Backache

Low back pain is often referred to as low back pain or low back pain. Low back pain or "low back pain" is an attack of acute lower back pain, which is usually associated with hypothermia and exertion. Low back pain occurs in many people and is often the cause of temporary disability. Often, sports injuries or sprains can be the cause of low back pain, but sometimes the factor that causes the pain to appear remains unknown. Low back pain is characterized by pain without radiating to the legs. Low back pain (low back pain) can occur acutely and progress gradually over the course of the day. There is often stiffness in the morning and gradually the stiffness turns into pain syndrome. Curvature of the spine (analgesic scoliosis) is also possible due to muscle spasm. The pain itself can be due to a muscle spasm, which in turn is related to other causes. This can be overload or sprain, sports injury, slipped disc, spondyloarthrosis (spondylosis), kidney disease (kidney infection or kidney stones). Sometimes the patient accurately determines the cause-effect relationship of the appearance of malaise with exertion, hypothermia, but often the pain appears for no apparent reason. Sometimes, back pain can also appear after sneezing, bending, or putting on shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.

Unlike low back pain, the term low back pain does not mean acute pain, but subacute or chronic pain. As a rule, pain with lombosis appears gradually over several days. Pain can also occur in the morning and can decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable body position). It is also characteristic of lumbodynia that pain is relieved by lying down in a certain position. Patients with lumbodynia have difficulty performing routine activities such as washing or wearing shoes due to muscle spasms. Due to the disease, there is a decrease in the volume of trunk movements (forward tilt or, to a lesser extent, lateral tilt or extension). Due to the pain syndrome, the patient often has to change positions when sitting or standing is required. Unlike low back pain, muscle spasm is less pronounced and, as a rule, does not cover the entire lower back, and there are often signs of a prevalence of spasm on one side.

Causes of back pain

Back pain is a symptom. The most common causes of back pain are diseases (injuries) of the muscles, bones and intervertebral discs. Sometimesbackacheit can be caused by diseases of the abdominal cavity, small pelvis and chest. Such pains are called reflex pains. Abdominal disease (eg, appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infection), pelvic organ infections, ovaries - all of these diseases can occurbackache. . . Even a normal pregnancy can lead to lower back pain due to sprains in the pelvic area, muscle spasms due to stress and irritation of the nerves.

Oftenbackacheis associated with the following diseases:

• Compression of the nerve root, which causes the symptoms of sciatica and is most often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is acute, has irradiation and reduced sensitivity in the area of innervation of the nerve root. A herniated disc occurs mainly due to disc degeneration. There is a swelling of the gelatinous part of the disc from the central cavity and pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at the age of 30 and beyond. But the very presence of a hernia does not always lead to an effect on nerve structures.
• Spondylosis - Degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) occur, which can affect nearby nerves, which leads to pain.
• Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience lower back pain radiating to both legs. Low back pain can appear as a result of standing or walking.
• Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs due to compression of the elements of the cauda equina (end of the spinal cord). A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and atony). This syndrome requires emergency surgery.
• Painful syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and tenderness at certain points (trigger points), a decrease in the volume of muscle movement in painful areas. The pain syndrome is reduced by relaxing the muscles located in the painful areas. With fibromyalgia, pain and soreness are common throughout the body. Fibromyalgia is not characterized by muscle pain and tightness.
• Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
• Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially worse in the morning.
• Tumors, most often cancer metastases, can be a source of lower back discomfort.
• Inflammation of the nerves and, consequently, painful manifestations (in the chest or lumbar region) can be caused by damage to the nerves themselves (for example with shingles)
• Given the variety of causes of symptoms, such as acute or subacute low back pain, it is very important to fully evaluate the patient and perform all necessary diagnostic procedures.

Symptoms

Pain in the lumbosacral region is the main symptom of low back pain, low back pain, low back pain.

• The pain can radiate along the front, side or back of the leg (lumbar iscalgia), or it can be localized only in the lumbar region (low back pain, low back pain).
• The feeling that the lower back hurts can intensify after exertion.
• Sometimes the pain can get worse at night or when sitting for a long time, such as during a long car ride.
• Perhaps the presence of numbness and weakness in the part of the leg, which is located in the innervation zone of the compressed nerve.

