Almost every adult has experienced 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 several groups:
musculoskeletal:
- Osteochondrosis;
- disc herniation;
- compression radiculopathy;
- Spondylolisthesis;
Inflammation, including infection:
- Osteomyelitis
- Tuberculosis
neurological;
Injury;
Endocrinologist;
blood vessel;
Tumor.
At the first visit to the doctor with back pain, the specialist should determine the cause and type of pain, paying special attention to the "red flags" - possible manifestations of a potentially dangerous disease. The "red flag" refers to a series of complaints and specific anamnesis data that require an in-depth examination of the patient.
"red flag":
- patient's age at onset of pain: younger than 20 or older than 50;
- a serious spinal injury in the past;
- the appearance of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, Lyme disease, etc. );
- 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;
- pelvic organ dysfunction, including impaired urination and defecation, numbness of the perineum, symmetrical weakness of the lower extremities;
- alcoholism;
- use of narcotic drugs, especially intravenously;
- treatment with corticosteroids and/or cytostatics;
- with pain in the neck, a throbbing nature of the pain.
The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but requires the attention of a doctor and a diagnosis.
Back pain is divided into several forms based on the duration:
- I- pain lasts less than 4 weeks;
- subacute- pain that lasts from 4 to 12 weeks;
- chronic- pain that lasts 12 weeks or more;
- recurring pain- resumption of pain if it has not occurred in the last 6 months or more;
- exacerbation of chronic painRecurrent pain less than 6 months after the previous episode.
Disease
Let's talk more about the most common causes of musculoskeletal back pain.
Osteochondrosis
This is a disease of the spine, which is based on the wear and tear of the spinal discs and, subsequently, the spine itself.
Is osteochondrosis a pseudodiagnosis? - No. This diagnosis is in the International Classification of Diseases ICD-10. Today, doctors are divided into two camps: some believe that such a diagnosis is wrong, others, on the contrary, often diagnose osteochondrosis. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. However, the term refers specifically to degenerative diseases of the spine in people of all ages. Also, the most common diagnoses are dorsopathy and dorsalgia.
- Dorsopathy is a pathology of the spine;
- Dorsalgia is a benign non-specific back pain that radiates from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.
The spine has several parts: cervical, thoracic, lumbar, sacral, and coccyx. Pain can occur in any of these areas, which is described by the following medical terms:
- Cervicalgia is pain in the cervical spine. The intervertebral discs in the cervical region have anatomical features (the intervertebral discs are absent in the upper part, and in the other they have a weakly expressed nucleus pulposus with regression, on average, 30 years), which makes them more susceptible to stress and injury, whichleads 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);
- Lumboischialgia is pain in the lower back that radiates to the legs.
Factors that lead 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 hours in front of a computer with a monitor that is not optimally located, which puts a strain on the neck;
- violation of posture;
- congenital structural features and anomalies of the spine;
- back muscle weakness;
- high growth;
- overweight;
- diseases of the joints of the feet (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. . ;
- natural wear and tear with age;
- smoke.
disc herniationis a protrusion of the intervertebral disc nucleus. It can be asymptomatic or cause compression of surrounding structures and manifest as a radicular syndrome.
Symptom:
- violation of the range of motion;
- stiff feeling;
- muscle tension;
- irradiation of pain to other areas: arms, shoulder blades, legs, groin, rectum, etc.
- "shot" of pain;
- numb;
- crawling sensation;
- muscle weakness;
- pelvic disorders.
The localization of pain depends on the degree to which the hernia is localized.
Disc herniation often resolves on its own in an average of 4-8 weeks.
Compression radiculopathy
Radicular (radicular) syndrome is a complex of manifestations that occurs due to compression of the spinal roots at the point of their departure from the spinal cord.
Symptoms depend on the degree to which spinal cord compression occurs. Possible manifestations:
- pain in the extremities of a shooting nature with irradiation to the fingers, aggravated by movement or coughing;
- numbness or feeling of flies crawling in a certain area (dermatoma);
- muscle weakness;
- back muscle spasms;
- violation of the power of reflexes;
- positive symptoms of tension (the appearance of pain with passive flexion of the limbs)
- limited spinal mobility.
Spondylolisthesis
Spondylolisthesis is the displacement of the upper vertebra relative to the lower one.
This condition can occur in both children and adults. Women are more often affected.
Spondylolisthesis may be asymptomatic with little displacement and may be an accidental X-ray finding.
Possible symptoms:
- uncomfortable feeling
- pain in the back and in the lower extremities after physical work,
- weakness in the legs
- radicular syndrome,
- decreased pain and touch sensitivity.
The development of vertebral displacement can lead to lumbar stenosis: the anatomical structure of the spine degenerates and grows, which gradually leads to compression of the nerves and blood vessels in the spinal canal. Symptom:
- constant pain (both at rest and on movement),
- in some cases, the pain may be reduced in the supine position,
- the pain is not aggravated by coughing and sneezing,
- the nature of the pain from pulling to very strong,
- pelvic organ dysfunction.
With a strong displacement, compression of the arteries may occur, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person can fall.
Diagnostic
Complaints collectionhelps the doctor to suspect a possible cause of the disease, to determine the localization of pain.
Pain Intensity Assessment- a very important stage of diagnosis, allowing you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analog Scale (VAS) is used, which is convenient for both the patient and the doctor. In this case, the patient evaluates the severity of pain on a scale from 0 to 10, where 0 points are no pain, and 10 points are the worst pain a person can imagine.
