitis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, by a decrease in chest movements during breathing. There are traction pains in the lower back. further the curvature of the spine in the thoracic region arises and progresses. X-ray examination corrects abnormalities of the sacroiliac joints: destruction, change of structure, "bamboo" spine. A thorough examination and determination of the reason 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.
- Oncological diseases (tumors, metastases), metabolic disorders (including NBO). It is necessary to exclude such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid gland, kidneys, gastrointestinal tract. lymphoma; multiple myeloma (multiple myeloma). Exceptions are the method of radiography and myelography.
- Osteomyelitis also causes prolonged, aching pain in the lower back. If this disease is suspected, bone tissue x-ray, skin examination with tuberculosis and ESR determination to determine the presence / absence of tuberculosis bacteria or pyogenic bacteria (pyogenic) in the body, usually Staphylococcus - the causative agents.
- Spinal cord tumors (endosclerotic tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause persistent back pain, initially without any accompanying neurological symptoms.
Causes of intermittent back pain. Many diseases of the internal organs cause periodic, acute or pulling pain in the lower back. At the same time, patients do not feel stiffness in the back area, there is no clear localization of pain and the pain does not increase with the maximum possible range of motion. To the question of what to do if the lower back does not hurt constantly, but from time to time, the answer is simple: do not wait until it hurts "as it should", but consult a doctor.
There is a clear effect of the pathology of one or another organ on a specific part of the spine. Thus, from the pelvic organs, the pain radiates to the sacrum, in diseases of the organs located in the lower abdominal cavity, it radiates to the lower back (parts L3-L5) and to the upper part - to the upper parts. lumbar region or the lower part of the thoracic region.
Diseases - the causes of pain in the waist and the area of distribution of pain:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine cancer, the back hurts. In men, such intermittent pain can be caused by chronic prostatitis or by the development of prostate cancer.
- Various kidney diseases cause pain in the joints of the ribs and the spine.
- Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - the pain spreads to the area of parts of the spine T10-L2.
- With ulcerative colitis, diverticulitis or tumors of the colon, the lower back hurts.
- If the back hurts in the chest / lumbar region, aortic dissection (anatomical aneurysm) should be ruled out.
Diagnosis for back pain
For low back pain and back pain, it is recommended that you have a computer (shows the condition of the bone tissue in the spine) and magnetic resonance imaging (allows you to assess the condition of the soft tissues), tomography and ultrasound of internal organs.
One method of diagnosis is x-rays, which are relatively inexpensive and can be useful in detecting a range of disorders, from bone fractures to kidney stones. Many of the changes detected indicate only the correct diagnosis and additional studies may be needed to confirm it. In addition, some radiological changes may be consequential findings that are not the cause of the pain.
It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological condition is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal area. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and waist can be diagnosed and treated.
Sometimes, based on the results of an orthopedic examination of a patient with a symptom of pain in the context of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- lumbar spine x-ray with functional examinations.
- Computed tomography of the lumbar spine.
- MRI of the lumbar spine.
The center of the intervertebral disc is occupied by the gelatinous pulpal nucleus. It is surrounded and supported by a fibrous ring, which consists of fibrous cartilage 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 approaching each other, reducing the intervertebral foramina and endangering the nerves and blood vessels located in them (osteochondrosis).
The protrusion of the discs (protrusion of the intervertebral disc) with their further protrusion in the lumen of the spine (disc herniation) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain radiating to the leg, armback of the head, neck, intercostal spaces in depending on the level of compression of the nerves) with weakening of muscle strength in the areas of their innervation and violation of sensitivity.
Often, a protrusion or hernia of the intervertebral disc is accompanied by muscle pain along the course 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 spine can also be affected. With spinal instability, the vertebrae move forward (anti-slip) or backward (retro-slip). To clarify the diagnosis, a lumbar spine x-ray with functional examinations may be required.
Most often, the nerve bundles that form the sciatic nerve due to their anatomical position suffer from a hernia compression or protrusion of the intervertebral disc. The sciatic nerve is composed 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 its stenosis (narrowing of the spinal canal) and compression of the nerves and spinal cord that pass through it. This is why in case of spinal stenosis, it is always necessary to carry out a complete course of treatment using a whole arsenal of different treatment methods and in case of ineffectiveness, surgical treatment.
Which doctor should I go to?
With back pain, first of all, you should contact a neurologist at the peripheral clinic if the patient's condition is stable or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastrointestinal problems.
Low back pain is associated with various infections, limb injuries. Pain in the lower back with diseases of the heart and lungs is not excluded. This can be seen by an in-depth examination. Once diagnosed, the patient is usually prescribed medications that reduce back pain, normalize blood circulation, and help repair nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and convulsions.
Surgery is usually required to diagnose disc herniation, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, repaired and the pain passes over time.
It is best to relax your spine and paravertebral muscles if you are sleeping on a hard mattress with a small pillow under your knees. At the same time, bed rest should not last long, because this is fraught with weakening of the paravertebral muscles, which will only aggravate the problem. Even with severe pain, you should try to maintain at least some lean physical activity.
How to relieve back pain
The appearance of a pain symptom is often due to muscle spasm, 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 a strong, unexpected pain in the lower back, it is recommended to take a muscle relaxant tablet, rub the back with a warming anesthetic gel. When using funds, you should strictly follow its instructions.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is recommended not to delay to contact a doctor, if at a certain time it is impossible to visit a specialist and the pain is very severe, he can take Pentalgin or No-shpu. The sore spot should not be warmed with a heating pad, as the heat contributes to the spread of the inflammatory process and, consequently, to the amplification of the 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 a strong anti-inflammatory, mild analgesic and antipyretic effect.
The course of treatment is prescribed taking into account the severity of the pain symptom. The ointment for back pain is used as a main or auxiliary treatment. With severe symptoms of osteochondrosis, rubbing the lower back with ketoprofen-based ointments, a substance with a strong analgesic effect, is indicated.
The main advantage of topical preparations is due to their effect not on the whole body as a whole, but on a specific area that needs treatment. Painkillers and anti-inflammatory ointments have fewer contraindications and side effects compared to similar tablets.
Exercises for back pain
Exercise is considered as an additional method of treating diseases of the lower spine. The exercises that appear to patients are quite simple and are not accompanied by a special load on the body. For example, the usual hanging on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate the lumbar spine - pain caused by pinching of its nerve roots. Therapeutic exercises for back ailments, accompanied by lower back pain, include exercises:
- raising the legs (so that the knee touches the chin).
- "bicycle", performed lying on his back.
- walking on his knees.
It is recommended to give exercises no more than 10-15 minutes every day, with severe pain - to refuse to perform them.