Pain in the spine (dorsopathy) is a universal body language indicating that there is trouble in the body. There are almost as many causes as there are terms used to describe the symptoms.
Spinal discomfort is the number one reason people seek medical attention. Nearly 80% of the adult population faces this problem. Back pain causes a significant level of disability and can be a problem that lasts from childhood to adulthood.
Dorsopathy affects almost every aspect of life. Sleep is disrupted and it becomes difficult to bend, reach or turn around. Difficulties arise when driving a car, walking, lifting objects and doing physical exercises. If you experience pain in your spine, you should seek medical attention immediately. The specialist will study the medical history, collect anamnesis and conduct an examination. If violations are detected, conservative or surgical treatment is prescribed.
Why does my spine hurt?
The cause of dorsopathy is muscle tension and spasms. Tension can be the result of intense physical work, uncomfortable positions and even poor posture.
Studying the anatomy of the spine can help understand the problem on a deeper level. Main parts of the spine:
- The cervix is a mobile segment subject to degenerative changes. As we age, pain often occurs in the "transition zone" between the flexible cervical vertebrae and the more rigid thoracic part of the spine.
- Thoracic – connected to the chest and ribs. In particular, older adults may experience compression fractures in this area due to bone loss.
- Lumbar – lower back. Younger patients are more prone to discogenic low back pain, while older patients are more likely to suffer from joint structural disorders.
- Sacral – the lowest part of the spine. It consists of a flat, triangular sacrum bone that connects to the hips and tailbone. Degeneration of this area usually occurs in elderly patients or after a fall.
Between the upper back and the coccyx are 17 vertebral bodies, numerous joints, the sacrum and coccyx, as well as fibrous and muscular support structures, the intervertebral discs, the spinal cord and nerve roots, and the vesselsblood. The spine is more than the sum of its parts, but here's what you need to know about those parts.
The spine is generally made up of 33 vertebrae, each divided by an intervertebral disc. Vertebrae are a series of small bones to which muscles are attached. Each vertebra is made up of two parts: the anterior body, which protects the spinal cord and nerve roots, and the posterior arch, which houses the canal and also protects the spinal cord.
The back muscles are divided into three groups:
- intermediate - responsible for the movement of the ribs;
- internal – stabilizes the spine, controls the movement and position of the spine;
- superficial – provides movement of the neck and upper limbs.
The muscles that support the spine are structured in layers. They function as the main stabilizers of bone and ligament structures. Tensions of these muscles are possible in patients of different age groups.
There are other parts of the spine that need to be considered when determining dorsopathy. These include ligaments and tendons, intervertebral discs and joints that provide stability and mobility.
Inflammatory diseases, malignancies, pregnancy, trauma, osteoporosis, nerve root compression, radiculopathy, plexopathy, osteochondrosis, herniated disc, spinal stenosis, sacral joint dysfunctioniliac joint, facet joint injuries, and infections are all part of the differential. Distinguishing the signs and symptoms of nociceptive (mechanical) pain from radiculopathy (neuropathic dorsopathy) is an important first step in establishing a diagnosis.
Degenerative pathologies
Degeneration includes endplate-related changes (sclerosis, defects, modal changes, and osteophytes) as well as disc changes (fibrosis, annular tears, desiccation, loss of height, and mucinous annular degeneration).
Degenerative changes in the disc are already observed in a third of healthy people aged 21 to 40 years. The high prevalence of asymptomatic degeneration should be considered when evaluating spinal symptoms.
With age, the intervertebral disc becomes more fibrous and less elastic. Degenerative changes progress when the structural integrity of the posterior annulus fibrosus is compromised by overload. This will eventually lead to the formation of cracks in the annulus fibrosus. A herniation is defined as a displacement of disc material (cartilage, nucleus, fragmented annular tissue, and apophyseal bone) beyond the intervertebral disc space.
Rachiocampsis
The natural curves of the spine are important to ensure its strength, flexibility and ability to evenly distribute load. There is a normal range of natural curves. Abnormal curvatures include lordosis, kyphosis and scoliosis.
Abnormal lordosis
Lordosis, a spinal disorder, is defined as a severe inward curvature of the spine. Although this disease most often affects the lumbar spine, it can also develop in the cervical spine.
The normal range of lordosis is considered to be between 40 and 60 degrees. Changes in posture can lead to unsteady gait and changes in silhouette - the buttocks become more visible. Causes of abnormal lordosis: spondylolisthesis, osteoporosis and obesity.
