Back pain in the lumbar region is familiar to everyone. According to statistics, it is she who becomes the cause of 25% of all requests for medical care. Its appearance can cause many different factors, from banal fatigue to quite serious illnesses. Therefore, you should not ignore the problem, especially if the discomfort appears regularly and even more with time. In such situations, you should contact a therapist as soon as possible or go directly to a neurologist and have a full examination.
This will help diagnose the disease in the early stages of its development and take timely action to stop its progression. But if on the eve of the onset of pain there was an injury or an unsuccessful fall, you should immediately register for a consultation with a traumatologist or spine surgeon.
Characteristics of low back pain and associated symptoms
Low back pain can be of different nature and severity. They can be loud, pull, whine, pull, etc. They are able to intensify during physical exertion, sitting or standing for a long time, and switch to rest or not. These are all important diagnostic factors that allow the doctor to make the correct diagnosis and find the true cause of the patient's condition.
Of fundamental importance in making a diagnosis is whether the pain radiates to the hip, buttock, knee, foot and if so, where and how. Also, an important point is the presence of restrictions on the mobility of the spine, whether the patient can freely tilt, turn the body or the range of motion is reduced.
Pain in the spine is called lumbodynia. If it spreads to the legs, it is called lumboischialgia.
Acute pains are those that persist less than 3 months, otherwise they speak of chronic pain. In the latter case, the disease is often accompanied by periods of exacerbation and remission.
Low back pain rarely occurs in isolation. In most cases, a complex of other disorders is also present, which patients themselves rarely associate with each other. Often back pain is associated with:
- feeling of crawling in the back and / or legs, numbness;
- muscle weakness;
- pain in the hip, knee joints;
- pelvic organ disturbance (menstrual irregularities, problems with potency, loss of control over urination, defecation);
- paralysis of the legs.
Similar signs indicate pathology of the spine.
But since not only can they cause the onset of back pain, there is another group of symptoms that can accompany lower back pain and indicate pathology of internal organs or cancer. Therefore, you should pay special attention to your own state when it appears:
- rapid and unnecessary weight loss;
- cuts and pain in the groin, perineum;
- increased urination, pain;
- increased body temperature, chills;
- changes in skin color in the area of the epicenter of pain;
- menstrual irregularities, unusual discharge.
If low back pain is associated with one or more of the above symptoms, you should seek immediate medical attention. When symptoms appear in the first group, consultation with a neurologist is required, from the second, help from a urologist, gynecologist, endocrinologist or other close specialists is required. The therapist will help you understand exactly which doctor to contact.
Causes of occurrence
All causes of back pain in the lumbar region can be divided into 2 groups: diseases of the spine and pathologies of internal organs, in particular gynecological diseases, pathologies of the kidneys, organs of the gastrointestinal tract-intestinal, endocrine disorders. But still, more often than not, they are the consequence of the development of changes in the spine and surrounding muscles. The most common causes of back pain are:
osteochondrosis- ;
- spondylosis;
- inflammatory diseases of the spine; myofascial syndrome
- ;
- ankylosing spondylitis; scoliosis
- ;
- injuries.
However, low back pain can also be the result of overwork or certain physiological changes. In such situations, they do not require special treatment, but only a decrease in physical activity and a more thrifty day regimen.
Osteochondrosis and intervertebral hernias
Osteochondrosis is the most common disease of the spine. Its development is often associated with inevitable age-related changes, as almost all older people have more or less their symptoms.
Osteochondrosis is the price humanity has to pay to be able to walk upright. It is characterized by a gradual destruction of the intervertebral discs, their thinning, a decrease in elasticity and firmness. As a result, they stop coping with stress and can swell. Thus, intervertebral hernias are formed.
Most often, osteochondrosis affects the intervertebral discs of the lumbar spine. When protruding into the spinal canal or foramen foramen, the nerves are almost inevitably impaired, which leads to the appearance of sharp pains in the lower back and their irradiation to the legs and buttocks.
Spondylosis
Spondylosis is a complication of advanced osteochondrosis, in which the intervertebral discs are almost completely destroyed and, due to ongoing degenerative processes and an increased load on the spine, bony protrusions called osteophytesform along the edges of the vertebrae.
Therefore, there is a high risk of compression and injury to nearby nerves. This causes severe pain which can radiate to the legs.