For timely diagnosis and treatment, a number of criteria (symptoms) deserve special attention:

• A recent history of injury, such as a fall from a height, car accident, or similar incident.
• The presence of minor injuries in patients over the age of 50 (for example, falling from a low height as a result of sliding and landing on the buttocks).
• History of long-term use of steroids (for example, in patients with bronchial asthma or rheumatological diseases).
• Any patient with osteoporosis (mostly elderly women).
• Any patient over the age of 70: at this age there is a high risk of cancer, infections and diseases of the abdominal organs, which can cause lower back pain.
• History of Oncology
• The presence of infectious diseases in the recent past
• Temperature over 100F (37. 7C)
• Drug use: Drug use increases the risk of infectious diseases.
• Low back pain worsens at rest: as a rule, this nature of pain is associated with oncology or infections, and such pain may also be associated with ankylosing spondylitis (ankylosing spondylitis).
• Significant weight loss (for no apparent reason).
• The presence of any acute nerve dysfunction is a signal for urgent medical attention. For example, this is a violation of walking, dysfunction of the foot, as a rule, are symptoms of acute nerve injury or compression. Under certain circumstances, such symptoms may require an emergency neurosurgical operation.
• Bowel or bladder dysfunction (both incontinence and urinary retention) can be a sign of a medical emergency.
• Failure of recommended treatment or increased pain may also require seeking medical attention.

The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.

Diagnostics

History is important in making an accurate diagnosis, as various conditions can cause lower back pain. The timing of pain onset, the relationship with physical exertion, the presence of other symptoms such as cough, increased temperature, bladder or bowel dysfunction, presence of convulsions, etc. A physical examination is carried out: identification of painful points, the presence of muscle spasm, a study of the neurological status is carried out. If a disease of the abdominal cavity or pelvic organs is suspected, an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, urine blood tests).

If the somatic genesis of low back pain is excluded, instrumental research methods such as radiography, CT or MRI may be prescribed.

Radiography is the initial examination method and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.

CT allows you to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).

MRI is the most informative research method that allows you to diagnose morphological changes in various tissues.

Densitometry is needed when osteoporosis is suspected (usually in women over 50)

EMG (ENMG) is used to determine the violation of conduction along the nerve fibers.

Laboratory tests (blood tests, urine tests, blood biochemistry) are prescribed mainly to rule out inflammatory processes in the body.

Pain treatment

After establishing the diagnosis and confirmation of vertebral genesis with low back pain and lumbosis, a certain treatment for low back pain is prescribed.

In acute pain, rest is needed for 1-2 days. Bed rest can reduce muscle tension and muscle spasm. In most cases, when the pain syndrome is due to a muscle spasm, the pain syndrome subsides within a few days without the use of drugs, only due to rest.

Drug. For pain syndrome, drugs from the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also comes with some risks. Since all drugs in this group have many side effects, taking drugs in this group should be short-lived and under the mandatory supervision of a doctor.

Muscle relaxants can be used to relieve spasm. But the use of these drugs is effective only in the presence of a spasm.

Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of pronounced side effects, steroid use should be selective and short-lived.

Manual therapy. This technique can be very effective in the presence of muscle blocks or facet joint subluxations. Motor segment mobilization can reduce both muscle spasm and lower back pain.

Physiotherapy. There are many modern physiotherapeutic procedures that can both reduce pain and inflammation, improve microcirculation (for example, electrophoresis, cryotherapy, laser therapy, etc. ).

Physical therapy. Exercise is not recommended for acute lower back pain. The connection of physical therapy is possible after reducing the pain syndrome. In the presence of chronic pain, exercise can be very effective in strengthening the muscle corset and improving the biomechanics of the spine. Exercises should be selected only with a physical therapy doctor, as often independent exercises can lead to an increase in pain manifestations. Systematic physical therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can preserve the functionality of the spine and significantly reduce the risk of pain syndromes.