Almost all adults have suffered from back pain in their lifetime. This is a very common problem, which can be based on various reasons, which we will analyze in this article.
Causes of back pain
All causes of back pain can be divided into groups:
Skeletal muscle:
- Osteochondrosis;
- slipped disc;
- compression radiculopathy;
- spondylolisthesis;
Inflammatory, including infectious:
- Osteomyelitis
- Tuberculosis
neurological;
injuries;
endocrinological;
Vascular;
Cancer.
At 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" refers to a specific data set of complaints and medical history that require a thorough examination of the patient.
"Red flags":
- age of the patient at the onset of pain: less than 20 years or more than 50;
- a severe spinal injury in the past;
- the appearance 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 - weakening;
- no improvement for 1 month or more;
- dysfunction of the pelvic organs, including urination and defecation disorders, numbness of the perineum, symmetrical weakness of the lower limbs;
- alcoholism;
- drug use, especially intravenously;
- treatment with corticosteroids and / or cytostatics;
- with neck pain, the throbbing nature of the pain.
The presence of one or more signs by itself does not mean the presence of a dangerous pathology, but it does require a doctor's attention and diagnosis.
Back pain is divided into the following forms by duration:
- acute- pain lasting less than 4 weeks;
- subacute- pain lasting from 4 to 12 weeks;
- chronic- pain lasting 12 weeks or more;
- relapse of pain- resumption of pain if it has not occurred in the last 6 months or more;
- exacerbation of chronic painPain relapse less than 6 months after the previous episode.
Diseases
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 of the vertebral discs and, subsequently, the vertebrae themselves.
Is osteochondrosis a pseudodiagnosis? - 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 is due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. However, this term specifically refers to a degenerative disease of the spine in people of any age. In addition, dorsopathy and back pain are often established diagnoses.
- Dorsopathy is a pathology of the spinal column;
- Back pain is nonspecific benign back pain that spreads 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, sacral and coccygeal. 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 section, and in other sections they have a weakly expressed nucleus pulposus with its regression, on average, by 30 years), which make them more susceptible to stress and injury , which lead to stretching of the ligaments and the 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 to 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 monitor position, which creates a load on the neck;
- violation of posture;
- congenital structural features and spinal anomalies;
- weakness of the back muscles;
- high growth;
- excess body weight;
- diseases of the joints of the legs (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. ;
- natural wear with age;
- to smoke.
slipped discit is a protrusion of the nucleus of the intervertebral disc. It can be asymptomatic or cause compression of surrounding structures and manifest as radicular syndrome.
Symptoms:
- violation of the range of motion;
- feeling of stiffness;
- muscle tension;
- irradiation of pain to other areas: arms, shoulder blades, legs, groin, rectum, etc.
- "blows" of pain;
- numbness;
- feeling of crawling;
- muscle 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 to 8 weeks on average.
Compression radiculopathy
Radicular (radicular) syndrome is a complex of manifestations that occur due to compression of the spinal roots at the starting points from the spinal cord.
Symptoms depend on the level at which spinal cord compression occurs. Possible manifestations:
- pain in the extremity of a stabbing nature with irradiation in the fingers, aggravated by movement or cough;
- numbness or a sensation of flies crawling in a certain area (dermatomes);
- muscle weakness;
- spasm of the back muscles;
- violation of the strength of reflexes;
- positive symptoms of tension (the appearance of pain with passive flexion of the limbs)
- limitation of spinal mobility.
Spondylolisthesis
Spondylolisthesis is the displacement of the upper vertebrae relative to the lower one.
This condition can occur in both children and adults. Women are most often affected.
Spondylolisthesis may cause no symptoms with a slight displacement and may be an accidental radiographic finding.
Possible symptoms:
- feeling of discomfort
- pain in the back and lower limbs after physical work,
- weakness in the legs
- radicular syndrome,
- decreased pain and tactile sensitivity.
The progression of spinal 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, pain may decrease in the supine position,
- the pain is not aggravated by coughing and sneezing,
- the nature of the pain to be pulled 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 severe 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 localization of pain.
Assessment of pain intensity- a very important phase of diagnosis, which allows you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is convenient for the patient and the physician. In this case, the patient rates the severity of the pain on a scale of 0 to 10, where 0 points is not pain and 10 points is the worst pain a person can imagine.
Interviewallows you to identify the factors that cause pain and destruction of the anatomical structures of the spine, to identify the movements and postures 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 an infectious lesion.
Evaluation of the neurological status:muscle strength and its symmetry, reflexes, sensitivity.
