Low back pain is probably known to almost every modern person. Employability can be affected for a variety of reasons. Among them are back pain, sciatica, osteochondrosis and other pathological changes in the lumbosacral spine. You should not be unaware of this because back pain can not only reach an incredible strength, making a person's life unbearable, but also prove to be a symptom of the most dangerous diseases.
Low back pain can vary: acute or dull, sore or burning, local (appears in one place) or spread to the entire back. Unpleasant sensations also occur in different ways: sometimes abruptly, suddenly and sometimes gradually, intensifying every day.
The response to pain and the ability to tolerate it depends on many factors: age, mental characteristics, accompanying symptoms and other factors. But in any case, you can not leave the disease to chance. Timely treatment helps to avoid dangerous consequences.
To diagnose the cause of back pain, it is necessary to examine the spine and some additional procedures: X-ray examination, computer or magnetic resonance imaging. Attacks of pain, lumbosacral, appear during life, in about 80% of modern inhabitants of European countries.
Acute or chronic low back pain is a consequence of a number of neurological, degenerative-dystrophic diseases in women and men. In some cases, low back pain is a consequence of diseases of internal organs, obesity, stress, mental disorders.
Pain syndrome - primary and secondary
Understanding why the lower back hurts, we must not forget that the causes of such pain are in the dozens, and a non-professional will never be able to determine the real source of the problems. In general, the medical classification distinguishes primary and secondary pain syndromes that may affect the lower back.
Primary low back pain syndrome occurs as a result of musculoskeletal changes of a morphofunctional nature. It is he who is the cause of the vast majority of cases of back pain in the lower back. The main of the causes are degenerative-dystrophic changes that occur in different parts of the spine:
- osteochondrosis, which is a lesion of bone and cartilage tissue, this disease has a dystrophic character. With it affecting the intervertebral disc and adjacent vertebrae, spondylosis begins to develop.
- Spondyloarthrosis is a form of osteoarthritis in which the disease affects the intervertebral joints, which are responsible for the movement of the spine, or 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 non-contagious in nature. For example, rheumatoid arthritis, Reiter's syndrome, etc . ;
- a tumor located on the vertebrae, in the spinal cord itself or in the retroperitoneal space, whether primarily or caused by metastases;
- fracture of one or more vertebrae. This is perhaps one of the most serious causes of back pain;
- various infectious diseases leading to damage to the vertebrae and the intervertebral discs (tuberculosis, brucellosis, epidural abscess, etc. );
- stroke where there is a severe violation of the blood supply to the spinal cord. In this case, there may also be a feeling that the lower back is hurting;
- diseases of the gastrointestinal tract. For example, acute appendicitis with atypical course, intestinal obstruction;
- often back pain is of a reflected nature. A similar problem can occur with some diseases of the organs located in the pelvic area. For example, renal colic, sexually transmitted diseases (gonorrhea, trichomoniasis, chlamydia, ureaplasmosis, andexitis - all of these diseases cause referred back pain).
Acute and chronic low back pain
Low back pain 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 pain sensations from deeper internal organs and structures in the body; in other words, it seems to the patient that the lower back hurts, but in fact a completely different part of the body is affected.
Most often, the back hurts in the lower back when pain is projected into this area from the pelvic organs, kidneys, pancreas, colon or tumors located behind the peritoneum. Many patients do not know what to do if their lower back hurts. But there is a clear recommendation what exactly should not be done: to self-medicate. The causes of pain are so different that only a qualified specialist can make a correct diagnosis.
Possible causes of acute low back pain include:
- The pain is accompanied by an acute stretching of the muscles. In this case, pain signals are localized in the back, they are provided by spastic long muscles. The pain does not tend to move to the groin or leg area. Human mobility is limited.
- One of the most common and serious causes of severe back pain is fractures of the spine (fractures of the vertebrae, including compression fractures). As a rule, this happens with a failed fall, bending of the back and other injuries; but in case a patient is diagnosed with osteoporosis, hyperparathyroidism, Cushing's syndrome, Paget's disease, which are cancerous tumors and their metastases in the vertebral region or other lesions of the skeletal system, vertebral fractures can occur literally "out of the blue", and even withoutfixation of sensations the patient at the time of the fracture.
