Back pain is probably familiar to almost all modern people. Employability can be affected for a wide variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be distracted at this, because back pain can not only reach incredible strength, making a person's life unbearable, but also turn out to be a symptom of the most dangerous diseases.
Lower back pain can be varied: sharp or dull, aching or burning, local (appears in one spot) or spread throughout the back. Unpleasant sensations also appear in different ways: sometimes suddenly, suddenly and sometimes gradually, intensifying every day.
The response to pain and the ability to tolerate it depend on many factors: age, mental characteristics, accompanying symptoms, and other factors. But either way, you can't leave the disease to chance. Timely 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 examination, MRI or computerized resonance. Attacks of pain, lumbosacral, appear during life, in about 80% of modern residents of European countries.
Acute or chronic back pain in the lumbar region is a consequence of a variety of neurological, degenerative-dystrophic diseases of women and men. In some cases, back pain is a consequence of diseases of the internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Realizing why the lower back hurts, we must not forget that the causes of such pain are dozens, and a non-professional will never be able to determine the true source of the problems. In general, the medical classification separates primary and secondary pain syndromes that can affect the lumbar region.
Primary low back pain syndrome occurs as a result of morphofunctional musculoskeletal alterations. He is the cause of the vast majority of cases of back pain in the lumbar region. The most significant of the causes are degenerative-dystrophic changes that occur in various parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissues, this disease has a dystrophic character. With it, the intervertebral disc and adjacent vertebrae are affected, spondylosis begins to develop.
- spondyloarthrosis is a form of osteoarthritis, in which the disease affects the intervertebral joints, which are responsible for the mobility of the spine, or the synovial joints.
Secondary pain syndrome has much more different causes of pain:
- scoliosis, which is a curvature of the spine, as well as some other growth diseases;
- various inflammations that are not infectious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc. ;
- a tumor localized on 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 perhaps 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 serious violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back hurts;
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
- back pain is often of a reflex nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, venereal diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis and andexitis - all of these diseases cause reported back pain).
Acute and chronic low back pain
Pain in the lumbar region is also divided into acute and chronic pain caused by various diseases of the nerve endings or the spine itself. The so-called displaced low back pain is also often observed: in this case there is a translation of the painful sensations from internal organs and deeper body structures; in other words, 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 pain is projected into this area from the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients don't know what to do if their lower back hurts. But there is a clear recommendation, what exactly should not be done - self-medicate. The causes of pain are so diverse that only a qualified specialist can make a correct diagnosis.
Possible causes of acute back pain include:
- The pain is accompanied by a sharp stretching of the muscles. In this case, pain signals are localized in the back, they are provided by spasmodic long muscles. The pain does not tend to travel to the groin or leg 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 fractures). As a rule, this happens with an unsuccessful fall, bending of the back and other injuries; but in the event that a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system are present, vertebral fractures can occur literally "out of the blue", and even without fixation by the patient's sensations at the time of the fracture.
- An equally unpleasant situation where the lower back hurts a lot is the displacement of the intervertebral discs that has occurred in the vertebral region. According to the frequency of lesions, the areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIV and higher are rarer cases.
Symptoms include severe lower back pain, forced posture, impaired mobility. Participation in the pathological process of the nerve roots is indicated by:
- root pain, usually one-sided;
- sensitivity disorders (numbness, increased or decreased sensitivity level);
- decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
- decreased intensity or absence of a knee jerk (indicates damage to the L3-L4 area).
The general trend is for a protruding intervertebral disc to affect the underlying root (eg, LIV-LV misalignment causes L5 root pathology). With the defeat of the cauda equina (ponytail), the functions of the bladder and rectum are disturbed. Also, a similar condition can occur with a strong protrusion of the spinal disc.
The back hurts a lot in the lumbar region with facet syndrome: in this case, the disc remains unaffected and the pain appears as a result of compression of the root itself at the exit of the spinal canal. The most commonly observed facet syndrome of the unilateral type in the L5 root area; arises on the basis of an increase in the facets of the intervertebral joint (upper and lower) and, consequently, narrowing of the intervertebral foramen.
In addition, severe lower 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 the pathology (pressure, tapping).
If there are signs of spinal cord compression, any highly effective medical measures, including surgery, are recommended. Another reason why the lower back hurts can be diseases of the hip joint, mainly coxarthrosis. In this case, the pain is characteristic, radiating to the lower part of the lower back, buttocks, and also from the legs to the knees.
Diseases characterized by chronic low back pain:
- Deforming spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligament apparatus and further bone growth; the bony growths press on the roots and narrow the spinal canal. In the event that aching pain in the lower back is accompanied by leg weakness, 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 establish the final diagnosis.
- Ankylosing spondyloarthrosis (or Bechterew's disease). In an initial phase it is characterized by reduced mobility, especially in the morning, by a reduction in the movements of the chest during breathing. There are back pains in the lower back; in addition, the curvature of the spine in the thoracic region arises and progresses. An X-ray exam resolves the abnormalities of the sacroiliac joints: destruction, change in structure, "bamboo" spine. A thorough examination is necessary and find out why the lower back hurts, 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, kidney, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged and aching pain in the lower back. If this disease is suspected, a bone x-ray, tuberculin skin test and ESR determination are done to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causative agents of osteomyelitis.