March test:carried out in case of suspected lumbar stenosis.
Important!Patients without "red flags" with a classic clinical picture are not recommended to conduct further studies.
Radiography:performed with functional tests for suspected instability of the structures of the spinal column. However, this diagnostic method is not informative and is mostly performed 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 |
magnetic resonance |
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Important!In most people, in the absence of ailments, degenerative changes in the spine are detected according to methods of instrumental examination.
Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women at 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 assessed using the FRAX scale.
Bone scan, PET-CT scan:carried out in the presence of suspicion of oncological disease according to other methods of examination.
back pain treatment
For acute pain:
- painkillers are prescribed in one course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dosage are selected based on the severity of pain;
- maintain moderate physical activity, special exercises to relieve pain;
Important!Physical inactivity with back pain increases pain, prolongs the duration of symptoms and increases the likelihood of chronic pain.
- muscle relaxants for muscle spasms;
- 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 relievers on request;
- special physical exercises;
- assessment of the psychological state, as it can be a significant factor in the development of chronic pain, and psychotherapy;
- drugs from the group of antidepressants or antiepileptic drugs for the treatment of chronic pain;
- manual therapy;
- lifestyle analysis and elimination of risk factors.
In radicular syndrome, blocks (epidural injections) or intraosseous blocks are used.
Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, with significant stenosis of the spinal canal, and the ineffectiveness of conservative therapy. Emergency surgical treatment is carried out in the presence of: pelvic disorders with numbness of the anogenital region and ascending weakness of the feet (cauda equina syndrome).
Rehabilitation
Rehabilitation should be started as early as possible and have the following objectives:
- improve the quality of life;
- elimination of pain and, if it is impossible to completely eliminate it, relief;
- restoration of operation;
- rehabilitation;
- self-service training and safe driving.
Basic rules of rehabilitation:
- the patient must feel his responsibility for his own health and compliance with the recommendations, however the doctor must choose the methods of treatment and rehabilitation that the patient can follow;
- systematic training and compliance with safety regulations during the execution of the exercises;
- pain is not an obstacle to exercise;
- a relationship of trust must be established between the patient and the doctor;
- the patient does not have to focus and focus on the cause of pain in the form of structural changes in the spine;
- the patient must feel comfortable and safe during the execution of the movements;
- the patient should feel the positive impact of rehabilitation on her condition;
- the patient needs to develop pain response skills;
- the patient should associate movement with positive thoughts.
Rehabilitation methods:
- Walking;
- Physical exercises, gymnastics, workplace gymnastics programs;
- Individual orthopedic devices;
- Cognitive Behavioral Therapy;
- Patient Education:
- Avoid excessive physical activity;
- Combat low physical activity;
- Exclusion of prolonged static loads (standing, being in an uncomfortable position, etc. );
- Avoid hypothermia;
- Organization of sleep.
Prevention
Optimal physical activity: strengthens the muscle structure, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes per week (at least 30 minutes at a time, 3 days per week).
With prolonged sedentary work, it is necessary to take breaks for warming up every 15-20 minutes and follow the rules of the session.
Tricks for life:how to sit down
- avoid overly upholstered furniture;
- the legs should 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 correct posture, your back should fit snugly against the back of the chair to avoid straining the back muscles;
- the head when reading a book or working on the computer should be in a physiological position (look straight ahead and not constantly down). To do this, it is recommended to use special stands and install the computer monitor at the optimum 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 lying down for a long time.
Tricks for life:how to sleep
- sleep better on a semi-rigid surface. If possible, you can choose an orthopedic mattress so that the spine maintains physiological curves;
- the pillow must be soft enough and of medium height to avoid stress on the neck;
- when sleeping in the prone position, it is recommended to put a small pillow under the stomach.
Quit Smoking: If you are having difficulty, consult your doctor who will refer you to a smoking cessation program.
Frequent questions
I use glucocorticosteroid ointments. Am I at an increased risk of osteochondrosis or osteoporosis?
No. External glucocorticosteroids (ointments, creams, gels) do not enter the systemic circulation in significant quantities 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 further examination methods, the doctor does not find anything that significantly limits the degree of load on the spine, it is possible to continue to play sports, but after undergoing a course of treatment and adding some exercises gives the course of physiotherapy and swimming exercises.
Can back pain go away forever if I have a herniated disc?
They can after a course of productive conservative therapy, after further implementation of the recommendations of the present neurologist, compliance with the rules of prevention, regular physical therapy and swimming.