Almost every adult has experienced back pain during their lifetime. This is a very common problem, which can be based on several reasons, which we will analyze in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Musculoskeletal:
- Osteochondrosis?
- herniated disc;
- Compressive radiculopathy?
- Spondylolisthesis?
Inflammatory, including infectious:
- Osteomyelitis
- Tuberculosis
neurological;
Injuries?
Endocrinological?
Vascular;
Volume.
During the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refer to a set of specific complaints and recollections that require an in-depth examination of the patient.
"Red flags":
- age of the patient at the time of onset of pain: less than 20 or more than 50.
- severe 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;
- unusual localization of pain.
- increased pain in a horizontal position (especially at night), in a vertical position - weakness.
- No improvement for 1 month or more.
- dysfunction of the pelvic organs, including disorders of urination and defecation, numbness of the perineum, symmetrical weakness of the lower limbs.
- alcoholism;
- the use of drugs, especially intravenous.
- treatment with corticosteroids and/or cytostatics.
- with pain in the neck, the throbbing nature of the pain.
The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but requires a doctor's attention and diagnosis.
Back pain is divided into the following forms during:
- acute- pain lasting less than 4 weeks.
- subacute- pain lasting from 4 to 12 weeks.
- chronic- pain lasting 12 weeks or more.
- recurrence of pain- recurrence of pain if it has not occurred within the last 6 months or more.
- worsening of chronic painRecurrence of pain less than 6 months after the previous episode.
Illnesses
Let's talk more about the most common, musculoskeletal causes of back pain.
Osteochondrosis
This is a disease of the spine, which is based on the wear and tear of the vertebral discs and, subsequently, the vertebrae themselves.
Is osteochondrosis a false diagnosis? - Not. This diagnosis exists in the International Classification of Diseases ICD-10. Currently, doctors are divided into two camps: some believe that such a diagnosis is incorrect, others, on the contrary, often diagnose osteochondrosis. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents related to growth. However, this term specifically refers to a degenerative disease of the spine in people of any age. Also, often established diagnoses are dorsal and dorsal.
- Spinal pathology is a pathology of the spine.
- Dorsal back pain is a benign non-specific 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 sections: cervical, thoracic, lumbar, sacrum and coccyx. Pain can occur in any of these areas, which is described by the following medical terms:
- Neck pain is pain in the cervical spine. The intervertebral discs of the cervical region have anatomical features (the intervertebral discs are absent in the upper part, and in other parts they have a weakly expressed nucleus pulposus with its regression, on average, by 30 years), which makes them more susceptible to stress. and injury, leading to stretching of the ligaments and early development of degenerative changes.
- Thoracalgia - pain in the thoracic spine.
- Lumbodynia - pain in the lumbar spine (lower back).
- Low back pain is pain in the lower back that radiates down the leg.
Factors leading to the development of osteochondrosis:
- heavy physical work, lifting and moving heavy loads.
- low physical activity;
- long sedentary work;
- long stay in an uncomfortable position.
- long work at the computer with a non-optimal screen position, which creates a load on the neck.
- violation of body posture.
- congenital structural features and anomalies of the spine.
- back muscle weakness;
- high growth;
- excess body weight;
- diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc.
- natural wear and tear with age.
- smoking.
herniated discis a protrusion of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of the surrounding structures and manifest as a radicular syndrome.
Symptoms:
- range of motion violation.
- feeling stiff;
- muscle tension?
- radiating pain to other areas: arms, shoulder blade, legs, groin, rectum, etc.
- "shootings" of pain;
- numbness;
- dragging feeling;
- muscular weakness;
- pelvic disorders.
The location of the pain depends on the level at which the hernia is located.
Herniated discs often resolve on their own within 4-8 weeks on average.
Compression radiculopathy
Radical (root) syndrome is a complex of manifestations that appear due to compression of the spinal roots at the points of their departure from the spinal cord.
Symptoms depend on the level at which spinal cord compression occurs. Possible events:
- shooting pain with radiation to the fingers, aggravated by motion or coughing;
- numbness or a crawling sensation in a certain area (dermatomas);
- muscular weakness;
- back muscle spasm;
- violation of the strength of reflexes.
- positive tension symptoms (appearance of pain with passive flexion of the limbs)
- limitation of spinal mobility.
Spondylolisthesis
Spondylolisthesis is the displacement of the upper vertebra relative to the lower one.
This condition can occur in both children and adults. Women are more often affected.
Spondylolisthesis may cause no symptoms with slight displacement and may be an incidental radiographic finding.
Possible symptoms:
- feeling of discomfort
- pain in the back and lower limbs after physical work,
- weakness in the legs
- root syndrome,
- reduced pain and touch sensitivity.
The progression of vertebral displacement can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, which gradually leads to compression of the nerves and blood vessels in the spinal canal. Symptoms:
- constant pain (both at rest and in motion),
- in some cases, the pain may decrease in the supine position,
- the pain does not worsen with coughing and sneezing;
- the nature of the pain from pulling to very strong,
- dysfunction of the pelvic organs.
With a strong displacement, compression of the arteries can occur, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person can fall.
Diagnostics
Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the location of the pain.
Assessment of Pain Intensity- a very important stage of diagnosis, which allows you to choose a treatment and evaluate its effectiveness over time. In practice, the visual analog scale (VAS) is used, which is convenient for the patient and the doctor. In this case, the patient rates the severity of the pain on a scale from 0 to 10, where 0 points are no pain and 10 points are the worst pain imaginable.