Inflammatory diseases of the spine
Most often inflammatory diseases of the spine occur in young people and mainly in men. They cause severe pain that bothers even at night, which is their specific difference. As it progresses, without prompt treatment, the pain becomes more severe and bothers the person more often.
It is not uncommon for patients to see a doctor several years after the onset of symptoms. As a result of such a long course of the inflammatory process in the spine, irreversible changes can occur, which can ultimately lead to immobility and disability.
Sometimes, in addition to lower back pain, there is discomfort in the joints of the legs and arms. In such cases, the cause of the discomfort may be arthritis, osteomyelitis.
Myofascial syndrome
Myofascial syndrome is a common condition in which pain occurs after prolonged stay in an awkward position or after physical exertion. Slightly more often myofascial syndrome occurs in women. With him, back pain occurs after reckless movement or physical exertion. Its peculiarity is the presence of so-called trigger points on the spasmodic muscles of the lumbar region and buttocks, pressure on which results in a sudden attack of pain. Myofascial syndrome significantly reduces the quality of human life, but does not pose a serious threat.
Bechterew's disease
Ankylosing spondylitis or ankylosing spondylitis is a chronic joint disease in which the sacroiliac joint, the joints of the spine and the surrounding soft tissues are primarily affected. With this disease, people are concerned about lower back and sacral pain and stiffness in movement, but the symptoms usually go away without a trace in the afternoon and night.
In addition, physical activity has a beneficial effect on the well-being of the patient and contributes to the elimination of the pain syndrome. A fairly specific symptom of ankylosing spondylitis is stooped curvature, curvature of the spine, and progressive limitation in mobility.
Scoliosis
Scoliosis is a lateral curvature of the spine. It can be of varying severity, which directly affects the intensity of back pain and other symptoms. Since the deformation of the spine leads to displacement of all anatomical structures, the nerves are often pinched, causing severe pain. In addition, other neurological signs may be present, including a feeling of numbness and paresis.
Compression fractures
In older people with osteoporosis and trauma, low back pain may be the result of an undetected spinal compression fracture. As a result, the vertebrae are flattened and occupy an abnormal position, which leads to the incorrect distribution of the load on the spine, degenerative processes in the intervertebral discs and the appearance of pain.
Physiological causes of low back pain
Performing heavy physical work, intense sports training creates an increased load on the muscles, as a result of which lactic acid accumulates in them, causing pain. Back pain is not uncommon with prolonged wearing of uncomfortable shoes, especially with heels.
In addition, lower back pain is often seen during pregnancy. In such situations, they are caused by a shift in the center of gravity and increased stress on the spine.
Diagnostics
To determine the causes of back pain in the lumbar region, it is recommended to consult a neurologist. Initially, you can consult a therapist, but, most likely, the doctor will always refer the patient to a neurologist.
During the appointment, the specialist will carry out a thorough investigation of the patient, find out what worries him, what lifestyle he leads, etc. In addition, an examination is necessary, during which the doctor assesses the severity of the reflexes, performs neurological tests and assesses the patient's mobility. Based on the results obtained, the doctor can make a preliminary diagnosis and understand what type of violations led to the appearance of back pain and lower back pain.
To confirm existing hypotheses, to determine the exact causes of pain, a complete examination of the patient is performed, which may include:
- general and biochemical blood tests - with their help, changes in the blood are detected, indicating inflammatory processes in the body, the presence of infection or a tumor;
- general urinalysis - used to differentiate kidney disease as a cause of pain in the lower back area;
- X-ray - shows the presence of a change in the bone structures of the spine, signs of fractures, provides information on bone density and allows you to diagnose major diseases of the spine, as well asosteoporosis (detection of pathologies of the spine is a reason for further examination by computed tomography or MRI);
- is a modern method of radiation diagnosis, which allows you to visualize all bone structures very clearly and to detect the slightest deviations from the norm;
- MRI - provides comprehensive information on the condition of soft tissues and cartilage, including intervertebral discs, with the help of MRI it is possible to diagnose intervertebral hernias of any size, changes inblood vessels, tumors.
The scannerTreatment of low back pain
Treatment of back pain is chosen strictly individually. At the same time, it is still complex and includes symptomatic therapy, changes in lifestyle and treatment aimed at eliminating the identified causes of low back pain. Therefore, if the first 2 components of therapy are usually universal and are prescribed for all patients, then etiotropic therapy is developed strictly individually, taking into account the existing disease.