- An equally unpleasant situation where the lower back hurts sharply is the displacement of the intervertebral discs that have occurred in the vertebral region. According to the frequency of lesions, areas are distinguished: LV-SII - most often; LIV-LV - second in frequency; LIII-LIFE and above are rarer cases.
Symptoms include severe low back pain, forced posture, limited mobility. Participation in the pathological process of the nerve roots is indicated by:
- radicular pain, usually unilateral;
- sensitivity disorders (numbness, increase or decrease in sensitivity level);
- decrease or disappearance of the Achilles reflex (in case of damage to the roots of S or S2);
- decrease in intensity or absence of a knee injury (indicates damage to the L3-L4 area).
The general tendency is that a protruding intervertebral disc affects the underlying root (e. g. , LIV-LV malposition causes L5 root pathology). With the defeat of the cauda equina (ponytail), the functions of the bladder and rectum are disturbed. A similar condition can also occur with a strong protrusion of the spinal disc.
The back hurts sharply in the lower back 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 outlet of the spinal canal. The most commonly observed facet syndrome of the unilateral type in the area of the root L5; occurs on the basis of an increase in facets of the intervertebral joint (upper and lower), and as a result narrowing of the intervertebral foramen.
Severe low back pain also accompanies an epidural abscess, a serious illness 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 pathology (pressure, knocking).
If there is evidence of spinal cord compression, all highly effective medical procedures, including surgery, are recommended. Another reason for low back pain can be diseases of the hip joint - primarily coxarthrosis. In this case, pain is characteristic that radiates to the lower part of the lower back, the buttocks and also to the legs to the knees.
Diseases characterized by chronic low back pain:
- Deformative spondylosis is a disease in which there is a dystrophic change in the lumbar vertebrae, calcification of their ligament apparatus and further bone growth; bone growths press on the roots and narrow the spinal canal. In the case where low back pain is accompanied by weakness in the legs, numbness and other neurological symptoms, the possibility of claudication intermittent syndrome, which may be caused by narrowing of the spinal canal, should be considered. An examination is necessary if results determine the final diagnosis.
- Ankylosing spondylarthrosis (or Bechterew's disease). At an early stage, it is characterized by limited mobility, especially in the morning, by a reduction in chest movements during breathing. There is pulling pain in the lower back; further, the curvature of the spine in the thoracic region occurs and progresses. An X-ray examination resolves anomalies in the sacroiliac joints: destruction, change in structure, "bamboo" spine. A thorough examination and finding out the cause of the low back pain is necessary, 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 rule out such causes of back pain: metastatic carcinoma of the lungs, breast, prostate and thyroid glands, kidneys, gastrointestinal tract; lymphoma; multiple myeloma (multiple myeloma). An exception is made by the method of X-ray examination and myelography.
- Osteomyelitis also causes prolonged, sore lower back pain. If this disease is suspected, an X-ray of the bone tissue, a skin test with tuberculin and an ESR test are performed to determine the presence / absence of tuberculosis bacteria or pyogenic (pyogenic) bacteria in the body, usually staphylococci - the causes of osteomyelitis.
- Tumors of the spinal cord (intradural tumors) of various types. Diseases such as lipoma, neurofibroma, meningioma can cause constant back pain, initially without accompanying neurological symptoms.
Causes of back pain of intermittent nature. Many diseases of the internal organs cause periodic, sharp or pulling pains 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 maximum possible range of motion. To the question of what to do if the lower back does not hurt 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 some organ on a particular part of the spine. Then from the pelvic organs radiates pain to the sacrum, in diseases of the organs located in the lower part of the abdominal cavity, it radiates to the lower part of the back (segments L3-L5) and in the upper part - to the segments of the upper lumbar zoneor the lower part of the chest zone.
Diseases - the causes of low back pain and the area of distribution of pain:
- If the pelvic organs are affected, with endometriosis, ovarian or uterine cancer, the lower back hurts. In men, such intermittent pain may be caused by chronic prostatitis or the development of prostate cancer.
- Various kidney diseases cause pain at the junctions between the ribs and the spine.