Interviewallows you to identify the factors that provoke pain and the destruction of the anatomical structures of the spine, to identify movements and postures that cause, intensify and relieve pain.
Physical examination:assessment of the presence of back muscle spasms, determination of skeletal muscle development, exclusion of signs of infectious lesions.
Neurological status assessment:muscle strength and symmetry, reflexes, sensitivity.
March test:performed in cases of suspected lumbar stenosis.
Important!Patients without "red flags" with classic clinical features are not recommended for additional studies.
Radiography:performed with functional tests for suspected spinal structural instability. However, this diagnostic method is not informative and is carried out mainly with limited financial resources.
Computed tomography (CT) and/or magnetic resonance imaging (MRI):doctors will prescribe based on clinical data, because this method has different indications and benefits.
CT |
MRI |
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Important!In most people, in the absence of complaints, degenerative changes in the spine are detected according to the method of instrumental examination.
Bone Densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women with a high risk of fracture and always aged 65 years, regardless of risk, men over 70 years, patients with fractures with a history of minimal trauma, long-term use of glucocorticosteroids. The risk of fracture over 10 years was assessed using the FRAX scale.
Bone scintigraphy, PET-CT:performed in the presence of suspicion of oncological disease according to other examination methods.
back pain treatment
For acute pain:
- painkillers are prescribed in the course, mainly from the group of nonsteroidal anti-inflammatory drugs (NSAIDs). Specific drugs and doses are selected depending on the severity of the 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, but their effectiveness according to various studies is still unclear;
- manual therapy;
- lifestyle analysis and risk factor elimination.
For subacute or chronic pain:
- use of painkillers on request;
- special physical exercises;
- assessment of the psychological state, as it can be an important 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 risk factor elimination.
In the radicular syndrome, blockade (epidural injection) or intraosseous block is used.
Surgical treatment is indicated by a rapid improvement in symptoms, the presence of spinal cord compression, with significant spinal canal stenosis, and the ineffectiveness of conservative therapy. Emergency surgical treatment is carried out in the presence of: pelvic disorders with numbness in the anogenital region and weakness of the rising leg (cauda equina syndrome).
Rehabilitation
Rehabilitation should start as soon as possible and have the following objectives:
- improve quality of life;
- elimination of pain, and if it is impossible to completely eliminate it - relief;
- function recovery;
- rehabilitation;
- self-service training and safe driving.
Basic rules of rehabilitation:
- the patient should feel his own responsibility for his health and adherence to the recommendations, but the doctor should choose a treatment and rehabilitation method that the patient can adhere to;
- systematic training and compliance with safety rules when performing exercises;
- pain is not an obstacle to exercise;
- a trusting relationship must be established between the patient and the doctor;
- the patient should not focus and focus on the cause of pain in the form of structural changes in the spine;
- the patient must feel comfortable and safe when performing the movement;
- the patient should feel the positive impact of rehabilitation on his condition;
- patients need to develop pain response skills;
- the patient should associate movement with positive thoughts.
Rehabilitation method:
- Walk;
- Physical exercise, gymnastics, gymnastics program at work;
- Individual orthopedic devices;
- Cognitive behavioral therapy;
- Patient Education:
- Avoid excessive physical activity;
- Combats low physical activity;
- Exclusion of prolonged static loads (standing, being in an uncomfortable position, etc. );
- Avoid hypothermia;
- Sleep organization.
Prevention
Optimal physical activity: strengthens the muscle skeleton, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes at a time, 3 days a week).
With prolonged sedentary work, it is necessary to take a break to warm up every 15-20 minutes and follow the rules of sitting.
Live hack:how to sit
- avoid upholstered furniture;
- feet should rest on the floor, which is achieved by 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 up straight, maintain correct posture, the back should fit snugly against the back of the chair to avoid straining the back muscles;
- the head when reading a book or working at a computer should be in a physiological position (looking straight ahead, and not constantly down). To do this, it is recommended to use a special stand and install the computer monitor at the optimal height.
With prolonged standing work, it is necessary to change positions every 10-15 minutes, alternately changing the supporting leg, and, if possible, walking in place and moving.
Avoid lying down for too long.
Live hack:how to sleep
- sleeps better on semi-rigid surfaces. If possible, you can opt for an orthopedic mattress so that the spine maintains a physiological curve;
- the pillow should be soft enough and of medium height to avoid pressure on the neck;
- when sleeping in the prone position, it is recommended to place a small pillow under the stomach.
Quitting smoking: If you are having trouble, see your doctor who will refer you to a smoking cessation program.
Frequently Asked Questions
I use ointments with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis?
Not. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation, and therefore do not increase the risk of developing this disease.
In every case of disc herniation, is surgery necessary?
Not. Surgical treatment is carried out only when indicated. On average, only 10-15% of patients require surgery.
Should you stop exercising if you have back pain?
Not. If, as a result of additional methods of examination, the doctor does not find anything that significantly limits the level of load on the spine, then it is possible to resume sports, but after undergoing treatment and adding certain exercises from the course of physiotherapy exercises and swimming.
Can back pain go away forever if I have a herniated disc?
They can after productive conservative therapy, subject to further implementation of the recommendations of the attending neurologist, adherence to preventive rules, regular exercise therapy and swimming.