In most cases, patients are initially offered conservative therapy, the main component of which is drug therapy. In more difficult cases, it is further recommended to carry out a course of physiotherapy, manual therapy and exercise therapy procedures.
But in any case, all patients with low back pain should:
- forgo heavy lifting and exhausting sports;
- to reduce weight in the presence of obesity;
- take regular breaks to warm up if a person is forced to sit for a long time;
- to increase the level of physical activity, but to avoid overwork and hard work (daily walks, morning exercises, performing a special complex of exercise therapy, swimming);
- use a support bandage, which will relieve the load on the lower back and thus provide favorable conditions for early recovery of the spine.
Depending on the source of the pain, patients may be advised to stay in bed for a few days or, conversely, to increase their level of physical activity, but within reasonable limits. For example, pain caused by nerve compression forces you to rest your back for a few days. In other diseases, on the contrary, moderate physical activity is one of the obligatory components of therapy. It helps to increase the effectiveness of drug treatment, reduce the risk of complications and prevent disability.
Unfortunately, conservative therapy cannot always be used to treat low back pain. In some cases, it turns out to be ineffective and does not give any results even after several months of constant compliance with medical recommendations. In other situations, the results of examinations show the presence of a pathology that can no longer be eliminated by non-surgical methods. In such situations, patients are advised to consult a neurosurgeon and perform appropriate surgery to restore the normal anatomy of the spine.
Drug treatment
To improve the patient's condition and quickly relieve pain, the following is prescribed:
- NSAIDs in the form of tablets, injections and topical preparations - have analgesic and anti-inflammatory properties;
- corticosteroids - given as a short course to control severe inflammation;
- muscle relaxants - needed to relieve muscle spasm, which is often a reflex reaction of the body to pain and makes it worse; Vitamins B
- - improve nerve conduction by normalizing the nutrition of nerve fibers and increasing the speed of transmission of nerve impulses.
For severe pain that cannot be tolerated, blockages can be performed. The procedure involves injecting an anesthetic solution directly into the area of pain or passage of nerve fibers. Thus, it is possible for a while to completely stop the pain syndrome and improve the patient's well-being.
But the blockade has only a temporary effect, and its implementation is possible only in a medical institution, since most often it is necessary to inject the drug into the points in the immediate vicinity ofthe spine, where a mass of nerves passes. Therefore, illiterate execution of the procedure can lead to serious and sometimes fatal consequences.
In addition to the drugs listed above, a set of others is prescribed, which helps to eliminate the underlying disease that caused the pain syndrome. Therefore, patients may also be prescribed antibiotics, chondroprotectors, immunomodulators, and drugs from other groups.
Physiotherapy
Physiotherapy treatments are often prescribed for patients with spinal disorders. Thanks to the correctly selected method of physical impact and the frequency of procedures, it is possible to achieve a pronounced anti-inflammatory and analgesic effect, as well as improve microcirculation, accelerate the elimination of edemalocal, muscle spasms, etc. Physiotherapy significantly increases the effectiveness of other methods of treatment, but is mainly used only after the elimination of acuteprocesses.
Most often patients are prescribed:
electrophoresis- ;
- UHF; ultrasound therapy
- ; magnetic therapy
- ; Reflexology
- ;
- diadynamic currents, etc.
Typically, the flow of procedures consists of 8-10 sessions, which are performed with some frequency.
Manual therapy
With osteochondrosis, scoliosis, and a number of other diseases, manual therapy sessions can have a truly amazing effect on the condition of the spine. But only a qualified chiropractor can competently lead a manual therapy session and benefit the patient, not harm.
The use of special techniques of manual exposure allows to achieve not only an improvement in microcirculation, relaxation of too toned and too relaxed muscles, but also an increase in the distance between the vertebrae, as well as normalizationof their position. A qualified chiropractor is able to find the place where the nerve is pinched and relieve the pressure of the anatomical structures on it.
Literally, after the first session, the majority of patients notice an improvement in their well-being and a significant decrease in the severity of the pain syndrome until it is completely eliminated. But to consolidate the results obtained, it is recommended to take a full course of manual therapy, and in the future to take support courses.
exercise therapy
Physical therapy exercises help the body cope with the stress it is under. For each disease, a special set of exercises has been developed, the regular implementation of which allows you to solve the most important tasks of the current situation. So, with the help of a correctly selected complex of physiotherapy exercises, it is possible to return the muscles to a normal tone and strengthen them. Thanks to this, the spine will experience less stress, which will become an effective prevention of the progression of the disease and create favorable conditions for its recovery.