- Tumors in the stomach, duodenum, gastric ulcer, pancreatic tumors (especially if the disease spreads beyond the peritoneum) - pain spread to the region of the spinal segments T10-L2;
- In ulcerative colitis, diverticulitis, or colon tumors, the lower back hurts;
- If the back hurts in the thoracic / lumbar regions, aortic dissection (dissecting aneurysm) should be ruled out.
Diagnosis of low back pain
For low back pain and low back pain, it is recommended to undergo a computer (showing the condition of the bone tissue in the spine) and magnetic resonance (allowing you to assess the condition of the soft tissue) tomography and an ultrasound scan of the internal organs.
One method of diagnosis is x-ray, which is relatively inexpensive and can be helpful in detecting a range of ailments, from bone fractures to kidney stones. Many of the detected changes only indicate the correct diagnosis, and further studies may be needed to confirm it. In addition, some radiological changes may be concomitant findings that are not the cause of pain.
It all starts with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological status is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.
Sometimes, according to the results of an examination performed by an orthopedist of a patient with a pain symptom on the background of osteochondrosis of the spine, the following additional diagnostic procedures may be prescribed:
- radiography 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 an annulus fibrosus consisting of fibrous cartilage and connective tissue. You can read more about this in the article on the human spine and the anatomy of the spinal cord.
The thickness of the discs decreases, the vertebral bodies approach each other, reducing the intervertebral foramina and endangering the nerves and vessels in them (osteochondrosis).
Protrusion of the discs (protrusion of the intervertebral disc) with their further prolapse into the lumen of the spinal canal (disc prolapse) most often leads to compression of the nerve roots, causing pain along the compressed nerve (pain radiating to the leg, arm, back of head, neck, intercostal spacein depending on the level of nerve compression) with a weakening of muscle strength in the areas of their innervation and a violation of sensitivity.
Often, a protrusion or herniation of the 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 may also be impaired. With spinal instability, the vertebrae move forward (anterolistesis) or backward (retrolistesis). To clarify the diagnosis, an X-ray of the lumbosacral spine with functional tests may be necessary.
Most often, the bundles of nerves 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 the fibers L5, S1, S2, S3 - spinal nerves.
Focus on chronic inflammation of 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 that pass through it. Therefore, in the case of spinal canal stenosis, it is always necessary to perform 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?
In case of pain in the spine, you should first contact a neurologist at the district clinic if the patient's condition is stable, or call an ambulance. Low back pain can be one of the symptoms of gynecological, urological, surgical, gastroenterological problems.
Low back pain is combined with various infections, injuries to the limbs. Low back pain with heart and lung disease is not excluded. This is established by an in-depth study. After the patient is diagnosed, he is usually prescribed medication that reduces back pain, normalizes blood circulation, and helps restore nerve tissue. It can be tablets, gels, ointments or injections that relieve inflammation and spasms.
Surgical intervention is usually required in the diagnosis of a herniated disc, which is a complication of osteochondrosis. The hernia that compresses the nerve root is removed, it is restored, and the pain goes away with time.
It is best to relax the spine and the paravertebral muscles if you are sleeping on a hard 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 pain symptom is often due to muscle spasms, which can be eliminated by special means - muscle relaxants. Such drugs are actively used to treat diseases of the spine.
So with a strong, unexpected pain in the lower back, it is recommended to take a muscle-relaxing tablet, rubbing the back with a warming anesthetic gel. When using funds, follow the instructions carefully.
In cases where an unpleasant symptom is due to the presence of inflammatory diseases of the internal organs, it is not recommended to delay contacting a doctor if at a certain time it is impossible to visit a specialist and the pain is too intense, you can takePentalgin or 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 symptoms that accompany it.
Ointment for back pain
Preparations in the form of ointments are often used to treat 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. Ointment for back pain is used as a head 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 strong analgesic effect.
The biggest plus 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 compared to 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 particular strain on the body. For example, the usual hanging on the crossbar of the horizontal bar has a beneficial effect on the condition of the spine, helps to relax the muscles and eliminate lumbago - pain caused by squeezing its nerve roots. Therapeutic exercises for diseases of the back, accompanied by pain in its lower part, include exercises:
- raising the legs (so that the knee touches the chin);
- "bicycle", performed lying on its back;
- go on your knees.
Every day it is recommended to give exercises no more than 10-15 minutes, with pronounced pain - to refuse to perform them.