Abnormal kyphosis
Kyphosis, a spinal disorder, is defined as excessive outward curvature of the spine and can result in forward leaning. It most often affects the thoracic or thoracolumbar region, but can also occur in the cervical region.
The normal range for kyphosis is considered to be between 20 and 45 degrees. But when a structural abnormality causes a kyphotic curve to develop outside of this normal range, the curvature becomes abnormal and problematic. Manifested by rounding the shoulders and tilting the head forward.
Scoliosis
Defined as an abnormal lateral curvature of the spine. Scoliosis is a progressive structural disease. Lordosis and kyphosis are characterized by a backward or forward curvature of the spine. Scoliosis involves an abnormal sideways curvature of the spine.
The most common form of scoliosis is adolescent scoliosis, diagnosed between the ages of 10 and 18. The remaining 20% are due to neuromuscular, congenital, degenerative and traumatic causes.
Developmental anomalies
The symptom often occurs with developmental defects and may be associated with neurological manifestations.
Dorsopathy is present with the following developmental abnormalities:
- Division – in case of small bone defects, there is moderate discomfort in the lumbosacral region. After a while, radicular syndrome appears.
- Lumbarization, sacralization - compression of the roots is accompanied by shooting or burning pain. Sensitivity disorders or paresis may be added.
- Wedge-shaped vertebrae - discomfort occurs when exercising under stress and maintaining a static body position for a long time. Accompanied by chest deformation and poor posture.
Osteoporosis
Typically affects the thoracic and thoracolumbar spine and can cause debilitating pain. This disorder is caused by a loss of bone mineral density, which leads to brittle bones.
Osteoporosis can cause vertebral compression fractures, loss of height, hunched posture, and even hunchback. To prevent osteoporosis, it is necessary to ensure a balanced diet, quit smoking and abuse alcohol. An active lifestyle is also recommended.
Injuries
The severity of dorsopathy corresponds to the severity of the injury. As a rule, this is associated with signs of damage to nervous tissue.
Traumatic causes of pain in the spine:
- A bruise is the result of a direct blow or a fall to the back. Dorsopathy is local, moderate. Disappears gradually in 1 to 2 weeks.
- Dislocation – occurs due to high energy impact. Accompanied by severe pain associated with impaired sensitivity and motor activity. The general condition also suffers.
- Spondylolisthesis is a traumatic injury to the spine in the lumbar region. Dorsopathy radiates to the legs, there is a positive symptom of axial loading.
- Compression fracture - occurs when falling on the buttocks or jumping from a height. At first, the pain is sharp, then becomes intense and progresses with movement.
Pathological fractures that occur against the background of osteoporosis or tumors are manifested by minor discomfort, throbbing and aching pain. They remain unchanged for a long time.
Inflammatory and infectious diseases
Ankylosing spondylitis is accompanied by a feeling of stiffness and dull pain in the lumbar region. There is a characteristic circadian rhythm: symptoms appear at night and intensify in the morning. The intensity decreases after physical activity and water procedures. Dorsopathy increases at rest and decreases with movement. Over time, spinal mobility is limited and thoracic kyphosis forms.
Also, pain in the spine occurs in cases of tuberculosis. Deep local discomfort is characteristic of spinal destruction. Dorsopathy increases with exercise and is accompanied by excessive skin sensitivity. With shooting and radiating pain, we speak of compression of the nerve roots. The condition is complemented by stiffness of movements.
With osteomyelitis, there is intense dorsopathy. The disease is diagnosed in patients of childhood and adolescence. Characterized by hematogenous nature. Discomfort increases with movement, so the patient remains in bed. Osteomyelitis is accompanied by fever, weakness and local swelling.
Arachnoiditis manifests itself as pain that radiates to the area of innervation of the nerve roots. The symptoms become constant and resemble sciatica. Added to them are motor disorders, sensitivity disorders and a loss of the ability to control the pelvic organs.
Tumors
Benign tumors have a hidden course or are accompanied by meager and slowly progressive symptoms. Most often, hemangiomas appear, which appear only in 10-15% of cases. The discomfort is painful, local. Progresses at night and after physical activity. Spinal cord neoplasia is accompanied by radicular pain and impaired nerve conduction.
Spinal sarcomas in the primary stage of progression are manifested by intermittent moderate pain, which intensifies at night. Accompanied by limitation of motor activity and radicular syndrome. The discomfort is localized in the internal organs, legs or arms (taking into account the level of localization of the tumor).
Other diseases
Discomfort in the spine is also observed with:
- Spinal epidural hemorrhage - similar to signs of radiculitis, accompanied by spinal conduction disorder.