Exercise therapy also helps improve blood circulation in the affected area, which speeds up the course of inflammatory processes and more likely leads to complete recovery. Exercise appropriate for many conditions can help reduce low back pain and reduce the frequency of its occurrence.
The training program is developed individually for each patient. This takes into account not only the type of pathology detected and the degree of its severity, but also the presence of concomitant diseases, the patient's level of fitness, age and other factors. Only a specialist is able to correctly choose the most effective and safe set of exercises.
The first lessons take place under his supervision. During these, the patient learns how to perform each proposed exercise correctly so that it is beneficial. Gradually, the load is increased, bringing it to the optimum level. But it is not recommended to increase the number of repetitions of exercises yourself or to complicate them. Any changes to the physiotherapy exercise program are introduced only by a specialist.
It is enough for the patient to strictly follow his recommendations and to practice daily in a comfortable environment. All the exercises are performed at a slow pace. Sudden movements are not allowed. But if pain occurs during the lesson, the exercise should be stopped immediately and consult your doctor as soon as possible.
Back pain surgery
Most often, the help of a spinal surgeon is needed for intervertebral hernias, the formation of which has resulted in spinal root damage and the development of radicular pain. If the bulge has already formed, it is impossible to force it to be removed by modern, non-invasive methods. The only way to eliminate it and at the same time get rid of lower back pain is to remove the intervertebral hernia by surgery.
There are several types of surgeries used for intervertebral hernias. The specific tactics of the surgical intervention are determined depending on the type, location and size of the hernia:
- Nucleoplasty and hydroplasty are methods of percutaneous surgery that remove part of the nucleus pulposus by puncturing tissue with a diameter of several centimeters and reduce the size of the hernia.
- Microdiscectomy is a radical way to solve the problem of an intervertebral hernia, which involves the removal of it or the entire disc through an incision up to 3 cm in length. But, unlike other methods, it allows you to remove a hernia of any size, regardless of its location in the spinal canal, and release it from a pinched nerve even in the most difficult part of the spine.
- Endoscopic surgery - involves the removal of a herniated disc by punctures up to 1 cm in diameter using special equipment with a video camera. It can be used to resect hernias of any size, but the technique cannot be used to remove neoplasms in anatomically difficult places.
Also, help from a spinal surgeon is needed for scoliosis. In this case, all forces are directed to restore the normal axis of the spine. Previously, this required making a large incision extending over most of the back. But today, it is possible to correct the deformity of the spine minimally invasively with miniature incisions.
Different types of metal structures are used to restore the normal axis of the spine, but their essence is roughly the same. The structure is fixed on the vertebrae with special screws and by correcting its tension at different points, it is possible to put the displaced vertebrae back in their place and fix them in the correct position. Modern types of metal structures allow, over time, to improve the initial result of the operation without reintervention in the body. This is achieved by correcting the position of the installed structure using special screws.
Surgery cannot be avoided in cases of vertebral fractures. In such situations, you can only get rid of back pain and lower back pain by restoring the normal shape, size and position of the vertebrae. Recently, kyphoplasty and vertebroplasty have been performed for this purpose. The essence of both operations comes down to the fact that through a thin puncture needle, a special bone cement is injected into the vertebrae destroyed as a result of injury. 
It fills all free space and hardens after 10 minutes. But in severe compression fractures, preference is given to kyphoplasty, as it can also help restore the normal shape of the vertebra, which in the future will ensure the correct distribution of the load on the spine and reduce therisk of complications. This operation involves the prior introduction of a special balloon into the destroyed vertebra, which is gradually inflated, returning the vertebra to its original appearance. After that, the balloon is lowered and removed, and the formed cavity is filled with bone cement.
So, back pain can be the result of physiological changes, joint muscle fatigue or a symptom of serious pathologies of the spine or internal organs. Therefore, if they occur regularly and especially against the background of the action of the same factors, do not hesitate and ignore the problem. Contact qualified specialists to make the treatment as quick and easy as possible. And if the disease could not be recognized in the early stages of its development, the modern level of neurosurgery will allow it to be removed surgically with minimal risk of complications.