Interviewallows you to identify factors that cause pain and destruction of the anatomical structures of the spine, to identify movements and positions that cause, intensify and relieve pain.
Physical examination:assessment of the presence of spasm of the back muscles, determination of the development of the muscular skeleton, exclusion of the presence of signs of infectious damage.
Assessment of neurological status:muscle strength and its symmetry, reflexes, sensitivity.
March test:performed in cases of suspected lumbar stenosis.
Great!In patients without "red flags" with a classic clinical picture, additional studies are not recommended.
X-ray:performed with functional tests for suspected instability of spinal structures. However, this diagnostic method is non-informative and is mainly carried out with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, as these methods have different indications and benefits.
CT |
MRI |
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Great!In most people, in the absence of complaints, degenerative changes in the spine are detected according to instrumental examination methods.
Bone Densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fractures and always at the age of 65, regardless of risk, men over 70, fracture patients with a minimal history of trauma, long-term use of glucocorticosteroids. The 10-year fracture risk is estimated using the FRAX scale.
Bone scintigraphy, PET-CT:it is carried out in the presence of suspicion of oncological disease according to other examination methods.
back pain treatment
For acute pain:
- Painkillers are prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage are chosen depending on the severity of the pain.
- maintaining moderate physical activity, special exercises to relieve pain.
Great!Physical inactivity with back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.
- Muscle relaxants for muscle spasm.
- it is possible to use vitamins, however, their effectiveness according to various studies remains unclear.
- manual therapy;
- lifestyle analysis and elimination of risk factors.
For subacute or chronic pain:
- use of pain medication on demand;
- special physical exercises.
- assessment of psychological status, as it may be an important factor in the development of chronic pain and psychotherapy.
- medicines from the group of antidepressants or antiepileptic medicines to treat chronic pain.
- manual therapy;
- lifestyle analysis and elimination of risk factors.
Blocks (epidural injections) or intraosseous blocks are used in radicular syndrome.
Surgical treatment is indicated with a rapid increase in symptoms, in the presence of spinal cord compression, with significant narrowing of the spinal canal and ineffectiveness of conservative treatment. Urgent surgical treatment is performed in the presence of: pelvic disorders with numbness in the anogenital area and ascending weakness of the legs (cauda equina syndrome).
Reform
Rehabilitation should begin as soon as possible and have the following objectives:
- improving quality of life;
- elimination of pain and if it is impossible to eliminate it completely - relief.
- restoration of function;
- Reform;
- self-service and safe driving training.
Basic recovery rules:
- the patient must feel his own responsibility for his health and compliance with the recommendations, however, the doctor must choose the methods of treatment and rehabilitation with which the patient can comply.
- systematic training and compliance with safety rules when performing exercises.
- Pain is not an obstacle to exercise.
- a relationship of trust must be established between the patient and the doctor.
- the patient should not focus and focus on the cause of pain in the form of structural changes in the spine.
- the patient must feel comfortable and safe when performing movements.
- the patient must feel the positive effect of rehabilitation on his condition.
- the patient must develop pain response skills.
- the patient must associate the movement with positive thoughts.
Recovery methods:
- Walking;
- Physical exercises, fitness, fitness programs in the workplace.
- Individual orthopedic devices.
- Cognitive Behavioral Therapy?
- Patient Education:
- Avoid excessive physical activity.
- Combating low physical activity.
- Exclusion of prolonged static loads (standing, uncomfortable position, etc. ).
- Avoid hypothermia.
- Sleep organization.
Prevention
Optimal physical activity: strengthens the muscular framework, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. Optimal physical activity is walking for more than 90 minutes per week (at least 30 minutes at a time, 3 days per week).
With prolonged sitting work, it is necessary to take warm-up breaks every 15-20 minutes and follow the rules of sitting.
Life hack:
how to sit
- Avoid overly upholstered furniture.
- the legs must rest on the floor, which is achieved with the height of the chair equal to the length of the lower leg.
- it is necessary to sit at a depth of up to 2/3 of the length of the hips.
- Sit straight, maintain the correct posture, the back should fit comfortably against the back of the chair to avoid straining the back muscles.
- the head when reading a book or working on a computer should have a normal position (you look straight ahead and not constantly down). To do this, it is recommended to use special supports and install the computer monitor at the optimal height.
With prolonged standing work, it is necessary to change the position every 10-15 minutes, alternately changing the supporting leg and, if possible, walking in place and moving.
Avoid prolonged lying down.
Life hack:
how to sleep
- sleep better on a semi-rigid surface. If possible, you can choose an orthopedic mattress so that the spine maintains normal curves.
- the pillow should be soft enough and of medium height to avoid pressure on the neck.
- when sleeping in a prone position, it is recommended to put a small pillow under the stomach.
Stop smoking: If you are having difficulty, see your doctor who will refer you to a smoking cessation program.
Frequent questions
I use glucocorticosteroid ointments. Am I at increased risk of osteochondrosis or osteoporosis? No. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation and therefore do not increase the risk of developing these diseases.
Is surgery necessary in every 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, as a result of additional examination methods, the doctor does not find anything that would significantly limit the degree of loading on the spine, then it is possible to continue playing sports, but after undergoing a course of treatment and adding some exercises from the course of physiotherapy exercisesand swimming.
Can back pain go away forever if I have a herniated disc? They can after a course of productive conservative treatment, subject to further implementation of the recommendations of the treating neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.