- Calvet's disease - radiates to the legs, occurs periodically, is mildly expressed. Decreases when lying down, increases during physical activity.
- Forestier's disease - localized in the thoracic region, spreads to the lower back or neck. Symptoms are usually short-lived. May be accompanied by pain in the elbow or shoulder joints. Spinal stiffness cannot be ruled out.
Dorsopathy sometimes occurs with mental disorders. In this case, the clinical picture is unusual - it does not correspond to the symptoms of possible diseases.
Causes of back pain by location
Chronic upper back dorsopathy affects 15-19% of people worldwide. Postmenopausal women are at greater risk, possibly due to osteoporosis and vertebral compression fractures.
Work activities also cause back pain. Those who must maintain a static body position for long periods of time, such as dentists or salespeople, are more likely than others to experience this problem. Office workers experience upper back discomfort due to poor workplace ergonomics.
Dorsopathy can occur in different locations on the spine. The localization zone indicates the cause of the discomfort and greatly facilitates diagnosis.
Right side pain
The cause is excessive body weight, herniated disc or myositis. On the right side of the back, discomfort also occurs with kyphosis.
Among the somatic pathologies are salpingitis, inflammation of the ovaries, nephritis, cholecystitis. Appendicitis and the presence of stones in the organs of the urinary system should also be highlighted.
Left side pain
The left back hurts from splenitis (inflammation of the spleen), urolithiasis, oophoritis, duodenitis, pinched roots. Discomfort above the lower back indicates inflammation of the serous membranes of the lungs, bronchial damage, ischemia and intercostal neuralgia.
Pain in the lumbar region
The lumbar region is more often than others prone to the development of pathological processes from the spine. This is due to the fact that it supports a colossal load. When the nerve roots are damaged, an inflammatory process develops. Hernia protrusion and osteochondrosis are also possible.
More rarely, the cause is a combination of prostatitis and urethritis, a violation of the structure of bone tissue, a decrease in density, lumbar sciatica, arthritis, spinal tuberculosis. Discomfort in the lower back is in most cases chronic.
Pain in the lower back on the right
Dorsopathy occurs when:
- myositis;
- tuberculosis;
- scoliosis;
- osteomyelitis;
- spondyloarthritis.
May indicate the presence of a neoplasm. I'm talking about radiculitis. Indicates liver dysfunction.
Pain in the left lumbar region
The discomfort is localized mainly after physical activity. The condition returns to normal after rest. If the discomfort does not improve with rest, then we speak of scoliosis, osteochondrosis, spinal infections and circulatory disorders.
Pinched nerve
In the vast majority of cases, the sciatic nerve is pinched (sciatica). At the same time, its myelin sheath is not damaged. Most often it develops against the background of osteochondrosis. Accompanied by acute and severe symptoms that radiate to the lower back, sacrum and lower limbs.
Spinal nerve roots are also compressed during compression radiculopathy. The cause is a herniated disc or a decrease in the distance between the vertebrae. "Superficial" discomfort is felt, which sharply intensifies during exercise, sneezing, coughing.
Intervertebral hernia
It is characterized by an extrusion (protrusion) of the nucleus into the intervertebral canal. In most cases, it develops against the background of osteochondrosis. The central part of the extruded core compresses the spinal cord. Even a slight load leads to the progression of the pathological process. Dorsopathy is acute and acute, radiating to the leg or arm.
Pain in the shoulder blades
Depending on the nature of the dorsopathy, a presumptive diagnosis can be determined:
- dull, growing – stomach ulcer;
- acute, worsening with movement – intercostal neuralgia;
- numbness of the hands, pressure changes, dizziness – osteochondrosis;
- radiating below the clavicle - exacerbation of angina pectoris.
Pain along the spine and back
Develops due to pinched nerve endings against the background of curvature of the spine. If the symptoms are not clearly expressed, we can speak of protrusion. Increased symptoms indicate osteochondrosis, myositis or fracture.
Severe discomfort along the spine indicates wear or thinning of the intervertebral discs. May indicate spondyloarthritis. The pain is constant and sharp.
Pain below the waist
Most often they occur with spondyloarthrosis and osteochondrosis. Less commonly observed in diseases of the female genital area (oophoritis, cervicitis, endometritis, etc. ). They can appear during pregnancy, during menstruation, with appendicitis, ulcerative colitis. In men, indicate diseases of the bladder or prostate.