- Spinal cord tumors (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without any accompanying neurological symptoms.
Causes of back pain of an intermittent nature. Many internal organ diseases cause periodic, sharp, or pulling pain in the lower back. At the same time, patients do not have a feeling of stiffness in the back area, there is no clear localization of pain, and the pain does not increase with the greatest possible freedom of movement. When asked what to do if the lower back hurts not 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 influence of the pathology of one or another organ on a certain section of the spine. Then, 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 (segments L3-L5), and in the upper - to the segments of the upper part of the lumbar area or the lower part of the chest area.
Diseases: the causes of back pain and the pain distribution area:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine cancer, the lower back hurts. In men, this intermittent pain can be caused by chronic prostatitis or the development of prostate cancer.
- Various kidney diseases cause pain in the joints of the ribs and spine.
- Tumors of the stomach, duodenum, peptic ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - pain spreads to the region of the spinal segments T10-L2;
- With ulcerative colitis, diverticulitis, or colon cancers, the lower back hurts;
- If the back hurts in the thoracic / lumbar regions, aortic dissection (dissecting aneurysm) should be excluded.
Diagnosis for low back pain
For low back pain and back pain it is recommended to undergo computed tomography (shows the state of the bone tissues of the spine) and magnetic resonance imaging (allows you to assess the state of the soft tissues) and ultrasound of the internal organs.
One method of diagnosis is radiography, which is relatively inexpensive and can be useful for detecting a range of ailments, from bone fractures to kidney stones. Many of the changes found only suggest the correct diagnosis and further studies may be needed to confirm it. Additionally, some radiological changes may be concomitant findings that are not the cause of the pain.
It all starts with a neurological and orthopedic visit by a doctor. During this examination, the neurological status of the patient is assessed and possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the back muscles and the gluteal region. Already at this stage of the study, it is possible to diagnose and treat a patient with osteochondrosis of the spine and back and lower back pain.
Sometimes, based on the results of an examination by an orthopedist of a patient with a painful symptom against the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- x-ray of the lumbosacral spine with functional tests;
- CT scan of the lumbosacral spine;
- MRI of the lumbosacral spine.
The center of the intervertebral disc is occupied by the gelatinous nucleus pulposus. It is surrounded and supported by a fibrous ring, consisting 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 move closer, reducing the intervertebral foramina and endangering the nerves and vessels found in them (osteochondrosis).
The protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (herniated disc) more often leads to compression of the nerve roots, causing pain along the compressed nerve (pain radiating to the leg, arm, back of the head, neck, intercostal spaces depending on the level of compression of the nerve) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.
Often, a protrusion or herniated 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 spinal segment can also be compromised. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). An x-ray of the lumbosacral spine with functional tests may be required to clarify the diagnosis.
Most often, the nerve bundles that form the sciatic nerve due to their anatomical location suffer from compression of a hernia or protrusion of the intervertebral disc. The sciatic nerve consists of L5, S1, S2, S3 fibers - spinal nerves.
The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord passing through it. That is why in case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods and, in case of ineffectiveness, surgical treatment.
Which doctor should I contact?
With pain in the spine, first of all, you should contact a neurologist at the district clinic, if the patient's condition is stable, or call an ambulance. Back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Back pain is combined with various infections, limb injuries. Pain in the lower back with diseases of the heart and lungs is not excluded. This is established by a thorough examination. After the patient is diagnosed, he is usually prescribed drugs that reduce back pain, normalize blood circulation and help restore nerve tissue. These can be tablets, gels, ointments or injections that relieve inflammation and spasms.
Surgery is usually required when diagnosing a herniated disc, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, restored, and the pain passes over time.
It is best to relax the spine and paravertebral muscles if you sleep on a firm mattress with a small pillow under your knees. At the same time, bed rest should not last too 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 weak physical activity.
How to relieve back pain
The occurrence of a painful symptom is often due to a 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 severe and 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, it is necessary to strictly follow its instructions.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of internal organs, it is recommended not to delay contact with a doctor, if at a certain time it is impossible to visit a specialist and the pain is too intense, Pentalgin can be taken o No-shpu. The sore spot should not be heated with a heating pad, as heat contributes to the spread of the inflammatory process and, consequently, to the strengthening of the accompanying symptoms.
Back pain ointment
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 pronounced anti-inflammatory, mild analgesic and antipyretic effect.
The course of treatment is prescribed taking into account the severity of the pain symptom. Back pain ointment is used as the main or auxiliary treatment. With pronounced symptoms of osteochondrosis, it is indicated to rub the lower back with ointments based on ketoprofen, a substance with a powerful analgesic effect.
The main advantage of local 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 than similar drugs in the form of tablets.
Exercises for back pain
Gymnastics is considered an additional method of treating diseases of the lower spine. The exercises shown to patients are quite simple and are not accompanied by a special load on the body. For example, the usual hanging from the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate low back pain, pain caused by pinching its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower part, include exercises:
- raise the legs (so that the knee touches the chin);
- "bicycle", performed lying on the back;
- walking on your knees.
Every day it is recommended to perform exercises no more than 10-15 minutes, with pronounced pain, to refuse to perform them.