Diagnostic
First, a physical exam is performed to identify signs indicating the need for further testing. The medical examination includes the following procedures:
- Back and posture examination to identify anatomical abnormalities.
- Palpation/percussion of the spine - assessment of the condition of the spine and painful areas.
- Neurological examination - assessment of reflexes, spinal sensitivity and gait characteristics. For patients with suspected radiculopathy, the neurological examination should focus on the L5 and S1 nerve roots.
Patients with a psychological disorder contributing to back pain may have associated physical signs, also called Waddell signs. These include patient overreaction during physical examination, superficial tenderness, and unexplained neurological deficits (eg, sensory loss, sudden weakness, or jerky movements during motor examination). The presence of multiple Waddell signs indicates a psychological component of dorsopathy.
Treatment of spinal pain
In case of dorsopathy, treatment must be carried out by a doctor. The specialist refers the patient for examination and, based on the results obtained, prescribes effective treatment.
Additional therapeutic measures should be used with caution and after consulting a doctor. Any type of medication carries risks and possible side effects, so self-medication is not acceptable.
Help before diagnosis
Basic home remedies that can be effective in combating mild to severe pain caused by muscle tension include:
- Short rest period. Many episodes of lower back pain can be relieved by eliminating physical activity. It is not recommended to rest for more than 2-3 days, as prolonged inactivity hinders healing.
- Change of activity. It is recommended to stay active, but avoid activities and body positions that aggravate dorsopathy. For example, if sitting for long periods of time in a car or at a table increases discomfort, then you should warm up every 20 minutes.
- Exposure to heat or cold. A heating pad or warm bath relaxes tense muscles and improves blood circulation, reducing discomfort. If your lower back hurts due to inflammation, you can use ice or cold compresses to reduce the swelling.
The most common over-the-counter medications for dorsopathy are ibuprofen, naproxen, and acetaminophen. Medications relieve inflammation and reduce discomfort in the lower back.
Conservative therapy
Oral drug therapy:
- Painkillers. Patients are prescribed drugs from the anilide group, such as paracetamol. Provides a long-lasting analgesic effect. They have a synergistic effect with NSAIDs and are used in combination to improve pain relief without increasing toxicity.
- Non-steroidal anti-inflammatory drugs. They have analgesic properties. At higher doses they have an anti-inflammatory effect.
- Muscle relaxers. They act centrally, influencing the activity of muscle stretch reflexes. The combination of an NSAID and a muscle relaxant provides significant relief from dorsopathy. The main side effects are drowsiness, headache, dizziness and dry mouth.
- Neuropathic analgesics. Tricyclic antidepressants relieve chronic pain. Low doses may be enough to control symptoms. They do not work immediately and may need to be continued for several weeks before symptoms improve. Plays a potential role when discomfort is mediated by both peripheral and central mechanisms.
Local or regional anesthesia, administered by injection, is part of the treatment regimen for some patients with back pain. The injection site may be an area of local injury or a myofascial trigger point (painful muscle area).
Epidural corticosteroid injections are used for radicular pain that does not respond to less invasive treatments. Used to relieve intervertebral hernias, spinal stenosis and radiculopathy. Reduce dorsopathy and quickly restore sensory functions.
Surgery
A small percentage of people with back pain require surgery to improve their condition. Surgical indications vary depending on patient characteristics and include:
- severe radicular symptoms, especially in the presence of progressive neurological motor deficits;
- radicular symptoms that are not amenable to conservative treatment.
The choice of surgical intervention is determined by the characteristics of the spinal cord injury. The operation is most effective when the clinical picture of patients is dominated by manifestations of nerve compression. The most common problem is inadequate neuronal decompression. Associated diseases including hip arthritis, osteoporosis and cardiovascular disease.
Surgery for patients with radicular pain due to a herniated disc primarily involves decompression. The protruding, extruded or insulated disc material is removed. The nerve root is examined and released.
Prevention
Complications are largely determined based on etiology. They are divided into physical and social. The first includes chronic pain, deformities, neurological effects with motor or sensory deficits, intestinal or bladder lesions. In social terms, complications are generally measured by disability and reduced performance.
Patients of all ages should:
- eliminate bad habits;
- lead an active lifestyle;
- strengthen the protective functions of the body;
- lift heavy objects correctly;
- undergo preventive examinations by a doctor.
It is important not to slouch and to keep your back straight. The place to sleep and work should be organized properly. It is recommended to perform light gymnastic exercises every day after waking up. You should also balance your diet by enriching it with foods containing sufficient vitamins and minerals. It is recommended to take a contrast shower in the morning.